AKI Occurs in 34.5% of U.S. Drug Overdose Hospitalizations, Highest in Older Adults and Men

The MMWR report analyzed national hospitalization records to track AKI trends alongside overdose admissions. Researchers calculated annual percentage changes in AKI documentation and severe inpatient courses, defined as ICU admission, mechanical ventilation, or death. Data covered patients across age and sex strata, revealing a 2.69% annual increase in AKI through 2022 before a reversal. This observational design captures documented diagnoses but cannot establish causation between specific substances and kidney injury.

Older patients aged 65 and above showed 37.4% AKI prevalence versus 28.2% in those 24 and younger, while men reached 38.1% compared with 29.4% in women. Among AKI cases, 60.9% experienced severe courses, though younger patients faced higher relative severity. These patterns align with known comorbidities such as reduced renal reserve in older adults and potential sex differences in drug metabolism or healthcare-seeking behavior.

The findings connect to broader overdose shifts, including declining mortality yet persistent nonfatal complications. Prior observational studies in JAMA and Kidney International have linked synthetic opioids and stimulants to rhabdomyolysis and prerenal azotemia, mechanisms likely amplified in patients with preexisting CKD. Public health efforts must prioritize post-discharge kidney follow-up, as continuity gaps remain unmeasured here.

Future surveillance should incorporate substance-specific toxicology and longitudinal creatinine trajectories to identify modifiable risks. Randomized interventions targeting early AKI recognition in overdose protocols would test whether the observed 2022-2025 decline can be sustained.