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[Preprint]. 2024 Mar 14:rs.3.rs-3660617.
doi: 10.21203/rs.3.rs-3660617/v1.

Sex Bias in Prediction and Diagnosis of Cardiac Surgery Associated Acute Kidney Injury

Sevag Demirjian  1 , Anne Huml  1 , Faisal Bakaeen  1 , Emilio Poggio  1 , Mariya Geube  1 , Andrew Shaw  1 , A Marc Gillinov  1 , Crystal A Gadegbeku  1
Affiliations

Sex Bias in Prediction and Diagnosis of Cardiac Surgery Associated Acute Kidney Injury

Sevag Demirjian et al. Res Sq. .

Update in

Abstract

Background: Female sex has been recognized as a risk factor for cardiac surgery associated acute kidney injury (CS-AKI). The current study sought to evaluate whether female sex is a risk factor for CS-AKI, or modifies the association of peri-operative change in serum creatinine with CS-AKI.

Methods: Observational study of adult patients undergoing cardiac surgery between 2000 and 2019 in a single U.S. center. The main variable of interest was registered patient sex, identified from electronic medical records. The main outcome was CS-AKI within 2 weeks of surgery.

Results: Of 58526 patients, 19353 (33%) were female; 12934 (22%) incurred AKI based on ≥ 0.3 mg/dL or ≥ 50% rise in serum creatinine (any AKI), 3320 (5.7%) had moderate to severe AKI, and 1018 (1.7%) required dialysis within 2 weeks of surgery. Female sex was associated with higher risk for AKI in models that were based on preoperative serum creatinine (OR, 1.35; 95% CI, 1.29-1.42), and lower risk with the use of estimated glomerular filtration, (OR, 0.90; 95% CI, 0.86-0.95). The risk for moderate to severe CS-AKI for a given immediate peri-operative change in serum creatinine was higher in female compared to male patients (p < .0001 and p < .0001 for non-linearity), and the association was modified by pre-operative kidney function (p < .0001 for interaction).

Conclusions: The association of patient sex with CS-AKI and its direction was dependent on the operational definition of pre-operative kidney function, and differential outcome misclassification due to AKI defined by absolute change in serum creatinine.

Keywords: acute kidney injury; body surface area; cardiac surgery; estimated glomerular filtration rate; patient sex.

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Conflict of interest statement

Conflict of interest disclosures: Dr. Demirjian and Cleveland Clinic Innovations Center hold U.S. Patent for predictive models for CS-AKI. Dr. Gillinov reports consultation services to Edwards, Medtronic, Artivion, Abbott, ClearFlow, and AtriCure. No other disclosures reported.

Figures

Figure 1
Figure 1
Mosaic plot of AKI incidence per patient Sex.
Figure 2
Figure 2
Forest plot of female vs. male odds for AKI incidence by definition used, and method of adjustment for preoperative kidney function. Footnote: eGFR is calculated with pre-operative serum creatinine based on CKD-EPI estimation equation without race. eGFRRAW is calculated by the multiplication of eGFR with patient BSA, and division by 1.73. BSA, stands for body surface area and is calculated per Du Bois & Du Bois method.
Figure 3
Figure 3
Adjusted Probability for Moderate to Severe Acute Kidney Injury within Two Weeks of Cardiac Surgery per Pre-operative Serum Creatinine and Patient Sex. Footnote: The shaded areas represent 95% confidence interval, based on the multivariable logistic regression model. Accompanying histogram shows female and male patient distribution by pre-operative serum creatinine. Female patients in red and male patients in black.
Figure 4
Figure 4
Adjusted Probability of Acute Kidney Injury Associated with Peri-operative Change in Serum Creatinine in Male and Female Patients Adjusted for Pre-operative Serum Creatinine of (a) 0.8 mg/dL, and (b) 1.2 mg/dL. The shaded areas represent 95% confidence interval, based on the multivariable logistic regression model. Accompanying histogram shows female and male patient distribution by peri-operative change in serum creatinine. Female patients in red and male patients in black.
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