Alcohol use disorder and long-term kidney outcomes after acute kidney disease: a retrospective cohort study

Background: Acute kidney disease (AKD) is associated with a high risk of adverse long-term kidney outcomes after hospital discharge. Alcohol use disorder (AUD) is prevalent and may adversely affect kidney function; however, its impact on outcomes after AKD remains unclear.Objectives: To evaluate the association between AUD and long-term kidney outcomes among adults who survived AKD.Methods: We conducted a retrospective cohort study using the TriNetX global federated health research network. Adults with AKD, defined by receipt of dialysis during the index hospitalization, were included. The index date was set at 90 days after discharge. Patients were classified based on a documented diagnosis of AUD prior to AKD hospitalization. After propensity score matching, outcomes were assessed over up to five years using Cox proportional hazards models. The primary outcome was major adverse kidney events (MAKE), defined as a composite of acute kidney injury (AKI), dialysis, or all-cause mortality.Results: After matching, 316,082 patients were included in each group (mean age 54.5 years; 31.2% female). The AUD group had a higher risk of MAKE (HR 1.25; 95% CI 1.23-1.27; p < .001). Risks of AKI (HR 1.50; 95% CI 1.48-1.53), dialysis (HR 1.21; 95% CI 1.17-1.26), and all-cause mortality (HR 1.03; 95% CI 1.02-1.05) were also increased.Conclusions: AUD was associated with increased risks of adverse kidney outcomes after AKD, suggesting its role as a clinically relevant risk marker during post-AKD recovery.