AKI a Risk to the Health, Survival of Soldiers

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WASHINGTON— Acute kidney injury (AKI) is a serious risk to the health and survival  in military personnel who are injured during combat in Iraq and Afghanistan, according to a study published online Dec. 8 in Clinical Journal of the American Society Nephrology (CJASN).

Captain Ian Stewart, MD, USAF (San Antonio Military Medical Center, Fort Sam Houston) and his colleagues examined military casualties who were evacuated from Iraq and Afghanistan to burn units. When they used two different classification systems for AKI, the researchers found that AKI prevalence rates were 23.8 percent (according to one system) and 29.9 percent (according to the other) among 692 evacuated casualties.

 Patients with AKI were much more likely to die than patients without AKI. The death rates among patients with moderate and severe AKI were 21.4 percent to 33.3 percent and 62.5 percent to 65.1 percent, respectively, compared with 0.2 percent among patients without AKI.

The majority of patients (57.6 percent) were diagnosed with AKI when they were admitted to the hospital, implying that factors related to combat may be responsible. Conversely, for patients who developed AKI after the first week (17.6 percent), complications from their hospitalization were likely the cause. Patients in the intermediate time range (24.8 percent) probably had some combination of factors.

“Our research shows that if a wounded warrior develops kidney damage, he or she is at an increased risk of dying,” said Stewart. “By preventing or modifying kidney injury, we may be able to improve survival in military personnel with burns and/or other traumatic injury,” he added. Additional studies are needed to test whether intervening to reduce AKI will save lives.

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