Acute kidney injury complications and kidney replacement therapy as mediators of mortality in critically ill patients
Authors' conclusion
Serum bicarbonate levels and fluid balance mediate approximately 40% of the mortality risk attributable to AKI. KRT is beneficial for AKI-associated mortality.
Study context
- Population
- Critically ill patients admitted 2008–2019 with ICU LOS >48 h (MIMIC-IV)70.2% severe acute kidney injury (AKI)
- Participants
- 28,549 patients
- Exposure
- Severe AKI vs no severe AKI
- Outcome
- 28-day mortality, with AKI-related complications (serum bicarbonate, BUN, potassium, fluid balance) as potential mediators
- Follow-up
- 28 days
Methodological detailsMIMIC-IV database, marginal structural Cox models, survival mediational g-formula
- MIMIC-IV database
- Marginal structural Cox models
- Survival mediational g-formula
Main finding
As reported in the abstract
28-day mortality
Proportion of increased mortality in severe AKI mediated by serum bicarbonate
33.2%
Proportion of increased mortality in severe AKI mediated by fluid balance
7.4%
Observational data: associations, not effects.
Further findings
- Reduction in mortality attributable to AKI associated with kidney replacement therapy (KRT)
- 17.6%
- P < 0.001
Original publication
Acute kidney injury complications and kidney replacement therapy as mediators of mortality in critically ill patients. Anaesth Crit Care Pain Med. Published 15 April 2026. doi:10.
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