Sex differences in acute kidney injury requiring dialysis

BMC Nephrol. 2018 Jun 8;19(1):131. doi: 10.1186/s12882-018-0937-y.


Background: Female sex has been included as a risk factor in models developed to predict the risk of acute kidney injury (AKI) associated with cardiac surgery, aminoglycoside nephrotoxicity and contrast-induced nephropathy. The commentary acompanying the Kidney Disease Improving Global Outcomes Clinical Practice Guideline for Acute Kidney Injury concludes that female sex is a shared susceptibility factor for acute kidney injury based on observations that female sex is associated with the development of hospital-acquired acute kidney injury. In contrast, female sex is reno-protective in animal models. In this context, we sought to examine the role of sex in hospital-associated acute kidney injury in greater detail.

Methods: We utilized the Hospital Episode Statistics database to calculate the sex-stratified incidence of AKI requiring renal replacement therapy (AKI-D) among 194,157,726 hospital discharges reported for the years 1998-2013. In addition, we conducted a systematic review of the English literature to evaluate dialysis practices among men versus women with AKI.

Results: Hospitalized men were more likely to develop AKI-D than hospitalized women (OR 2.19 (2.15, 2.22) p < 0.0001). We found no evidence in the published literature that dialysis practices differ between men and women with AKI.

Conclusions: Based on a population of hospitalized patients which is more than 3 times larger than all previously published cohorts reporting sex-stratified AKI data combined, we conclude that male sex is associated with an increased incidence of hospital-associated AKI-D. Our study is among the first reports to highlight the protective role of female gender in AKI.

Keywords: AKI; Acute kidney injury; Acute renal failure; Gender; Sex.

Publication types

  • Review

MeSH terms

  • Acute Kidney Injury / diagnosis*
  • Acute Kidney Injury / epidemiology
  • Acute Kidney Injury / therapy*
  • Databases, Factual / trends
  • Female
  • Humans
  • Male
  • Patient Discharge / trends
  • Renal Dialysis / trends*
  • Risk Factors
  • Sex Characteristics*