Persistent Racial Inequities in Acute Kidney Injury Among U.S. Hospitalizations: A Nationwide Cohort Analysis

Background Acute kidney injury (AKI) is a major contributor to morbidity, mortality, and healthcare utilization among hospitalized adults. Long-standing racial and ethnic inequities in U.S. healthcare--including unequal access to care, neighborhood disadvantage, and other structural factors--are known to influence kidney health, yet national data describing how these inequities manifest in AKI remain limited. Methods We conducted a retrospective, cross-sectional analysis of the 2022 National Inpatient Sample. AKI was identified using ICD-10-CM codes N17.x, and race/ethnicity followed HCUP categories. Descriptive analyses compared characteristics across groups. Survey-weighted logistic regression estimated adjusted odds of developing AKI, in-hospital mortality among AKI patients, and dialysis use, adjusting for demographics, payer, and comorbidities. Age-specific predicted AKI probabilities were derived from the adjusted model. Results AKI prevalence ranged from 15% to 23% across racial and ethnic groups. After adjustment, Black (OR 1.34), Native American (OR 1.08), and Other patients (OR 1.07) had higher odds of AKI, whereas Asian/Pacific Islander (OR 0.94) and Hispanic (OR 0.98) had slightly lower or similar odds. Among AKI hospitalizations, mortality was modestly lower for Black and Hispanic patients relative to White patients and higher for Asian/Pacific Islander and Native American patients. All non-White groups had higher odds of dialysis use. Age-specific curves showed persistent risk differences across adulthood. Conclusions Substantial racial disparities in AKI incidence, mortality, and dialysis use persisted after adjustment, reflecting broader structural inequities. Addressing these gaps will require both targeted clinical strategies and policy interventions focused on upstream determinants.