Occurrence, Associated Factors, and In-Hospital Outcomes of Acute Kidney Injury in Patients Hospitalized with Hyperosmolar Hyperglycemic State: A Retrospective Analysis of the Nationwide Inpatient Sample (2013–2022)

BACKGROUND: Hyperosmolar hyperglycemic state (HHS) is a serious hyperglycemic emergency frequently complicated by acute kidney injury (AKI). However, large-scale national data on AKI occurrence, associated factors, and in-hospital outcomes in HHS patients remain lacking. METHODS: We performed a retrospective cohort study of 80,557 U.S. hospitalizations for hyperosmolar hyperglycemic state (HHS) between 2013 and 2022, using data from the Nationwide Inpatient Sample. Acute kidney injury (AKI) was identified using ICD diagnosis codes, and associations with demographic, institutional, comorbid, and complication-related factors were assessed through multivariable logistic regression. RESULTS: Within this cohort, 45,202 individuals (56.1%) had documented AKI, with its occurrence increasing from 45.9% in 2013 to 63.6% in 2022. Independent predictors encompassed advanced age, Black or Asian/Pacific Islander race, affiliation with large or teaching hospitals, and geographic location in the South or West. Several comorbidities were significantly associated with increased AKI risk, including deficiency anemia, coagulopathy, diabetes with chronic complications, heart failure, hypertension, fluid and electrolyte disorders, other neurological disorders, paralysis, chronic kidney disease excluding end-stage renal disease and acute pancreatitis. AKI was significantly associated with worse clinical outcomes, manifested as longer median hospital stay (4 vs. 3 days), higher total charges ($35,026 vs. $24,279), greater in-hospital mortality (4.6% vs. 1.3%), and increased utilization of dialysis (1.3% vs. 0.1%) and mechanical ventilation (4.2% vs. 2.0%) (P<0.001). CONCLUSION: AKI was common among HHS patients and associated with increased mortality and healthcare costs, underscoring the importance of early recognition and targeted intervention.