ArticleInternational urology and nephrology2026
Obstructive acute kidney injury: predictors of mortality and need for renal replacement therapy.
Article in International urology and nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeObstructive acute kidney injury (AKI) is a significant clinical entity with varying outcomes. This study aims to describe the clinical, diagnostic, and therapeutic characteristics of obstructive AKI in a large cohort of adult patients and to identify predictors of in-hospital mortality and the need for renal replacement therapy (RRT).
methodsWe conducted a retrospective, observational single-center study at the Fondazione Policlinico Universitario A. Gemelli IRCCS (Rome, Italy). Adult patients presenting to the Emergency Department between 2018 and 2022 with KDIGO-defined AKI and a documented diagnosis of urinary tract obstruction established during the index Emergency Department evaluation were included. Multivariable logistic regression analysis was performed to identify independent predictors of in-hospital mortality and RRT requirement.
resultsThe study included 1,351 patients (median age 71 years). In-hospital mortality was 12% (n=167), and RRT was required in 6% (n=80). Independent predictors of mortality included older age, higher triage priority (OR 4.96, 95% CI 2.99-8.20), higher serum creatinine, and lower hemoglobin. A significant interaction was found between pre-existing chronic kidney disease (CKD) and RRT (OR 11.11, 95% CI 1.23-100.02), identifying a subgroup with the highest mortality risk. Predictors for RRT included admission serum creatinine (OR 1.37, 95% CI 1.16-1.62) and pre-existing CKD (OR 5.26, 95% CI 1.22-22.73).
conclusionObstructive AKI is associated with substantial mortality, particularly in elderly patients and those with pre-existing CKD who required RRT during hospitalization. The interaction between CKD and RRT highlights a vulnerable population where serum creatinine alone may underestimate clinical risk. Early risk stratification using functional and laboratory markers is essential to guide management.
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