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Acute kidney injury mortality rates lower than ever among military members

A retrospective case series of military members who sustained severe acute kidney injury during the Iraq and Afghanistan wars showed individuals had a better in-hospital survival than predicted historically and by acute kidney injury integer score.

Jonathan A. Bolanos, MD, of Walter Reed National Military Medical Center, and colleagues analyzed medical records for 51 military members who were evacuated and treated for post-traumatic acute kidney injury requiring dialysis. Study participants were followed for a median of approximately 3 years.

Researchers found that the majority of injuries were due to blasts or projectiles.

Twenty-two percent of participants died within 60 days, which is significantly less than expected, according to researchers: Previously reported mortality rates for military casualties with severe acute kidney injury and the reported average in recent civilian studies are approximately 50%.

Of the 40 survivors, one developed end-stage kidney failure, one was diagnosed with stage 2 chronic kidney disease and 36 regained normal kidney function but developed proteinuria.

“It is reasonable to assume that the cases reported were similarly injured to those in the Vietnam and Korean wars, and yet the outcomes are very significantly better. Although the reason for the better outcomes cannot be established for sure, it is likely that earlier evacuation from the field, very aggressive resuscitation, and multiple surgical interventions made the difference in permitting survival of those with dialysis-requiring [acute kidney injury],” Jorge Cerdá, MD, FACP, FASN, of Albany Medical College’s Division of Nephrology, and a member of the acute kidney injury advisory group of the American Society of Nephrology, said in a press release.

Although most survivors normalized their kidney function, the presence of proteinuria is concerning for permanent and possibly progressive injury, which warrants life-long follow up, according to Cerdá. – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.