Sex-specific AKI risk in acute myocardial infarction patients with type 2 diabetes mellitus

TL;DR

This study finds that female and male patients with heart attacks and type 2 diabetes have different risks for kidney injury, suggesting the need for sex-specific care.

Contribution

The study identifies sex-specific risk factors for acute kidney injury in patients with acute myocardial infarction and type 2 diabetes.

Findings

Females had a higher AKI incidence (17.2%) compared to males (12.1%).

Hyperphosphatemia strongly predicts AKI risk in males, while hyperkalemia and Killip class are key in females.

Elevated HbA1c paradoxically reduced AKI risk in both sexes.

Abstract

While sex differences in cardiovascular outcomes are recognized, their role in the risk and clinical outcomes of acute kidney injury (AKI) among acute myocardial infarction (AMI) comorbid with type 2 diabetes mellitus (T2DM) remains unstratified in clinical guidelines. The aim of this study is to explore the sex differences in the occurrence of AKI among AMI-T2DM patients, so as to provide ideas for the precision management of these patients.

This retrospective cohort study enrolled AMI patients with T2DM from The First Affiliated Hospital of Xi’an Jiaotong University from 2018 to 2022. Clinical data and medication information were collected through the hospital’s biospecimen information resource center. Patients enrolled were divided into male group and female group. The primary outcome is AKI during hospitalization.

Among 2,631 AMI patients complicated with T2DM (76.1% male, median age 67.0 years (55.9–78.1), acute kidney injury occurred in 13.3% (n = 351) of the cohort. It shows higher AKI incidence in females (17.2% vs. 12.1%, P = 0.026) with distinct sex-specific risks: Higher HbA1c was paradoxically protective in both sexes (female OR = 0.73; male OR = 0.81), hyperkalemia impact (OR = 5.88 vs. 4.02), and HDL protection (OR = 0.16); males exhibited hyperphosphatemia hazard(OR = 14.32). STEMI unexpectedly reduced AKI risk in both sexes (female OR = 0.36; male OR = 0.64). Univariate regression analysis shows the association between electrolyte imbalances, particularly hyperphosphatemia, and AKI risk was significantly stronger in males (OR = 14.3) than in females (OR = 5.2). Conversely, abnormalities in lipid metabolism demonstrated a significant protective effect against AKI exclusively in females. Additionally, advanced age, higher Killip class, hypoalbuminemia, and elevated fibrinogen were significant predictors of AKI development in both sexes.

This study reveals significant sex disparities in AKI risk among T2DM-AMI patients: females show higher incidence, while hyperphosphatemia strongly predicts risk in males and hyperkalemia/Killip class in females. Elevated HbA1c paradoxically reduced risk in both. We recommend sex-specific management: monitor phosphorus in males and potassium with hemodynamics in females. Future work should develop sex-stratified risk models and clarify mechanisms.

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