A newly published national analysis found acute kidney injury in more than one in three drug-overdose-involved hospitalisations over a decade in the United States. The study counted 448,136 hospitalisations involving acute kidney injury among 1,297,847 hospitalisations involving drug overdose between 2016 and 2025.
Among the hospitalisations involving both overdose and acute kidney injury, 273,093, or 60.9 per cent, also involved a severe inpatient course. The researchers defined a severe course as one involving acute dialysis, respiratory compromise, shock or hypotension, or death in hospital. These are hospital-discharge figures: a person could contribute more than one hospitalisation, so the totals do not represent unique patients.
What the analysis found
The analysis found that the adjusted percentage of overdose-involved hospitalisations with acute kidney injury rose between 2016 and 2022, with an annual percentage change of 2.69 per cent. It then fell between 2022 and 2025, with an annual percentage change of minus 5.11 per cent. The report also found that severe inpatient courses among hospitalisations involving overdose and acute kidney injury increased from 2016 to 2023, then decreased through 2025.
The study examined hospital discharge records from the Premier Healthcare Database, an all-payer hospital database covering about 1,400 hospitals and health systems and representing approximately a quarter of annual US inpatient admissions. Researchers used projection weights to estimate national totals. The overdose definition covered hospitalisations with recorded poisoning by opioids, cocaine or psychostimulants; records for people with end-stage kidney disease or chronic dialysis dependence were excluded.
Acute kidney injury means a sudden decline in kidney function. In this analysis it was identified from diagnosis codes recorded in a hospital discharge record. The researchers calculated adjusted percentages, accounting for factors including year, age, sex, race and ethnicity, existing kidney and other health conditions, and the drug category involved.
Why early recognition matters
The report describes acute kidney injury as a serious complication that can be under-recognised after an overdose. It notes that kidney injury is associated with an increased risk of later chronic kidney disease, kidney failure and death. The analysis did not follow individual patients after discharge, so it does not measure how many people developed those longer-term outcomes.
Researchers said the findings support attention to early detection of kidney injury during overdose-related care, linkage to care after discharge and prevention of further overdoses, including access to substance-use treatment. The study identifies a substantial burden in hospital records, but it does not show that overdose caused every recorded episode of kidney injury, or that any particular intervention would prevent it.
There are other limits to what the figures can establish. They describe hospitalisations rather than people, and the database represents participating hospitals rather than every hospital directly. The analysis covers specified drug categories and relies on diagnoses recorded in discharge data. The observed changes over time are trends in adjusted percentages, not proof of why the percentages rose or fell.
The report’s authors are researchers at the US Centers for Disease Control and Prevention. They say the high proportion of severe inpatient courses, including among younger patients, warrants continued attention to kidney injury detection and follow-up. The findings add a measure of serious non-fatal complications to an area of overdose monitoring that has often focused on deaths and emergency department visits.
