Clinical and Resource Burden of Acute Kidney Injury Among Adults Hospitalized with Sepsis: A Retrospective Cross-Sectional study

Background: Acute kidney injury (AKI) is a frequent and serious complication of sepsis, yet contemporary national estimates of its clinical and health-system impact remain limited. We used a large national database to characterize the burden of AKI among adults hospitalized with sepsis in the United States. Methods: We conducted a cross-sectional study of adult sepsis hospitalizations in the 2022 NIS. AKI was identified using ICD-10-CM codes. Clinical outcomes included in-hospital mortality, mechanical ventilation, vasopressor use, and in-hospital dialysis. Resource outcomes included length of stay, total hospital charges, and discharge disposition. Survey-weighted logistic and gamma regression models were used to estimate adjusted odds ratios (aORs) and adjusted ratios of geometric means (aROMs) after adjusting for demographic, socioeconomic, and comorbidity factors. Results: Among 2.96 million weighted sepsis hospitalizations, 1.32 million (44.5%) involved AKI. Patients with AKI were older and had higher comorbidity burden than those without AKI. Unadjusted mortality (19.8% vs 7.5%), mechanical ventilation (22.3% vs 9.3%), and vasopressor use (10.1% vs 5.8%) were substantially higher in the AKI group, and these differences persisted in adjusted analyses (mortality aOR 2.44; mechanical ventilation aOR 2.66; vasopressor use aOR 1.70). AKI was also associated with longer length of stay (aROM 1.33), higher hospital charges (aROM 1.50), and worse discharge outcomes, including lower home discharge (26.0% vs 43.8%) and greater transfer to post-acute care facilities (40.4% vs 30.8%). Conclusions: Sepsis-associated AKI remains a widespread and highly consequential complication, independently associated with higher mortality, greater organ support needs, prolonged hospitalization, increased financial burden, and poorer post-acute recovery. These findings underscore the need for early identification and prevention of AKI in sepsis and highlight the urgent need for early AKI mitigation strategies to improve clinical and recovery outcomes in sepsis.