The Impact of Sex on KRT in Acute Kidney Injury: A Secondary Analysis of the STARRT-AKI Trial.

Abstract

Background: The purpose of this study is to evaluate whether sex modifies the initiation, prescription, or outcome of KRT, or the relationship between KRT initiation strategy and patient outcomes.

Methods: We performed a secondary analysis of STARRT-AKI, a multinational randomized controlled trial comparing accelerated-initiation and standard-initiation of RRT in critically ill adults with acute kidney injury. The primary outcome was all-cause mortality at 90 days. Secondary and tertiary outcomes included renal recovery, mortality in the intensive care unit (ICU) or hospital, and resource utilization. We used logistic and linear regression analyses and interaction testing to explore the effect of KRT initiation strategy on outcomes according to sex.

Results: A total of 2,926 participants from STARRT-AKI were included in this secondary analysis, of whom 937 were female (32%). Females had a lower pre-morbid serum creatinine level and were more likely to be admitted with a medical diagnosis, especially sepsis, compared to males. KRT was initiated with equal frequency in males and females, although females received a higher KRT dose and ultrafiltration intensity. There was no difference in 90-day mortality between sexes, even after covariate adjustment, nor in the number of days alive and free of ventilation, ICU, or hospital. Sex did not modify the association between KRT initiation strategy and survival, KRT dependence, or resource utilization.

Conclusions: In this secondary analysis of the STARRT-AKI trial, KRT initiation and outcome did not differ by sex. An accelerated strategy of KRT initiation did not confer better outcomes to either females or males.