Abstract: FR-PO0402
Higher Mortality with Less Care in AKI
Session Information
- AKI: Biomarkers, Diagnostics, and Risk Prediction
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Tai, Brent, BayCare Health System, Clearwater, Florida, United States
- Mittal, Ajay, BayCare Health System, Clearwater, Florida, United States
- D'Cunha, Prakas Thomas, BayCare Health System, Clearwater, Florida, United States
Background
AKI is associated with substantial morbidity/mortality. We evaluated whether uninsured status is associated with differences in care delivery and outcomes.
Methods
Retrospective cross-sectional study using 2022 National Inpatient Sample. Adult AKI admissions identified using ICD-10-CM codes. Insurance categorized as Medicaid or uninsured. Outcomes: mortality, dialysis-requiring AKI, APR-DRG extreme severity, LOS, charges, post-acute care use. Survey-weighted multivariable regression with interaction analyses performed.
Results
171,708 AKI admissions included; 137,790 Medicaid-insured and 33,918 uninsured. Uninsured patients had higher mortality (8.03% vs 7.53%; aOR 1.27, 95% CI 1.20–1.35), despite lower dialysis use (aOR 0.75), extreme severity classification (aOR 0.85), LOS (adjusted ratio 0.82), and charges (adjusted ratio 0.85). Among survivors, uninsured patients had lower post-acute care use. Mortality differences increased with illness severity (interaction p<0.001).
Conclusion
Insurance status may represent an important structural determinant of AKI care delivery and outcomes, particularly among patients with greater illness severity.
Acknowledgment
We wanted to acknowledge all the HCUP Data Partners that contribute to HCUP. A link to the HCUP-US web page that contains the list of State organizations is here. (hcup-us.ahrq.gov/db/hcupdatapartners.jsp).
Adjusted inpatient outcomes by insurance status in AKI
| Outcome | Adjusted association (Uninsured vs Medicaid) | 95% CI | P value |
| In-hospital mortality | 1.27 | (1.20–1.35) | <0.001 |
| Extreme illness severity (APR-DRG) | 0.85 | (0.81–0.89) | <0.001 |
| Mechanical ventilation | 1.00 | (0.95–1.06) | 0.916 |
| AKI requiring dialysis (AKI-D) | 0.75 | (0.70–0.81) | <0.001 |
| Length of stay (adjusted ratio) | 0.82 | (0.80–0.85) | <0.001 |
| Total hospital charges (adjusted ratio) | 0.85 | (0.81–0.90) | <0.001 |
Predicted mortality by illness severity and insurance status in AKI.
Adjusted discharge disposition by insurance status among AKI admissions