Neuroanaesthesia & neurocritical care
Early osmotherapy exposure and subsequent incident acute kidney injury in neurocritical care patients: a MIMIC-IV retrospective cohort study
Authors' conclusion
Among adult neurocritical care patients who were alive, remained in the ICU, and were AKI-free at the 48-h landmark, early osmotherapy exposure was associated with a higher risk of subsequent incident AKI. This association was not materially attenuated by early serum sodium or chloride burden in exploratory adjustment models.
Study context
- Population
- Adult first-ICU neurocritical care patients alive, in ICU and acute kidney injury (AKI)-free at 48 h after ICU admission624 (22.6%) developed AKI
- Participants
- 2,756 participants
- Exposure
- Any osmotherapy within first 48 ICU hours vs no osmotherapy
- Any osmotherapyn = 365
- Outcome
- Incident AKI after the 48-h landmark
- Follow-up
- Through ICU day 7 or ICU discharge
Methodological details48-h landmark design, MIMIC-IV version 3.1, doubly robust overlap-weighted models, Dose-proxy and hypertonic saline concentration-specific analyses exploratory: dose capture incomplete, 23.4% hypertonic saline exposure sparse
- 48-h landmark design
- MIMIC-IV version 3.1
- Doubly robust overlap-weighted models
- Dose-proxy and hypertonic saline concentration-specific analyses exploratory: dose capture incomplete, 23.4% hypertonic saline exposure sparse
Main finding
As reported in the abstract
Any osmotherapy vs No osmotherapyEstimate (95% CI)P value
Doubly robust overlap-weighted logistic model
OR 1.48(1.12–1.96)
P = 0.006Doubly robust overlap-weighted modified Poisson
RR 1.30(1.08–1.57)
P = 0.006Observational data: associations, not effects.
Further findings
Adjustment for early sodium/chloride burden (lab-complete subset, n = 2,455; exploratory)
| OR (95% CI) | P value | ||
|---|---|---|---|
| Early sodium burdenExploratory adjustment models | 0.99 (0.92–1.07) | P = 0.792 | |
| Early chloride burdenExploratory adjustment models | 1.01 (0.94–1.09) | P = 0.743 | |
| 0.512Odds ratio (log scale) |
- Did not materially attenuate the observed association
Clinical relevance of subsequent AKI (exploratory)
- Patients with subsequent AKI had higher hospital mortality and lower creatinine-based renal recovery at ICU and hospital discharge
- Exploratory
Original publication
Early osmotherapy exposure and subsequent incident acute kidney injury in neurocritical care patients: a MIMIC-IV retrospective cohort study. J Intensive Care. Published 20 July 2026. doi:10.
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