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. 2025 Mar 20;29(1):128.
doi: 10.1186/s13054-025-05351-5.

Epidemiology of sepsis-associated acute kidney injury in the ICU with contemporary consensus definitions

Tomonori Takeuchi  1   2 , Alexander H Flannery  3   4 , Lucas J Liu  5 , Lama Ghazi  6 , Augusto Cama-Olivares  1   7 , Kiyohide Fushimi  2 , Jin Chen  1 , Sarah C Huen  8 , Ashita J Tolwani  1 , Javier A Neyra  9
Affiliations

Epidemiology of sepsis-associated acute kidney injury in the ICU with contemporary consensus definitions

Tomonori Takeuchi et al. Crit Care. .

Abstract

Background: The definition of sepsis-associated acute kidney injury (SA-AKI) was updated in 2023. This study aims to describe the epidemiology of SA-AKI using updated consensus definition and to evaluate clinical outcomes.

Methods: The study was a retrospective cohort analysis conducted at two academic medical centers. Adult patients admitted to intensive care units (ICU) between 2010 and 2022 were included and categorized as SA-AKI, sepsis alone, or AKI alone. SA-AKI was further classified by time of onset (early < 2 days from sepsis diagnosis vs. late 2-7 days following sepsis diagnosis) and presence of septic shock. Clinical outcomes included hospital mortality and major adverse kidney events (MAKE = death, kidney replacement therapy, or reduced kidney function from baseline) at discharge.

Results: 187,888 adult ICU patients were included, and SA-AKI was found in nearly half of sepsis patients and about 1 in 6 ICU admissions. 1 in 4 patients with SA-AKI died during hospitalization and 37.7% experienced at least one MAKE by hospital discharge. Compared to sepsis or AKI alone, SA-AKI was associated with higher mortality (adjusted HR 1.59; 95% CI 1.51-1.66) and higher odds of MAKE (adjusted OR 3.35; 95% CI 3.19-3.51). The early clinical phenotype of SA-AKI was most common, with incident AKI decreasing daily from sepsis onset. The presence of septic shock significantly worsened outcomes.

Conclusions: Applying updated consensus definitions highlights the high prevalence of SA-AKI in the ICU and its significant associated morbidity and mortality. Outcomes differ based on clinical phenotypes, including the timing of SA-AKI onset and the presence of shock.

Keywords: Acute kidney injury (AKI); Epidemiology; Sepsis; Sepsis-associated acute kidney injury (SA-AKI).

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the Institutional Review Boards of both institutions, which granted a waiver of informed consent given its minimal risk and retrospective nature. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Cohort derivation. ICU intensive care unit; ESKD end-stage kidney disease; SA-AKI sepsis-associated acute kidney injury
Fig. 2
Fig. 2
Venn diagram of patient categorization for analysis. Displayed areas are representative of relative proportions. Letters A–F are for reference of specific patient cohorts. AKI acute kidney injury; ICU intensive care unit; SA-AKI sepsis-associated acute kidney injury
Fig. 3
Fig. 3
Incident AKI in relation to sepsis onset. AKI acute kidney injury; SA-AKI sepsis-associated acute kidney injury
Fig. 4
Fig. 4
Adjusted survival curves from cox proportional hazards model. AKI acute kidney injury; SA-AKI sepsis-associated acute kidney injury
See this image and copyright information in PMC

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