Kidney Week

Abstract: TH-OR013

Association of Social Determinants of Health with Risk of ESKD Among Survivors of Critical Illness and AKI

Session Information

• AKI Across the Care Continuum: From Detection to Recovery
  October 22, 2026 | Location: Room 203, Convention Center
  Abstract Time: 05:00 PM - 05:10 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Acharya, Dilaram, The University of Alabama at Birmingham, Birmingham, Alabama, United States

Dilaram Acharya, PhD

• Babroudi, Seda, Division of Nephrology, Tufts Medical Center, Boston, MA, USA, Boston, Massachusetts, United States

Seda Babroudi, MD, MS, FASN

• Ekrikpo, Udeme E., The University of Alabama at Birmingham, Birmingham, Alabama, United States

Udeme E. Ekrikpo, MBBS, MSc, PhD

• Takeuchi, Tomonori, University of New Maxico, NM, New Mexico, United States

Tomonori Takeuchi, MD

• Ghazi, Lama, The University of Alabama at Birmingham, Birmingham, Alabama, United States

Lama Ghazi, MD, PhD

• Gutierrez, Orlando M., The University of Alabama at Birmingham, Birmingham, Alabama, United States

Orlando M. Gutierrez, MD

• Neyra, Javier A., The University of Alabama at Birmingham, Birmingham, Alabama, United States

Javier A. Neyra, MD, MS, FASN

Background

This study evaluated the association of individual- and neighborhood-level social determinants of health (SDOH) with risk of developing end-stage kidney disease (ESKD) in intensive care unit (ICU) survivors of acute kidney injury (AKI) following hospital discharge.

Methods

This retrospective cohort study included 30,498 adults with ICU-acquired AKI who survived to hospital discharge at a major academic medical center in the southern US (2012–2022). Patients were followed for up to 2 years using the hospital electronic health record and the U.S. Renal Data System. Individual-level SDOH included race, ethnicity, and insurance status. Neighborhood-level SDOH were derived from census-based indices: Area Deprivation Index (ADI), Low-Income Low-Access (LILA), Rural–Urban Commuting Area (RUCA), residential segregation (dissimilarity and isolation indices), and Social Vulnerability Index (SVI).
ESKD was defined by kidney failure with an estimated glomerular filtration rate (GFR) or the initiation of kidney replacement therapy (dialysis or transplantation). Association of SDOH with incident ESKD were evaluated using multivariable cause-specific Cox proportional hazards models.

Results

The median age was 58 years, 40% were women, 63% were White, 31% were Black, and 88% were insured. The median follow-up time was 730 days after hospital discharge; 2,723 (9%) patients died and 326 (1%) developed ESKD. In adjusted models, Black race was associated with higher ESKD risk compared with White race (adjusted hazard ratio [aHR] 1.43, 95% CI 1.05–1.94), whereas having health insurance coverage was associated with a lower risk of ESKD (aHR 0.60, 95% CI 0.39–0.92). Neighborhood-level socioeconomic disadvantage was also independently associated with increased risk of ESKD, with higher hazards observed among residents of moderately and highly deprived neighborhoods (Area Deprivation Index [ADI] tertile 2: aHR 1.42, 95% CI 1.01–2.00; tertile 3: a HR 1.58, 95% CI 1.08–2.33).

Conclusion

Black race, lack of health insurance, and residence in socioeconomically deprived neighborhoods were independently associated with a higher hazard of progression to ESKD. Standardized SDOH assessment in clinical practice may improve risk stratification and identify AKI survivors most likely to benefit from personalized post-discharge care.

Funding

• NIDDK Support