Cardiogenic shock complicated by acute kidney injury: Sex-specific differences and prognostic impact

BACKGROUND: Acute kidney injury (AKI) is a frequent and prognostically relevant complication in infarct-related cardiogenic shock (CS). Although sex differences in cardiovascular outcomes are increasingly recognized, their role in AKI incidence and prognosis in CS remains unclear. OBJECTIVES: To assess sex-specific differences in the incidence, severity, and prognostic impact of AKI in patients with infarct-related CS. METHODS: We retrospectively analyzed 369 consecutive patients with infarct-related CS enrolled in a prospective registry between 2015 and 2020. AKI was classified using KDIGO criteria. Baseline characteristics, treatment exposure, renal replacement therapy (RRT), and in-hospital mortality were compared between women and men. Multivariable logistic regression identified independent predictors of AKI and mortality. RESULTS: AKI occurred in 158 patients (42.8 %). Women had a higher crude incidence than men (48.4 % vs. 39.7 %, p = 0.045) and a trend toward more severe AKI (stage 3: 43.3 % vs. 30.6 %, p = 0.061). After adjustment, female sex was not an independent predictor of AKI (adjusted OR 1.36, 95 % CI 0.84-2.21; p = 0.217). Among patients with AKI, women showed higher in-hospital mortality (74.6 % vs. 55.3 %, p = 0.018), and female sex remained independently associated with mortality (adjusted OR 1.81, 95 % CI 1.01-3.28; p = 0.047). Rates of RRT did not differ by sex. Sensitivity analyses confirmed the robustness of these findings. CONCLUSION: Women with infarct-related CS experienced a higher crude incidence and severity of AKI, although sex was not an independent predictor after adjustment. In contrast, female sex independently predicted mortality among patients with AKI. These results indicate sex-specific vulnerability of the cardiorenal axis and highlight the need for closer renal monitoring and tailored management strategies in women with CS.