Sex-Based Disparities in Acute Kidney Injury

Sex-based disparities in acute kidney injury are related to differential access to diagnostic tests, testing thresholds, and nonharmonized data collection and acute kidney injury reporting across the globe. Differential exposure to acute kidney injury risk factors and sex-based social risk and discrimination, affect accurate acute kidney injury reporting. In animal models of acute kidney injury, males are at consistently higher risk likely driven by hormonal, genetic, and epigenetic factors. Female protection generally wanes in older animals; however, in humans, the risk of acute kidney injury is more difficult to describe because of inconsistent definitions, inconsistent statistical and reporting techniques, and lack of sex-stratified gold standard tests. Hospital-acquired, including acute kidney injury requiring dialysis, and community-acquired acute kidney injury studies show a higher propensity among men, except for certain specific circumstances. The recent use of standardized acute kidney injury definitions and careful comorbidity adjustment has debunked the notion that women are at higher acute kidney injury risk as reported in past studies referencing certain clinical scenarios. The heterogeneity of epidemiologic reports from around the world does not allow for reliable inferences about sex-based acute kidney injury risk. In this review we present a summary of the greater literature on biologic drivers of acute kidney injury sex differences and the various complexities involved in describing epidemiologic sex-based acute kidney injury patterns.