A third of overdose hospitalizations over a decade also involved acute kidney injury

Of 1,297,847 U.S. hospitalizations involving a drug overdose between 2016 and 2025, 448,136 also involved acute kidney injury, a share of 34.5 percent. That is roughly one in three, according to a Centers for Disease Control and Prevention report published October 22 in its Morbidity and Mortality Weekly Report.

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Among those with kidney injury, 273,093 patients, or 60.9 percent, had a severe hospital course. The damage that follows a survived overdose, in other words, is common and often serious.

What the CDC counted

The findings appear in volume 75, issue 41 of the weekly report, on pages 614 to 621. The analysis was led by Sola Han, Fang Xu, Hui Xie, Gery Guy and Meda E. Pavkov, all of the CDC. They drew on the Premier Healthcare Database, which Premier Inc. compiles from about 1,400 hospitals and roughly a quarter of U.S. inpatient admissions, so the totals describe that large sample weighted to national estimates.

An overdose hospitalization qualified if it carried a poisoning code for opioids, cocaine or psychostimulants that was present on admission. All intents were included. Kidney injury was identified from diagnosis codes in any field, and patients with end-stage kidney disease or chronic dialysis dependence were excluded.

A “severe inpatient course” meant any of four outcomes among patients with kidney injury: acute dialysis, respiratory compromise, shock or low blood pressure, or death in the hospital.

Who was hit hardest

Kidney injury rose with age. It appeared in 28.2 percent of overdose hospitalizations among patients 24 and younger, 33.8 percent at ages 25 to 44, 35.4 percent at 45 to 64 and 37.4 percent at 65 and older. Men were affected more often than women, 38.1 percent against 29.4 percent.

The severity numbers run the other way on age. Among patients with kidney injury, 68.1 percent of those 24 and younger had a severe course, compared with 62.5 percent at ages 25 to 44, 61.0 percent at 45 to 64 and 56.1 percent at 65 and older. Women with kidney injury were slightly more likely than men to have a severe course, 61.9 percent to 60.4 percent.

The authors suggest the age pattern may reflect differences in the drugs used across age groups. They single out younger patients as a particular worry because acute kidney injury is linked to later chronic kidney disease, and a young survivor has more years in which that risk can play out.

A rise, then a fall

The trend is not a straight line. The share of overdose hospitalizations with kidney injury rose by an average of 2.69 percent a year from 2016 to 2022, then fell 5.11 percent a year from 2022 to 2025. The severe-course share climbed through 2023 before dropping.

The decline is steepest among the youngest patients. For those 24 and younger, kidney injury prevalence fell 15.31 percent a year after 2023. Even so, the report’s own table puts the overall prevalence at about 31.6 percent in 2016 and 31.9 percent in 2025, and the severe share among kidney-injury cases rose from 57.1 to 61.1 percent over the decade. The recent drop, in other words, mostly walks back an earlier climb.

Younger patients are where the numbers diverge most from what intuition might suggest. They have the lowest overall rate of kidney injury, yet the highest chance that an injury turns severe, a combination that makes the 15.31 percent annual decline after 2023 worth watching but not yet a settled improvement; the report notes the matching drop in severe course for that group was not statistically significant.

The authors note that wider naloxone availability may have changed which opioid overdoses end in a hospital stay, which could affect how the trend should be read.

Limits and the follow-up gap

The report is careful about what it cannot show. It counts hospitalizations, not unique patients, so one person can appear more than once. Kidney injury was found through diagnosis codes rather than laboratory values, which the authors say likely undercounts it. The data also lack drug combinations, adulterants, doses and ICU use.

The finding that may matter most to patients comes after discharge. Guidelines from KDIGO call for a kidney function check within three months of an episode of acute kidney injury, yet only 13.6 percent of Medicare beneficiaries in 2023 got that follow-up, below the Healthy People 2030 target of 16.4 percent.

The CDC’s recommended response combines overdose prevention measures such as naloxone distribution and treatment access with earlier kidney checks in the hospital and referral to kidney follow-up and substance use treatment on discharge. The National Institute of Diabetes and Digestive and Kidney Diseases publishes patient information on the condition for readers who want the clinical basics.

This article was produced with the assistance of AI and reviewed by Morning Overview editors prior to publication.

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