ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Cardiovascular Endocrinology
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1654587
Sex-Specific AKI Risk in Acute Myocardial Infarction Patients with Type 2 Diabetes Mellitus
Provisionally accepted
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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1. Abstract: Background/Objectives: 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. Methods: 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. Results: 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. Conclusions: 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.
Keywords: Acute myocardial infarction (AMI), acute kidney injury (AKI), Type 2 diabetes mellitus (T2DM), Sex-specific, risk factor
Received: 26 Jun 2025; Accepted: 01 Sep 2025.
Copyright: © 2025 Huang, Yuan and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Wei Yuan, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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