Joel Neugarten1, Sandipani Sandilya2, Beenu Singh2, Ladan Golestaneh2. 1. Nephrology Division, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York jneugart@montefiore.org. 2. Nephrology Division, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Abstract
BACKGROUND AND OBJECTIVES: Being a woman is a well established risk factor for the development of cardiothoracic surgery-associated AKI. In striking contrast, women are less likely to develop AKI associated with noncardiac surgical procedures than men. In an attempt to ascertain why being a woman might be protective for ischemic AKI after general surgery but deleterious in patients undergoing cardiothoracic surgery, we examined cardiothoracic surgery-associated AKI in greater detail. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We performed a systematic review and meta-analysis of cardiothoracic surgery-associated AKI studies published between January of 1978 and December of 2015 to further explore the relationship between sex and cardiothoracic surgery-associated AKI. RESULTS: Sixty-four studies were identified that provided sex-specific data regarding the incidence of cardiothoracic surgery-associated AKI among 1,057,412 subjects. Using univariate analysis, women were more likely than men to develop AKI postoperatively (odds ratio, 1.21; 95% confidence interval, 1.09 to 1.33; P<0.001). However, when the analysis was restricted to the 120,464 subjects reported in 29 studies that used the Acute Kidney Injury Network criteria, the RIFLE criteria, or the Kidney Disease Improving Global Outcomes criteria to define AKI, there was no significant sex-related difference in risk. Seventeen studies used multivariate analysis to assess risk factors for cardiothoracic surgery-associated AKI and provided sex-specific odd ratios. Among the 1,587,181 individuals included in these studies, the risk of developing cardiothoracic surgery-associated AKI was not significantly associated with sex (odds ratio, 1.04; 95% confidence interval, 0.92 to 1.19; P=0.51). However, when the analysis was restricted to the 5106 subjects reported in four studies that used the Acute Kidney Injury Network criteria to define AKI, the risk of developing AKI was significantly lower in women compared with in men (odds ratio, 0.75; 95% confidence interval, 0.65 to 0.87; P<0.001). CONCLUSIONS: Our systematic review and meta-analysis contradict the generally held consensus that being a woman is an independent risk factor for the development of cardiothoracic surgery-associated AKI.
BACKGROUND AND OBJECTIVES: Being a woman is a well established risk factor for the development of cardiothoracic surgery-associated AKI. In striking contrast, women are less likely to develop AKI associated with noncardiac surgical procedures than men. In an attempt to ascertain why being a woman might be protective for ischemic AKI after general surgery but deleterious in patients undergoing cardiothoracic surgery, we examined cardiothoracic surgery-associated AKI in greater detail. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We performed a systematic review and meta-analysis of cardiothoracic surgery-associated AKI studies published between January of 1978 and December of 2015 to further explore the relationship between sex and cardiothoracic surgery-associated AKI. RESULTS: Sixty-four studies were identified that provided sex-specific data regarding the incidence of cardiothoracic surgery-associated AKI among 1,057,412 subjects. Using univariate analysis, women were more likely than men to develop AKI postoperatively (odds ratio, 1.21; 95% confidence interval, 1.09 to 1.33; P<0.001). However, when the analysis was restricted to the 120,464 subjects reported in 29 studies that used the Acute Kidney Injury Network criteria, the RIFLE criteria, or the Kidney Disease Improving Global Outcomes criteria to define AKI, there was no significant sex-related difference in risk. Seventeen studies used multivariate analysis to assess risk factors for cardiothoracic surgery-associated AKI and provided sex-specific odd ratios. Among the 1,587,181 individuals included in these studies, the risk of developing cardiothoracic surgery-associated AKI was not significantly associated with sex (odds ratio, 1.04; 95% confidence interval, 0.92 to 1.19; P=0.51). However, when the analysis was restricted to the 5106 subjects reported in four studies that used the Acute Kidney Injury Network criteria to define AKI, the risk of developing AKI was significantly lower in women compared with in men (odds ratio, 0.75; 95% confidence interval, 0.65 to 0.87; P<0.001). CONCLUSIONS: Our systematic review and meta-analysis contradict the generally held consensus that being a woman is an independent risk factor for the development of cardiothoracic surgery-associated AKI.
Authors: David M Shahian; Sean M O'Brien; Giovanni Filardo; Victor A Ferraris; Constance K Haan; Jeffrey B Rich; Sharon-Lise T Normand; Elizabeth R DeLong; Cynthia M Shewan; Rachel S Dokholyan; Eric D Peterson; Fred H Edwards; Richard P Anderson Journal: Ann Thorac Surg Date: 2009-07 Impact factor: 4.330
Authors: Kristian Kandler; Mathias E Jensen; Jens C Nilsson; Christian H Møller; Daniel A Steinbrüchel Journal: J Cardiothorac Vasc Anesth Date: 2014-10-16 Impact factor: 2.628
Authors: K Karkouti; W S Beattie; D N Wijeysundera; V Rao; C Chan; K M Dattilo; G Djaiani; J Ivanov; J Karski; T E David Journal: J Thorac Cardiovasc Surg Date: 2005-02 Impact factor: 5.209
Authors: David R McIlroy; M Clin Epi; Michael Argenziano; David Farkas; Tianna Umann Journal: J Cardiothorac Vasc Anesth Date: 2012-04-21 Impact factor: 2.628
Authors: Etienne Macedo; Josée Bouchard; Sharon H Soroko; Glenn M Chertow; Jonathan Himmelfarb; T Alp Ikizler; Emil P Paganini; Ravindra L Mehta Journal: Crit Care Date: 2010-05-06 Impact factor: 9.097
Authors: Karl A Nath; Vesna D Garovic; Joseph P Grande; Anthony J Croatt; Allan W Ackerman; Gianrico Farrugia; Zvonimir S Katusic; John D Belcher; Gregory M Vercellotti Journal: Am J Physiol Renal Physiol Date: 2019-06-19
Authors: Marcin P Szczechowicz; Sabreen Mkalaluh; Saeed Torabi; Jerry Easo; Matthias Karck; Alexander Weymann Journal: Indian J Thorac Cardiovasc Surg Date: 2020-08-12
Authors: Karl A Nath; Raman Deep Singh; Joseph P Grande; Vesna D Garovic; Anthony J Croatt; Allan W Ackerman; Michael A Barry; Anupam Agarwal Journal: Kidney360 Date: 2021-05-18
Authors: Chetna K Pande; Mallory B Smith; Danielle E Soranno; Katja M Gist; Dana Y Fuhrman; Kristin Dolan; Andrea L Conroy; Ayse Akcan-Arikan Journal: Front Pediatr Date: 2022-06-30 Impact factor: 3.569
Authors: Neil A Hukriede; Danielle E Soranno; Veronika Sander; Tayla Perreau; Michelle C Starr; Peter S T Yuen; Leah J Siskind; Michael P Hutchens; Alan J Davidson; David M Burmeister; Sarah Faubel; Mark P de Caestecker Journal: Nat Rev Nephrol Date: 2022-02-16 Impact factor: 42.439
Authors: Mital Patel; Anna Heipertz; Emily Joyce; John A Kellum; Christopher Horvat; James E Squires; Shawn C West; Priyanka Priyanka; Dana Y Fuhrman Journal: Pediatr Transplant Date: 2021-10-20
Authors: Mark D DeBoer; Stephanie L Filipp; Solomon K Musani; Mario Sims; Mark D Okusa; Matthew Gurka Journal: Kidney Blood Press Res Date: 2018-04-06 Impact factor: 2.687