Sex-disaggregated analysis of acute kidney injury in hospitalized children with sickle cell anemia in Uganda.

ABSTRACT

A growing body of research is categorizing sex differences in both sickle-cell anemia (SCA) and acute kidney injury (AKI), however, most of this work is being conducted in high-resource settings. Here, we evaluate risk factors and clinical parameters associated with AKI and AKI severity, stratified by sex, in a cohort of children hospitalized with SCA and vaso-occlusive pain crisis (VOC). The purpose of this study is to explore sex disparities in a high-risk, vulnerable population. This study is a secondary analysis of data collected from a cohort of Ugandan children between 2 and 18 years of age prospectively enrolled. A total of 185 children were enrolled in the primary study, 41.6% were female and 58.4% were male, with a median age of 8.9 years. Incident or worsening AKI (p=0.026) occurred more frequently in female compared to male children, despite no differences in AKI on admission. Female children also had altered markers of renal function including higher creatinine levels at admission (p=0.03), and higher peak creatinine (p=0.006); and higher urine NGAL at admission (p = 0.003) compared to male children. Female children had elevated total (p=0.045) and conjugated bilirubin at admission (p=0.02) compared to male children, and higher rates of hematuria at admission (p=0.004). Here we report sex differences in AKI in children with SCA and VOC, including increased incidence and worsening of AKI in female pediatric patients, in association with an increase in biological indicators of poor renal function including creatinine, estimated glomerular filtration rate (eGFR), and NGAL.