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Abstract: PO0212

Premenopausal Age in Females Is Associated with Protection from Development of Postoperative AKI

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Privratsky, Jamie, Duke University School of Medicine, Durham, North Carolina, United States
  • Fuller, Matt, Duke University School of Medicine, Durham, North Carolina, United States
  • Raghunathan, Karthik, Duke University School of Medicine, Durham, North Carolina, United States
  • Ohnuma, Tetsu, Duke University School of Medicine, Durham, North Carolina, United States
  • Bartz, Raquel, Duke University School of Medicine, Durham, North Carolina, United States
  • Schroeder, Rebecca A., Duke University School of Medicine, Durham, North Carolina, United States
  • Price, Thomas M., Duke University School of Medicine, Durham, North Carolina, United States
  • Sigurdsson, Martin I., Landspitali, Reykjavik, Iceland
  • Mathis, Michael R., University of Michigan, Ann Arbor, Michigan, United States
  • Naik, Bhiken I., University of Virginia, Charlottesville, Virginia, United States
  • Krishnamoorthy, Vijay, Duke University School of Medicine, Durham, North Carolina, United States
Background

Acute kidney injury (AKI) is one of the most common forms of perioperative organ injury. Preclinical and clinical studies examining the influence of sex on AKI have yielded conflicting results. The objective of our study was to determine the association of sex hormones on postoperative AKI. We hypothesized that pre-menopausal-aged females would display lower incidence of postoperative AKI than males of similar age; and the protection would be lost in post-menopausal-aged females.

Methods

This was a retrospective observational study of the Multi-center Perioperative Outcomes Group database. We reviewed surgical patients at 46 institutions between 2013-2019. Our primary exposure was an interaction between age younger or older than 50 years and sex. Our primary outcome was development of AKI by KDIGO criteria. A mixed effects multivariable logistic regression was used to determine the association of sex hormone status with postoperative AKI. Secondary analyses consisted of ascending age groupings over 40 years.

Results

After excluding patients with CKD5 and cardiac, transplant, urologic and obstetric procedures, among 390,382 patients undergoing index surgeries, 25809 (6.6%) developed postoperative AKI. In the adjusted model, the lowest risk of AKI was in women under 50 (OR 1.0), with higher risk in men under 50 (OR 1.90 [1.79, 2.01]; p<.0001), women over 50 (OR 1.51 [1.43, 1.59]; p<.0001), and men over 50 (OR 2.06 [1.96, 2.17]; p<.0001). In the secondary analysis, risk of AKI gradually increased in women as they aged, whereas men had very little change in risk based on age (Fig. 1).

Conclusion

Younger females display a lower risk of postoperative AKI that gradually increases with age. These results suggest that female sex hormones might protect against AKI. To explore this possibility, we are examining the risk of postoperative AKI in patients receiving sex hormone replacement or antagonism at time of surgery.