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.

中文翻译：

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性别、急性肾损伤和年龄：一项前瞻性队列研究。


基本原理和目标 肾脏疾病的动物模型表明女性性激素具有保护作用，但在人类中，一些权威人士断言女性是急性肾损伤（AKI）的危险因素。为了更好地了解 AKI 的风险，我们研究了整个生命周期中荷尔蒙不同年龄组的性别与 AKI 发病率之间的关联强度。研究设计 前瞻性队列研究。设置和参与者 所有在2015年10月15日至2019年1月1日期间在Montefiore卫生系统住院的患者，不包括肾衰竭或产科诊断的患者。曝光 男性与女性。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 根据合并症、社会人口学因素和疾病严重程度进行调整的 logistic 回归。分析分为 3 个年龄类别，6 个月至 ≤16 岁，年龄 >16 岁 - <55 岁和年龄 ≥55 岁。结果 共 132,667 例住院，共 235,629 次。平均年龄为 55.2 （SD 23.8） 岁。女性住院人数 （%） 为 129,912 （55%）。黑人和西班牙裔患者的住院人数 （%） 分别为 71,834 例 （30.5%） 和 24,199 例 （10.3%）。AKI 发生在 53,926 例 （22.9%） 住院患者中。在调整后的模型中，年龄和性别之间存在显着交互作用 （p<0.001）。在所有年龄组中，男孩和男性患 AKI 的风险更高，这种关联在 >16 岁与 <55 岁年龄组中更为明显，其中男性的 OR 为 1.7 （95% CI，1.6-1.8）。这种基于年龄的模式在预先指定的住院类型中保持一致。 在敏感性分析中，接受雌激素处方的 55 岁以上女性患 AKI 的几率低于没有处方的女性。局限性 残余混杂。结论 男性 AKI 的最大相对风险发生在 >16 至 <55 岁之间。接受补充雌激素的绝经后妇女的风险较低，这支持了女性性激素的保护作用。