Retrospective Analysis of the Association of Preoperative Sex Hormone Therapy With the Development of Postoperative Acute Kidney Injury.

Abstract

BACKGROUND Postoperative acute kidney injury (AKI) worsens surgical outcomes. Previous studies have observed an age- and sex-dependent effect on postoperative AKI rates. The objective of our study was to determine whether preoperative exposure to male or female sex hormone therapies modified AKI risk after both noncardiac and cardiac surgery. We hypothesized that women older than 55 years on estrogen/progesterone replacement therapy and men on antiandrogen therapy would have lower odds of postoperative AKI compared to counterparts not receiving sex hormone therapies. METHODS We conducted a retrospective cohort study, using data from Duke University Medical Center from 2013 to 2023. The study included women older than 55 years and men older than 18 years undergoing surgery. Exclusions included patients with missing creatinine values, patients with chronic kidney disease stage 5 (CKD5), transplant cases, and minor cases. The primary exposure was preoperative utilization of exogenous sex hormones, and the primary outcome was the development of postoperative AKI, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria. Multivariable logistic regression was used to examine the association of preoperative sex hormones with postoperative AKI. RESULTS There were 82,557 patients in the cohort, with 68,471 undergoing noncardiac surgery and 14,086 undergoing cardiac surgery. Among men undergoing noncardiac surgery, exposure to antiandrogens was associated with lower odds of postoperative AKI (0.83, 95% confidence interval [CI], 0.72-0.96, P < .01). Among women undergoing noncardiac surgery, preoperative exposure to vaginal estrogen was associated with lower odds of postoperative AKI (adjusted odds ratio [OR], 0.61, 95% CI, 0.47-0.79, P < .001). Neither male nor female sex hormone exposures were associated with AKI risk after cardiac surgery. CONCLUSIONS Preoperative antiandrogen therapy in men and vaginal estrogen therapy in women older than 55 years were associated with reduced odds of postoperative AKI after noncardiac surgery. Our findings provide correlative evidence that sex hormones might modify postoperative AKI outcomes, while revealing complexity in drug and patient selection.