Burned military casualties with AKI may have adverse outcomes

Acute kidney injury (AKI), an abrupt or rapid decline in kidney function, is a serious and increasingly prevalent condition. Little information has been available about how common or how severe AKI is in military personnel who are injured during combat in Iraq and Afghanistan. A new study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN) investigates this question in those burned during combat.

Captain Ian Stewart, MD, USAF (San Antonio Military Medical Center, Fort Sam Houston) and his colleagues examined military casualties who were evacuated from Iraq and Afghanistan to burn units. When they used two different classification systems for AKI, the researchers found that AKI prevalence rates were 23.8% (according to one system) and 29.9% (according to the other) among 692 evacuated casualties. Patients with AKI were much more likely to die than patients without AKI: the death rates among patients with moderate and severe AKI were 21.4% to 33.3% and 62.5%to 65.1%, respectively, compared with 0.2% among patients without AKI.

The majority of patients (57.6%) were diagnosed with AKI when they were admitted to the hospital, implying that factors related to combat may be responsible. Conversely, for patients who developed AKI after the first week (17.6%), complications from their hospitalization were likely the cause. Patients in the intermediate time range (24.8%) probably had some combination of factors.

"Our research shows that if a wounded warrior develops kidney damage, he or she is at an increased risk of dying," said Dr. Stewart. "By preventing or modifying kidney injury, we may be able to improve survival in military personnel with burns and/or other traumatic injury," he added. Additional studies are needed to test whether intervening to reduce AKI will save lives.