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Title: Sex and mortality in septic severe acute kidney injury.
Austin Authors: O'Brien, Zachary ;Cass, Alan;Cole, Louise;Finfer, Simon;Gallagher, Martin;McArthur, Colin;McGuiness, Shay;Myburgh, John;Bellomo, Rinaldo ;Mårtensson, Johan
Affiliation: Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
St George Clinical School, University of New South Wales, Sydney, NSW, Australia
Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Cardiovascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
Menzies School of Health Research, Charles Darwin University, Darwin, Winnellie, NT, Australia
Department of Intensive Care, Nepean Hospital, Sydney, Australia
The George Institute for Global Health, University of Sydney, Level 13, Sydney, NSW, Australia
Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
Issue Date: 2019
Date: 2018-10-23
Publication information: Journal of Critical Care 2019; 49: 70-76
Abstract: To investigate the relationship between sex and mortality and whether menopause or the intensity of renal replacement therapy (RRT) modify this relationship in patients with severe septic acute kidney injury (AKI). Post-hoc analysis of patients with sepsis included in the Randomized Evaluation of Normal versus Augmented Level renal replacement therapy (RENAL) trial. Of 724 patients, 458 (63.3%) were male and 266 (36.7%) were female. The mean delivered effluent flow rate was 25.6 ± 7.4 ml/kg/h (80 ± 15% of prescribed dose) in males and 27.4 ± 7.6 ml/kg/h (83 ± 15% of prescribed dose) in females (p = .01). A total of 237 (51.7%) males and 118 (44.5%) females died within 90 days of randomization (p = .06). The adjusted hazard ratio (HR) for 90-day mortality was significantly decreased in females as compared with males (HR 0.74, 95% CI 0.57 to 0.96, p = .02). The relationship between sex and mortality was not significantly altered by menopausal status (adjusted P value for interaction 0.99) or by RRT intensity allocation (adjusted P value for interaction 0.27). In a cohort of patients with sepsis and severe AKI, female sex was associated with improved survival. The relationship between sex and survival was not altered by menopausal status or RRT intensity.
DOI: 10.1016/j.jcrc.2018.10.017
ORCID: 0000-0002-1650-8939
Journal: Journal of Critical Care
PubMed URL: 30388491
Type: Journal Article
Subjects: Acute kidney injury
Renal replacement therapy
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