Acute kidney injury does not explain sex differences in kidney replacement therapy initiation or death amongst individuals with chronic kidney disease reported to the UK Renal Registry.
Takahiro Tsuji, Anna Casula, Laurie Tomlinson, Dorothea Nitsch, Barnaby Hole
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引用次数: 0
Abstract
Background: Why more males than females start kidney replacement therapy (KRT) is incompletely understood. Acute kidney injury (AKI) is a possible factor underlying sex differences in chronic kidney disease (CKD) progression, but previous studies regarding this have been inconclusive. We investigated sex differences in the association between AKI and CKD progression in UK nephrology care.
Methods: This cohort study uses UK Renal Registry data. Adults with CKD stages 4/5 in 14 nephrology centres in England were followed from January 2018 to December 2021. We compared their baseline characteristics by sex and calculated cause specific hazard ratio (HR) for outcomes: time to AKI stage 2/3 (AKI2/3), initiation of chronic KRT and death by all causes.
Results: A total of 15 547 patients were included. Fewer females (43.8%) were seen in renal centres than males (56.2%). During follow-up, 3909 (25.1%) AKI2/3 episodes, 3510 (22.6%) KRT initiations, and 7293 (46.9%) deaths were observed. Males were more likely than females to experience each outcome: AKI2/3 [adjusted HR 1.39, 95% confidence interval (CI) 1.31-1.49], KRT initiation (adjusted HR 1.51, 95% CI 1.39-1.65) and death (adjusted HR 1.11, 95% CI 1.05-1.16). Adjustment for AKI2/3 did not change the association between being male and the higher risk of KRT initiation.
Conclusion: Being male was associated with a higher risk of AKI2/3, KRT initiation and death. Fewer females appeared in nephrology care data than expected from population CKD prevalence. However, no evidence was found to support the hypothesis that AKI2/3 explains the higher KRT initiation rates seen amongst males.
背景：为什么更多的男性比女性开始肾脏替代治疗（KRT）尚不完全清楚。急性肾损伤（AKI）是慢性肾脏疾病（CKD）进展中性别差异的一个可能因素，但之前的研究对此尚无定论。我们调查了英国肾病护理中AKI和CKD进展之间相关性的性别差异。方法：该队列研究使用英国肾脏登记处的数据。2018年1月至2021年12月，对英格兰14个肾病中心的CKD 4/5期成人进行了随访。我们按性别比较了他们的基线特征，并计算了结果的病因特异性风险比（HR）：到达AKI2/3期的时间（AKI2/3）、开始慢性KRT和全因死亡。结果：共纳入15 547例患者。女性（43.8%）少于男性（56.2%）。随访期间，观察到3909例（25.1%）AKI2/3发作，3510例（22.6%）KRT启动，7293例（46.9%）死亡。男性比女性更有可能经历这些结局：AKI2/3[调整后危险度1.39,95%可信区间（CI） 1.31-1.49]、KRT起始（调整后危险度1.51,95% CI 1.39-1.65）和死亡（调整后危险度1.11,95% CI 1.05-1.16）。调整AKI2/3并没有改变男性与KRT起始高风险之间的关系。结论：男性与kiki2 /3、KRT起始和死亡风险较高相关。肾脏病护理数据中出现的女性比预期的人群CKD患病率少。然而，没有证据支持AKI2/3解释男性中较高的KRT启动率的假设。
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About the Journal
Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.
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