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Multicenter Study
. 2025 Jul;51(7):1306-1319.
doi: 10.1007/s00134-025-08008-7. Epub 2025 Jul 14.

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

Suri Tangchitthavorngul  1   2   3 , Nuttha Lumlertgul  4   2   3 , Sadudee Peerapornratana  4   2   3 , Anh Tuan Mai  5   6 , Mohd Shahnaz Hasan  7 , Carolyn Tze Ing Loh  7 , Girish V Kumthekar  8 , Rajasekara Chakravarthi  9 , Jonny Jonny  10   11   12 , Abdul Halim Abdul Gafor  13 , Watanyu Parapiboon  14 , Veerapatr Nimkietkajorn  15 , Sompote Intarak  16 , Theerapon Sukmark  17 , Kamol Khositrangsikun  18 , Petchdee Oranrigsupak  19 , Atchara Aksornrat  20 , Mohd Zulfakar Mazlan  21 , Anan Chuasuwan  22 , Kamonwan Tangvoraphonkchai  23 , Thao T N Pham  5 , Tien D Truong  5 , Linh T Tran  5 , Viet Ha T Truong  5 , Ly T Dinh  5 , Bach X Nguyen  5 , Ngan Hoang Kim Trieu  5 , Yen H Le  5 , Duy L M Nguyen  5 , Noot Sengthavisouk  24 , Karjbundid Surasit  25 , Pichaya Tantiyavarong  26 , Wanjak Pongsittisak  27 , Phu Nguyen Trong Tran  28 , Kriang Tungsanga  4 , Yingyos Avihingsanon  4 , Nattachai Srisawat  29   30   31   32
Affiliations
Multicenter Study

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

Suri Tangchitthavorngul et al. Intensive Care Med. 2025 Jul.

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.

Keywords: Acute kidney injury; Long-term outcomes; Major adverse kidney events; Non-recovery.

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Conflict of interest statement

Declarations. Conflicts of interest: All authors declare no support from any organization for the submitted work and no competing interests with regard to the submitted work. Ethical approval: In Thailand, ethics approval was obtained from the Central Research Ethics Committee (CREC No. 044/62) before the study commenced, and written informed consent was obtained from participants. For other participant centers, local ethics committees approved the study in accordance with local regulations.

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