Long-Term Kidney Outcomes Following Snake Envenomation: The Role of Snakebite-Related Acute Kidney Injury in a Nationwide Korean Cohort

Long-term renal outcomes following snake envenomation may vary across regions, yet remain poorly characterized in South Korea. We investigated the long-term risk of chronic kidney disease (CKD) following snake envenomation and snakebite-related acute kidney injury (AKI). This nationwide population-based cohort study used data from the Korean National Health Information Database (2012–2023). We matched 729 adults hospitalized for snake envenomation who received antivenom to 2916 individuals without snake envenomation (1:4). Using a 1-year landmark design, we assessed incident CKD with Cox proportional hazards models and Kaplan–Meier analysis. CKD occurred in 48 patients with snake envenomation and in 156 controls, with incidence rates of 7.16 and 5.59 per 1000 person-years, respectively. Snake envenomation was not significantly associated with incident CKD (adjusted hazard ratio [aHR], 1.15; 95% confidence interval [CI], 0.85–1.55). Among patients with snake envenomation, 73 patients (10.0%) had coded AKI during the index hospitalization. Snakebite-related AKI was associated with incident CKD (aHR, 4.25; 95% CI, 2.15–8.40), whereas the association with severe envenomation did not reach statistical significance. CKD developed in 17 of the 73 patients with AKI (23.3%). Thus, no statistically significant association was detected between snake envenomation and incident CKD overall, whereas coded AKI was associated with subsequent CKD among envenomated patients. New CKD events continued to occur throughout follow-up.