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E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Abstract titles should be brief and reflect the content of the abstract.
Acute kidney injury (AKI) affects 10–15% of hospitalized patients and over 50% in ICUs, with higher incidence in low- and middle-income countries. Cardiac-associated AKI is common—occurring in 5–43% of cardiac surgery patients and ~33% with heart failure—yet long-term data from resource-limited settings are scarce. We compared epidemiology and outcomes of severe cardiac-associated versus non-cardiac AKI in Southeast Asia and India.
This secondary analysis used data from a prospective, multicenter study enrolling adults with KDIGO stage 3 AKI from 24 ICUs in six countries (Apr 2019–Dec 2023). Patients with pre-hospital kidney failure or stage 5 CKD were excluded. The primary outcome was 2-year major adverse kidney events (MAKE: persistent kidney dysfunction, chronic dialysis, transplant, or death). Secondary outcomes included mortality, new CKD, and CKD progression. Multivariable multilevel mixed-effects survival models were used to account for within-country clustering.
Renal Trajectory and Acute Management
Among 1,145 AKI survivors, 281 (24.5%) had cardiac-associated AKI. They were older (median 65 vs. 58 years), with more hypertension, dyslipidemia, CKD, and ischemic heart disease (all P<0.001). Baseline eGFR was higher, but dialysis dependence at discharge was greater (29.3% vs. 17.7%, P<0.001).
Primary Outcome: 2-year Major Adverse Kidney Events
2yr-MAKE occurred in 65.6% of cardiac-AKI vs. 46.5% of non-cardiac AKI (P<0.001).
Secondary Outcomes
Mortality was 45.8% vs. 32.7% (P<0.001); kidney failure requiring treatment (KFRT), 23.4% vs. 12.4% (P<0.001); and new CKD, 61.9% vs. 43.9% (P=0.001), respectively. CKD progression rates were similar in both groups.
Risk factors for 2-year MAKEs
Independent predictors of 2yr-MAKE included admission to mixed/other ICUs (aHR 5.45), pre-existing CKD (aHR 1.75), ischemic heart disease (aHR 1.44), and failure to recover renal function by 28 days/discharge (aHR 5.56; all P<0.05). Initial RRT type and post-discharge use of ACEI/ARBs or beta-blockers were not associated with risk.
Severe cardiac-associated AKI in resource-limited settings confers markedly worse 2-year kidney and survival outcomes than non-cardiac AKI. Lack of early renal recovery is the strongest predictor of poor prognosis, highlighting the need for targeted monitoring and cardiorenal protection strategies in high-risk patients.
