Epidemiology and long-term outcomes of critically ill patients with severe AKI in India and Southeast Asia.

BACKGROUND

Acute kidney injury (AKI) is associated with significant short-term morbidity and mortality. However, its long-term outcomes, particularly in resource-limited settings, remain poorly understood. This study aimed to evaluate 2-year major adverse kidney events (MAKE) in patients with severe AKI.

METHODS

We analyzed data from the India and Southeast Asia Renal Replacement Therapy (InSEA-RRT) registry, a multicenter cohort study conducted between April 2019 and December 2023 across 24 hospitals in Southeast Asia and India. Critically ill patients with AKI stage 3, as defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria, were enrolled. The primary outcome was 2-year MAKE, defined as a composite of persistent kidney dysfunction, long-term dialysis, and all-cause mortality at 2 years post-enrollment.

RESULTS

A total of 2,315 patients were enrolled, of whom 1,033 (47%) died during hospitalization. Among surviving patients, the incidence of 2-year MAKE was 46.6 per 100 person-years (95% CI 42.7-50.6). Notably, mortality (32%) was the dominant component of MAKE. The incidence of new chronic kidney disease (CKD) and CKD progression at 2 years post-AKI was 58.6 and 35.4 per 100 person-year (95% CI 51.0-67.0 and 26.0-47.0), respectively. Multivariable-adjusted models identified older age, male sex, preexisting CKD, malignancy, cardiac-associated AKI, and non-recovery of kidney function after AKI as independent risk factors for 2-year MAKE.

CONCLUSIONS

Patients with severe AKI face a high incidence of 2-year MAKE and poor long-term clinical outcomes. Early recognition and close follow-up of these patients are crucial. Further research is needed to identify effective strategies to improve long-term outcomes in this high-risk population.