Key result
Compared to females 50 years or younger, the odds of postoperative AKI were higher in females older than 50 (OR 1.51; 95% CI 1.43-1.59), males 50 or younger, and males older than 50.
Why the study?
Studies examining the influence of sex on AKI after noncardiac surgery have yielded conflicting results and typically do not account for age-related changes.
Do age and sex influence the risk of postoperative acute kidney injury in adults undergoing major noncardiac surgery?
Cohort (n=390,382)
Yes
Do age and sex influence the risk of postoperative acute kidney injury in adults undergoing major noncardiac surgery?
Odds Ratio: 1.51 (95% CI 1.43–1.59)
Absolute Event Rate: 6.5% vs 3.7%
Younger females have a significantly lower risk of postoperative AKI after noncardiac surgery compared to males and older females, suggesting age and sex are important modifiers of AKI risk.
May support age-sex risk stratification post-noncardiac surgery; leaves open confirmation of lower AKI risk in younger females.
BACKGROUND: Acute kidney injury (AKI) after noncardiac surgery is common and has substantial health impact. Preclinical and clinical studies examining the influence of sex on AKI have yielded conflicting results, although they typically do not account for age-related changes. The objective of the study was to determine the association of age and sex groups on postoperative AKI. The authors hypothesized that younger females would display lower risk of postoperative AKI than males of similar age, and the protection would be lost in older females. METHODS: This was a multicenter retrospective cohort study across 46 institutions between 2013 and 2019. Participants included adult inpatients without pre-existing end-stage kidney disease undergoing index major noncardiac, nonkidney/urologic surgeries. The authors' primary exposure was age and sex groups defined as females 50 yr or younger, females older than 50 yr, males 50 yr or younger, and males older than 50 yr. The authors' primary outcome was development of AKI by Kidney Disease-Improving Global Outcomes serum creatinine criteria. Exploratory analyses included associations of ascending age groups and hormone replacement therapy home medications with postoperative AKI. RESULTS: Among 390,382 patients, 25,809 (6.6%) developed postoperative AKI (females 50 yr or younger: 2,190 of 58,585 [3.7%]; females older than 50 yr: 9,320 of 14,4047 [6.5%]; males 50 yr or younger: 3,289 of 55,503 [5.9%]; males older than 50 yr: 11,010 of 132,447 [8.3%]). When adjusted for AKI risk factors, compared to females younger than 50 yr (odds ratio, 1), the odds of AKI were higher in females older than 50 yr (odds ratio, 1.51; 95% CI, 1.43 to 1.59), males younger than 50 yr (odds ratio, 1.90; 95% CI, 1.79 to 2.01), and males older than 50 yr (odds ratio, 2.06; 95% CI, 1.96 to 2.17). CONCLUSIONS: Younger females display a lower odds of postoperative AKI that gradually increases with age. These results suggest that age-related changes in women should be further studied as modifiers of postoperative AKI risk after noncardiac surgery.
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Privratsky et al. (2022) conducted a cohort in Postoperative Acute Kidney Injury (AKI) (n=390,382). Older age and male sex vs. Females 50 years or younger was evaluated on Development of AKI by Kidney Disease-Improving Global Outcomes serum creatinine criteria (OR 1.51, 95% CI 1.43 to 1.59). Compared to females 50 years or younger, the odds of postoperative AKI were higher in females older than 50 (OR 1.51; 95% CI 1.43-1.59), males 50 or younger, and males older than 50.
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