Acute Kidney Injury Among Patients with Drug Overdose-Involved Hospitalizations - United States, 2016-2025.

Acute kidney injury (AKI) is a serious, often underrecognized complication among patients hospitalized for drug overdose. Although overdose mortality has recently declined in the United States, less is known about whether serious nonfatal complications, including AKI, have followed similar trends. Adjusted percentages of hospitalizations of patients with drug overdose and AKI were calculated using hospital discharge data during 2016-2025. The percentage with a severe inpatient course (i.e., acute dialysis, respiratory compromise, shock or hypotension, or in-hospital death) was also calculated. Among 1,297,847 drug overdose-involved hospitalizations, AKI was documented in 448,136 (34.5%). The percentage of patients with AKI was 28.2% among those aged ≤24 years, 37.4% among those aged ≥65 years, 29.4% among females, and 38.1% among males. AKI among patients with a drug overdose-involved hospitalization increased during 2016-2022 (annual percent change [APC] = 2.69%) and decreased during 2022-2025 (APC = -5.11%). Among patients with a drug overdose-involved hospitalization and AKI, 273,093 (60.9%) experienced a severe inpatient course, including 68.1% of persons aged ≤24 years, 56.1% of those aged ≥65 years, 61.9% of females, and 60.4% of males. The percentage of drug overdose-involved hospitalizations with a severe inpatient course increased during 2016-2023 (APC = 1.82%), before decreasing during 2023-2025 (APC = -2.89%). Disproportionately severe inpatient courses among younger patients, who might have more years of life at risk for developing chronic kidney disease or kidney failure after AKI, warrants continued attention to early kidney injury detection after drug overdose, postdischarge linkage to care, and overdose prevention through improved access to substance use treatment.