性别、急性肾损伤和年龄：前瞻性队列研究

IF 9.4 1区医学 Q1 UROLOGY & NEPHROLOGY

American Journal of Kidney Diseases Pub Date : 2024-10-22 DOI:10.1053/j.ajkd.2024.10.003

Ladan Golestaneh,Abby Basalely,Andreas Linkermann,Tarek M El-Achkar,Ryung S Kim,Joel Neugarten

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引用次数: 0

摘要

理论依据与目标肾脏疾病动物模型表明女性性激素具有保护作用，但在人类中，一些权威人士认为女性性别是急性肾损伤（AKI）的危险因素。为了更好地了解急性肾损伤的风险，我们研究了不同年龄组的患者在整个生命周期中性别与急性肾损伤发病率之间的关联强度。结果根据KDIGO定义，住院期间发生的急性肾损伤（AKI）。分析方法广义估计方程逻辑回归调整了合并症、社会人口因素和疾病严重程度。分析分为 3 个年龄组：6 个月至小于 16 岁、年龄大于 16 岁-16 岁、16 岁至小于 55 岁。绝经后妇女补充雌激素的风险较低，这支持了女性性激素的保护作用。

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Sex, Acute Kidney Injury, and Age: A Prospective Cohort Study.

RATIONALE & OBJECTIVE Animal models of kidney disease suggest a protective role for female sex hormones but in humans, some authorities assert that female sex is a risk factor for acute kidney injury (AKI). To better understand the risk of AKI, we studied the strength of association between sex and AKI incidence in hormonally distinct age groups across the life span. STUDY DESIGN Prospective cohort study. SETTINGS & PARTICIPANTS All patients hospitalized in the Montefiore Health System between 10/15/2015 and 1/1/2019, excluding those with kidney failure or obstetrics diagnoses. EXPOSURE Male versus female sex. OUTCOMES Acute kidney injury (AKI) occurring during hospitalization based on KDIGO definitions. ANALYTICAL APPROACH Generalized Estimating Equation logistic regression adjusted for comorbidities, socio-demographic factors, and severity of illness. Analyses were stratified into 3 age categories, 6 months to ≤16 years, age >16 years - <55 years, and age ≥55 years. RESULTS A total of 132,667 individuals were hospitalized a total of 235,629 times. The mean age was 55.2 (SD 23.8) years. The counts (%) of hospitalizations for women were 129,912 (55%). Hospitalization counts (%) among Black and Hispanic patients were 71,834 (30.5%) and 24,199 (10.3%), respectively. AKI occurred in 53,926 (22.9%) hospitalizations. In adjusted models, there was a significant interaction between age and sex (p<0.001). Boys and men had higher risk of AKI across all age groups, an association more pronounced in the age group >16 years to <55 years in which the OR for men was 1.7 (95% CI, 1.6-1.8). This age-based pattern remained consistent across prespecified types of hospitalizations. In a sensitivity analysis, women older than 55 years who received prescriptions for estrogen had lower odds of AKI than those without prescriptions. LIMITATIONS Residual confounding. CONCLUSION The greatest relative risk of AKI for males occurred during ages >16 to <55 years. The lower risk among post-menopausal women receiving supplemental estrogen supports a protective role for female sex hormones.

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来源期刊

American Journal of Kidney Diseases 医学-泌尿学与肾脏学

CiteScore

20.40

自引率

2.30%

发文量

732

审稿时长

3-8 weeks

期刊介绍： The American Journal of Kidney Diseases (AJKD), the National Kidney Foundation's official journal, is globally recognized for its leadership in clinical nephrology content. Monthly, AJKD publishes original investigations on kidney diseases, hypertension, dialysis therapies, and kidney transplantation. Rigorous peer-review, statistical scrutiny, and a structured format characterize the publication process. Each issue includes case reports unveiling new diseases and potential therapeutic strategies.