The efficacy of Cordyceps sinensis preparations in improving kidney outcomes among patients with AKI during hemorrhagic fever with renal syndrome: evidence from a Chinese cohort.

Hemorrhagic fever with renal syndrome (HFRS) is frequently complicated by acute kidney injury (AKI). Although most patients recover from AKI with supportive care, some progress to chronic kidney disease (CKD). The incidence and determinants of CKD progression in patients with HFRS-AKI remain uncertain. Here, 99 patients with HFRS-AKI treated at Jinling Hospital were analyzed retrospectively to determine the rate of CKD progression and identify associated risk factors. Patients were divided into complete recovery (CR) and incomplete recovery (ICR) groups according to CKD progression. Baseline clinical and laboratory data were collected and analyzed. Overall, 27.3% of patients with HFRS-AKI progressed to CKD despite receiving supportive care. Facial flushing was more frequent in the ICR group than in the CR group (40.7% vs. 18.1%, p = 0.033). Multivariate analysis revealed that treatment with Cordyceps sinensis preparations during the AKI phase was an independent protective factor against incomplete kidney recovery (OR: 0.323, 95% CI: 0.114-0.916, p = 0.034). Inverse probability weighting analysis further demonstrated that the use of Cordyceps sinensis preparations was inversely associated with incomplete kidney recovery (β: -1.184, 95% CI: -2.224 - -0.144, p = 0.026). Survival analysis confirmed that Cordyceps sinensis preparation therapy was associated with improved kidney outcomes (log-rank test, p = 0.004). This study provides the first clinical evidence that adjunctive therapy with Cordyceps sinensis preparations during HFRS-AKI is associated with improved kidney outcomes, suggesting that Cordyceps sinensis preparations represents a promising therapeutic approach for viral-induced AKI.