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

Tangchitthavorngul S 1 , Lumlertgul N 2 , Peerapornratana S 2 , Mai AT 3 , Hasan MS 4 , Loh CTI 4 Show all authors , Kumthekar GV 5 , Chakravarthi R 6 , Jonny J 7 , Gafor AHA 8 , Parapiboon W 9 , Nimkietkajorn V 10 , Intarak S 11 , Sukmark T 12 , Khositrangsikun K 13 , Oranrigsupak P 14 , Aksornrat A 15 , Mazlan MZ 16 , Chuasuwan A 17 , Tangvoraphonkchai K 18 , Pham TTN 3 , Truong TD 3 , Tran LT 3 , Truong VHT 3 , Dinh LT 3 , Nguyen BX 3 , Trieu NHK 3 , Le YH 3 , Nguyen DLM 3 , Sengthavisouk N 19 , Surasit K 20 , Tantiyavarong P 21 , Pongsittisak W 22 , Tran PNT 23 , Tungsanga K 2 , Avihingsanon Y 2 , Srisawat N 24

Affiliations 

  • 1 Division of Nephrology, Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
  • 2 Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  • 3 Cho Ray Hospital, Ho Chi Minh City, Vietnam
  • 4 Department of Anesthesiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
  • 5 Department of Nephrology, Symbiosis University Hospital and Research Center, Symbiosis Medical College for Women, Symbiosis International University, Lavale, Pune, Maharashtra, India
  • 6 Division of Nephrology and Kidney Transplantation, Yashoda Hospitals and Renown Clinical Services, Hi Tech City,, Hyderabad, Telangana, India
  • 7 Department of Internal Medicine, Gatot Soebroto Indonesia Central Army Hospital, Jakarta, Indonesia
  • 8 Faculty of Medicine, Universiti Kebangsaan Malaysia, Bangi, Malaysia
  • 9 Department of Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
  • 10 Buddhachinaraj Hospital, Phitsanulok, Thailand
  • 11 Department of Medicine, Mahasarakham Hospital, Mahasarakham, Thailand
  • 12 Thungsong Hospital, Nakhon Si Thammarat, Thailand
  • 13 Maharaj Nakhon Si Thammarat Hospital, Nakhon Si Thammarat, Thailand
  • 14 Nan Hospital, Nan, Thailand
  • 15 Sichon Hospital, Nakhon Si Thammarat, Thailand
  • 16 Department of Anesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
  • 17 Division of Nephrology, Department of Medicine, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, Thailand
  • 18 Faculty of Medicine, Mahasarakham University, Mahasarakham, Thailand
  • 19 Division of Nephrology, Mittaphab Hospital, Vientiane Capital, Laos
  • 20 Nakornping Hospital, Chiang Mai, Thailand
  • 21 Division of Nephrology, Department of Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
  • 22 Division of Nephrology, Department of Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
  • 23 Department of Internal Medicine, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
  • 24 Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. drnattachai@yahoo.com
Intensive Care Med, 2025 Jul;51(7):1306-1319.
PMID: 40658243 DOI: 10.1007/s00134-025-08008-7

Abstract

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

MeSH terms
Similar publications