Prabhahar A, Vijaykumar NA, Kaur H, Sharma N, Pannu AK. Baseline predictors of in-hospital mortality among patients with chronic kidney disease admitted to the emergency department. World J Nephrol 2025; 14(4): 109382 [DOI: 10.5527/wjn.v14.i4.109382]
Corresponding Author of This Article
Ashok K Pannu, MD, Additional Professor, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, 4th Floor, F Block, Chandigarh 160012, India. gawaribacchi@gmail.com
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Emergency Medicine
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Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 25, 2025 (publication date) through Dec 23, 2025
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World Journal of Nephrology
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2220-6124
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Prabhahar A, Vijaykumar NA, Kaur H, Sharma N, Pannu AK. Baseline predictors of in-hospital mortality among patients with chronic kidney disease admitted to the emergency department. World J Nephrol 2025; 14(4): 109382 [DOI: 10.5527/wjn.v14.i4.109382]
World J Nephrol. Dec 25, 2025; 14(4): 109382 Published online Dec 25, 2025. doi: 10.5527/wjn.v14.i4.109382
Baseline predictors of in-hospital mortality among patients with chronic kidney disease admitted to the emergency department
Arun Prabhahar, Niranjan A Vijaykumar, Harpreet Kaur, Navneet Sharma, Ashok K Pannu
Arun Prabhahar, Niranjan A Vijaykumar, Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Harpreet Kaur, Navneet Sharma, Ashok K Pannu, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Author contributions: Prabhahar A, Vijaykumar NA, Kaur H, Sharma N, and Pannu AK collected data; Pannu AK designed the research study and analyzed the data; Prabhahar A, Vijaykumar NA, Kaur H, Sharma N, and Pannu AK wrote the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the Postgraduate Institute of Medical Education and Research, approval No. INT/IEC/2021/SPL-1062.
Informed consent statement: Informed consent was waived as the study involved the anonymized retrospective patient data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ashok K Pannu, MD, Additional Professor, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, 4th Floor, F Block, Chandigarh 160012, India. gawaribacchi@gmail.com
Received: May 9, 2025 Revised: June 17, 2025 Accepted: September 17, 2025 Published online: December 25, 2025 Processing time: 228 Days and 19.5 Hours
Abstract
BACKGROUND
Chronic kidney disease (CKD) contributes significantly to emergency department (ED) presentations in low- and middle-income countries. These patients frequently have multiple comorbidities and face high in-hospital mortality. However, limited data exist on early predictors of mortality at ED admission. Identifying key clinical and laboratory features associated with adverse outcomes may support timely risk stratification and targeted interventions for acutely ill CKD patients.
AIM
To identify baseline predictors of in-hospital mortality in adult Indian patients with CKD admitted to the ED.
METHODS
This retrospective study was conducted from January 2021 to December 2022 at the Acute Care and Emergency Medicine Unit of the Postgraduate Institute of Medical Education and Research, Chandigarh, India. CKD was diagnosed and staged following the Kidney Disease: Improving Global Outcomes guidelines. Data were extracted from medical records using a structured form. All consecutive patients aged ≥ 18 years were included. Independent mortality predictors were identified using multivariate Cox regression analysis.
RESULTS
Among 354 patients (mean age 49 years; 58% males), 60.5% had CKD stage 5, and 41.2% were on maintenance dialysis. Hypertension (74.9%) and diabetes (46.0%) were common comorbidities. Diabetic kidney disease was the primary etiology in 35.6%, while 43.2% had unknown causes. Infection (63.0%) was the most frequent cause for ED admission. In-hospital mortality was 29.1% (n = 103). Independent mortality predictors were Glasgow coma scale (GCS) < 15 [hazard ratio (HR): 1.822, P = 0.017], hyperglycemia (HR: 1.641, P = 0.020), and low albumin (HR: 1.270, P = 0.028). Advanced age, Charlson comorbidity Index, quick Sequential Organ Failure Assessment, and neutrophilia were significant in univariate but not multivariate analysis. CKD stage, dialysis dependency, cardiovascular disease, and neutrophil-lymphocyte ratio were not predictive.
CONCLUSION
A low GCS, hyperglycemia, and low albumin levels at admission independently predict in-hospital mortality in CKD patients presenting to the ED, warranting early recognition and targeted interventions.
Core Tip: Despite the high burden of chronic kidney disease (CKD) in Indian emergency departments, baseline prognostic markers remain underexplored. This study found a high in-hospital mortality rate among adult patients with CKD. Independent predictors of mortality included a low Glasgow coma scale, hyperglycemia, and low serum albumin at admission. These findings highlight the importance of early risk stratification and targeted interventions to improve short-term survival in acutely ill patients with CKD.
