One in three US drug-overdose hospitalisations involved acute kidney injury
A CDC analysis of nearly 1.3 million overdose hospitalisations from 2016 to 2025 found acute kidney injury in 34.5% of them, and a severe inpatient course in three-fifths of those cases.
| Group | Value (%) |
|---|---|
| Aged ≤24 | 28.2 |
| Aged 25–44 | 33.8 |
| Aged 45–64 | 35.4 |
| Aged ≥65 | 37.4 |
A drug overdose is usually counted, in the surveillance data, as one of two outcomes: the patient dies, or the patient survives. A report published on 22 October in the CDC's Morbidity and Mortality Weekly Report argues that the second category hides a large amount of organ damage. Across nearly 1.3 million overdose-involved hospitalisations in the United States over a decade, roughly one in three came with acute kidney injury [s1].
What the data show
The analysis drew on the Premier Healthcare Database, a large hospital-based, all-payer source that the report says covers about 25% of annual US inpatient admissions across roughly 1,400 hospitals and health systems [s1]. From it, the authors identified 1,297,847 hospitalisations involving overdoses of opioids, cocaine, or psychostimulants between 2016 and 2025 [s1].
Acute kidney injury, or AKI, was recorded in 448,136 of those admissions — 34.5% after adjustment (95% confidence interval 34.0–35.1) [s1]. Among the hospitalisations where AKI occurred, 273,093, or 60.9%, also involved a severe inpatient course [s1]. In other words, when the kidneys were hit, the admission was far more likely to be a serious one.
The analysis was restricted to overdoses involving opioids, cocaine, or psychostimulants, the three drug classes that dominate the US overdose burden; the report does not break the AKI totals down by which substance was involved [s1].
The risk rose steadily with age. The adjusted AKI rate ran from 28.2% among patients aged 24 or younger to 33.8% at 25–44, 35.4% at 45–64, and 37.4% among those aged 65 and over [s1]. It was also higher in men than women — 38.1% against 29.4% [s1]. The paradox of age is worth noting: older patients were more likely to develop AKI but, among those who did, somewhat less likely to have a severe inpatient course, which fell from 68.1% in the youngest group to 56.1% in the oldest [s1]. By sex, the severe-course share among AKI cases was close either way — 61.9% in women and 60.4% in men — so it was men's higher rate of AKI in the first place, not a worse course once it occurred, that separated them [s1].
The trend is not flat
AKI did not hold steady over the decade. The adjusted rate increased from 2016 to 2022, at an average annual percent change of 2.69% (95% CI 1.79–3.65), then decreased from 2022 to 2025, at −5.11% (95% CI −7.13 to −2.90) [s1]. The severe-course measure followed a similar arc, rising through 2023 before turning down [s1]. The report does not attribute the recent decline to any single cause, and the raw, unadjusted figures barely moved — AKI was 31.6% of hospitalisations in 2016 and 31.9% in 2025 — a reminder that the shape of a trend depends heavily on what is adjusted for [s1]. The gap between the two readings is the whole point: once the changing age, sex and clinical mix of overdose patients is accounted for, a rise and then a fall appears that the headline proportion conceals.
Why it matters, and the limits
The report's framing is deliberately forward-looking. Drug overdose–involved AKI, it argues, should be considered both an acute inpatient complication and a marker of long-term risk for chronic kidney disease [s1]. A patient who survives an overdose and leaves hospital with injured kidneys is not simply back to baseline. And because the exposure is identifiable and potentially avoidable, the authors note, some of this AKI might be preventable [s1].
The main limitation is in how AKI was counted. It was identified from ICD-10-CM diagnosis codes rather than from laboratory criteria such as serum creatinine, so the true frequency may be underestimated — milder injury that was never coded would not appear [s1]. The figures are also drawn from hospitalised patients, which excludes overdoses that never reached inpatient care, and from a sample of hospitals rather than a national census. None of that undercuts the central observation: in a large, multi-year hospital dataset, kidney injury was a routine feature of the overdoses serious enough to put someone in a bed, not a rare complication.
What the report adds to the overdose picture is a reason to look past the survive-or-die binary. The patients counted here lived. A third of them left with a documented kidney insult whose consequences, if the authors are right, outlast the admission that recorded it.
Sources
- Acute Kidney Injury Among Patients with Drug Overdose–Involved Hospitalizations — United States, 2016–2025 — Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention , October 22, 2026
More on
A review flags acute kidney injury as an under-counted toll of Yemen's cholera crisis
Severe dehydration from diarrhoeal disease and sepsis can shut down the kidneys. In a health system with little dialysis, a review argues this is a preventable driver of death that surveillance is missing.
Substance use burden sits well below the global average across 22 Arab countries
A Global Burden of Disease analysis puts substance use disorder prevalence at 0.78% across the Arab League in 2023, about 63% below the global figure — yet women's opioid prevalence topped men's in 19 of 22 countries.
What the 2023 Türkiye earthquakes taught about crush injury and after
One study maps the five barriers that delayed life-saving crush-syndrome care; another finds the long-term health burden of the disaster fell hardest on young women.
NSAIDs raise kidney-injury risk modestly — but sharply in a few specific situations
Across studies, current NSAID use was tied to about a 73% higher odds of acute kidney injury, more in older people and those with existing kidney disease. The combination with two blood-pressure drugs is the real hazard.