Department of Medicine, Nephrology Division, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E. 210 St, Bronx, NY, 10467, USA.
BMC Nephrol. 2018 Nov 8;19(1):314. doi: 10.1186/s12882-018-1122-z.
Female 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.
To 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.
Twenty-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.
Our meta-analysis contradicts the established belief that female sex confers a greater risk of AKI and instead suggests a protective role.
女性性别已被纳入预测 AKI 发展的模型中的一个危险因素。此外，AKI 的肾脏病改善全球结局临床实践指南的评论得出结论，女性性别是医院获得性 AKI 的一个危险因素。相比之下，在缺血性 AKI 的动物模型中已经证明了女性性别具有保护作用。
为了进一步探讨这个问题，我们对 1978 年 1 月至 2018 年 4 月期间发表的 AKI 研究进行了荟萃分析，确定了 83 项研究报告了近 2.4 亿例与医院相关的 AKI 患者的性别分层数据。
28 项研究（6758124 例患者）利用多变量分析评估了与医院相关的 AKI 的危险因素，并提供了性别分层的 OR。对这一组的荟萃分析表明，男性发生医院相关 AKI 的风险明显高于女性（OR 1.23（1.11，1.36））。由于 AKI 不是一种单一的疾病，而是代表一组以肾功能急性下降为特征的异质性疾病，我们进行了亚组荟萃分析。在接受非心脏手术的患者的研究中，男性性别与 AKI 的关联最强。在包括未选择的住院患者的研究中以及在接受重症监护病房治疗的重症患者的研究中，男性性别也与 AKI 相关。相比之下，心脏手术后相关 AKI 和造影剂诱导的 AKI 没有性别二态性。
我们的荟萃分析与女性性别赋予 AKI 更大风险的既定信念相矛盾，而是表明了一种保护作用。
