High-altitude ICU study finds 21% AKI incidence in neurocritical patients

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Frontiers in Medicine Published April 24, 2026 Medically reviewed April 24, 2026 Study authors: Quzhen Danzeng, Yingyu Pan, Zihan Lin, Jinwei Wang, Nan Li, Guoying Lin, Dong Wu DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Note that AKI is common in high-altitude neurocritical patients and linked to age and hemoglobin, but causation is not established.

This was a retrospective cohort study of 390 adult neurocritical patients admitted to the ICU of People’s Hospital of Xizang Autonomous Region (3,650 m altitude) from January 2022 to February 2024. The primary outcome was the incidence of acute kidney injury (AKI) within 7 days of ICU admission.

Within the 7-day follow-up period, 83 out of 390 patients (21.3%) developed AKI. Independent predictors of AKI included older age (OR = 1.058 [1.032–1.087], p < 0.001) and higher hemoglobin levels (OR = 1.015 [1.005–1.025], p = 0.003). Altitude-related erythrocytosis was also noted as a contributing factor.

Safety and tolerability data were not reported. Key limitations include the retrospective design, single-center setting, and confinement to a high-altitude region, which may limit generalizability. The study design does not allow for causal inference.

Practice relevance suggests that AKI is common in neurocritical patients at high altitude and is independently associated with adverse outcomes. Altitude-related erythrocytosis may contribute to AKI risk, indicating a potential need for tailored renal protection strategies, though specific interventions require further evidence.

Study Details

Study typeCohort

EvidenceLevel 3

PublishedApr 2026

View Original Abstract ↓

Acute kidney injury (AKI) is a frequent complication in intensive care unit (ICU) patients with acute brain injury. High-altitude hypoxia may aggravate renal vulnerability, but relevant evidence is limited. This study aims to investigate the incidence, risk factors, and outcomes of AKI among neurocritical patients at high altitude. Adult neurocritical patients admitted to the ICU of People’s Hospital of Xizang Autonomous Region (3,650 m) from January 2022 to February 2024 were retrospectively analyzed. AKI was defined using the 2012 KDIGO serum creatinine criteria. Multivariable logistic regression identified independent predictors, and hemoglobin levels were modeled with linear spline regression. Propensity score matching (PSM) was performed to evaluate the impact of specific interventions. Among 390 patients, 83 (21.3%) developed AKI within 7 days of ICU admission. Independent predictors included older age (OR = 1.058 [1.032–1.087], p  At high altitude, AKI is common in neurocritical patients and independently associated with adverse outcomes. Beyond traditional risk factors, altitude-related erythrocytosis significantly contribute to AKI risk, suggesting that tailored renal protection strategies are necessary in high-altitude neurocritical care.