Acute Kidney Injury Documented in About One Third of Drug Overdose Hospitalizations

Acute kidney injury (AKI) was documented in about one third of US hospitalizations involving opioid, cocaine or psychostimulant overdose during 2016–2025, and most of those patients had a severe inpatient course, according to a report in CDC’s Morbidity and Mortality Weekly Report.

The CDC authors noted that overdose surveillance has focused mainly on deaths and emergency department visits, and less is known about inpatient complications such as AKI. They analyzed discharge data from the Premier Healthcare Database, which represents about 25% of US inpatient admissions, and applied weights to produce national estimates. Patients with end-stage kidney disease or chronic dialysis dependence were excluded. A severe inpatient course was defined as acute dialysis, respiratory compromise, shock or hypotension, or in-hospital death.

Of 1,297,847 overdose-involved hospitalizations, 448,136 included AKI (adjusted percentage, 34.5%; 95% CI, 34.0%-35.1%), and 60.9% of those involved a severe inpatient course. The percentage with AKI rose during 2016–2022 and fell during 2022–2025, while severe courses rose through 2023 before declining.

AKI was more common with older age, ranging from 28.2% among patients aged 24 years or younger to 37.4% among those aged 65 years or older, and was more common among males than females (38.1% vs 29.4%). Among patients with AKI, however, severe courses were more frequent in the youngest group than in the oldest (68.1% vs 56.1%) and slightly more frequent among females (61.9% vs 60.4%). The recent decline in severe courses was not statistically significant among patients aged 44 years or younger or among females.

The authors noted that AKI was identified from diagnosis codes rather than laboratory criteria, which might have underestimated its occurrence. They also noted that the analysis counted hospitalizations rather than unique patients, and that participating hospitals might differ from others. They said severe courses among younger patients, who might have more years at risk for chronic kidney disease or kidney failure, warrant continued attention. They pointed to early kidney injury detection, postdischarge linkage to care and overdose prevention through better access to substance use treatment.

Source: Han S, Xu F, Xie H, Guy G, Pavkov ME. Acute kidney injury among patients with drug overdose–involved hospitalizations — United States, 2016–2025. MMWR Morb Mortal Wkly Rep. 2026;75(41):614-621. doi:10.15585/mmwr.mm7541a1