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Acute Kidney Injury and Outcomes in the Cardiac Intensive Care Unit: Insights from the Critical Care Cardiology

Narayana Sarma V Singam1,2,3,4, Mitchell Padkins1, Alexander I Papolos3,4

  • 1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.

Journal of Intensive Care Medicine
|April 9, 2026
PubMed

Insights

Acute kidney injury (AKI) affects nearly one in four patients in cardiac intensive care units (CICUs). Higher stages of AKI are linked to increased hospital mortality, emphasizing the need for preventative strategies.

Area of Science:

  • Nephrology
  • Cardiology
  • Critical Care Medicine

Background:

  • Acute kidney injury (AKI) is a significant complication in critically ill patients, associated with substantial morbidity and mortality.
  • Epidemiological data on AKI within cardiac intensive care units (CICUs) are limited.
  • This study addresses the scarcity of multicenter analyses on AKI in CICU populations.

Purpose of the Study:

  • To determine the prevalence of AKI in a contemporary multicenter CICU population.
  • To identify predictors associated with AKI development and severity.
  • To evaluate the impact of AKI on in-hospital mortality within the CICU setting.

Main Methods:

  • Utilized data from the Critical Care Cardiology Trials Network (CCCTN) registry, a collaboration of North American CICUs.
  • Assessed patient and hospital-level outcomes based on creatinine-only Kidney Disease: Improving Global Outcomes (KDIGO) AKI stages.
  • Employed logistic regression to analyze associations between AKI and in-hospital mortality.

Main Results:

  • The overall prevalence of AKI was 23.7% across 21,603 admissions, with KDIGO stage 1 (12.7%), stage 2 (1.7%), and stage 3 (9.2%).
  • Higher AKI prevalence and severity were observed in patients with pre-existing kidney disease, hypertension, diabetes, heart failure, cardiogenic shock, and cardiac arrest.
  • Hospital mortality demonstrated a stepwise increase with AKI severity (Stage 1: 23%, Stage 2: 39%, Stage 3: 42%), with adjusted odds ratios for mortality of 2.1, 3.7, and 3.4 for stages 1, 2, and 3, respectively.

Conclusions:

  • AKI is prevalent in approximately one in four CICU admissions.
  • Progressive stages of AKI are incrementally associated with higher in-hospital mortality.
  • These findings underscore the critical need for developing targeted strategies to prevent and manage AKI in CICU patients.

Keywords:
acute kidney injurycardiac intensive carecardiac outputcardiogenic shockcritical caremyocardial infarction

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