Abstract
BackgroundFemale sex has been included as a risk factor in models developed to predict the development of AKI. In addition, the commentary to the Kidney Disease Improving Global Outcomes Clinical Practice Guideline for AKI concludes that female sex is a risk factor for hospital-acquired AKI. In contrast, a protective effect of female sex has been demonstrated in animal models of ischemic AKI.MethodsTo further explore this issue, we performed a meta-analysis of AKI studies published between January, 1978 and April, 2018 and identified 83 studies reporting sex-stratified data on the incidence of hospital-associated AKI among nearly 240,000,000 patients.ResultsTwenty-eight studies (6,758,124 patients) utilized multivariate analysis to assess risk factors for hospital-associated AKI and provided sex-stratified ORs. Meta-analysis of this cohort showed that the risk of developing hospital-associated AKI was significantly greater in men than in women (OR 1.23 (1.11,1.36). Since AKI is not a single disease but instead represents a heterogeneous group of disorders characterized by an acute reduction in renal function, we performed subgroup meta-analyses. The association of male sex with AKI was strongest among studies of patients who underwent non-cardiac surgery. Male sex was also associated with AKI in studies which included unselected hospitalized patients and in studies of critically ill patients who received care in an intensive care unit. In contrast, cardiac surgery-associated AKI and radiocontrast-induced AKI showed no sexual dimorphism.ConclusionsOur meta-analysis contradicts the established belief that female sex confers a greater risk of AKI and instead suggests a protective role.
Highlights
Female sex has been included as a risk factor in models developed to predict the development of acute kidney injury (AKI)
AKI was defined by Kidney Disease Improving Global Outcomes (KDIGO) criteria in 10 studies, by RIFLE criteria in 1 study, by Acute Kidney Injury Network (AKIN) criteria in 2 studies, by the need for renal replacement therapy in 7 studies, and by investigator-created, creatinine-based criteria in the remaining 8 studies
On the basis of these observations, the commentary to the KDIGO Clinical Practice Guideline for Acute Kidney Injury concludes that female sex is a risk factor for hospital-acquired AKI, while recognizing that male sex predominates in certain forms of community-acquired AKI
Summary
The commentary to the Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Acute Kidney Injury (arguably the most authoritative commentary in the field) states that female sex is among the “shared susceptibility factors” that confer a higher risk of AKI [19] This conclusion is based on observations that female sex is associated with a higher risk for AKI after cardiac surgery and after the administration of radio-contrast or aminoglycosides. On this basis, the commentary concludes that, “contrary to most chronic kidney disease disorders, it is the female gender that carries a higher risk for AKI.”. The commentary concludes that, “contrary to most chronic kidney disease disorders, it is the female gender that carries a higher risk for AKI.” This conclusion, is qualified by the observation that
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