{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:22:07Z","timestamp":1787026927773,"version":"build-2736575974"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Recurrent acute kidney injury (rAKI) is a common complication among critically ill patients and is associated with progressive renal deterioration and increased long-term morbidity. Iron deficiency anemia (IDA) may compromise renal adaptive responses through impaired oxygen delivery and cellular energetics; however, whether pre-existing IDA is associated with rAKI risk remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a propensity score-matched retrospective cohort study using the TriNetX database (2010\u20132024). Adults with AKI during intensive care unit admission were stratified by pre-existing IDA status diagnosed within 6 months before the index AKI episode. A 90-day landmark approach was employed to minimize immortal-time bias. The primary outcome was rAKI occurring between 3 months and 3 years. Secondary outcomes included progression to end-stage renal disease (ESRD), all-cause mortality, major adverse cardiovascular events (MACEs), and estimated glomerular filtration rate (eGFR) decline below 30 ml\/min\/1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After matching, 13,002 individuals were included in each cohort. Pre-existing IDA was associated with a significantly higher risk of rAKI (hazard ratio [HR], 1.53; 95% confidence interval [CI], 1.44\u20131.63;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001) and eGFR decline below 30 ml\/min\/1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      (HR, 1.19; 95% CI, 1.11\u20131.29;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). These associations between IDA and rAKI risk persisted during the extended follow-up (3\u20135 years) and remained consistent across the sensitivity analyses and demographic subgroups. Although MACEs showed a statistically significant association (HR, 1.16;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001), the effect size was limited. The associations of IDA with long-term risks of ESRD or mortality were not observed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pre-existing IDA is associated with an increased risk of rAKI and accelerated renal function decline among critically ill AKI survivors. However, owing to the observational design, a causal relationship cannot be established. Prospective investigations are warranted to validate these observations and to clarify the underlying biological mechanisms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1779193","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T04:16:52Z","timestamp":1777954612000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Pre-existing iron deficiency anemia and long-term risk of recurrent acute kidney injury in survivors of ICU-associated AKI: a propensity-matched study"],"prefix":"10.3389","volume":"13","author":[{"given":"Kuo-Chuan","family":"Hung","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Chi Mei Medical Center","place":["Tainan, Taiwan"]},{"name":"School of Medicine, College of Medicine, National Sun Yat-sen University","place":["Kaohsiung, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsiu-Lan","family":"Weng","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, E-Da Hospital, I-Shou University","place":["Kaohsiung, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Ning","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Chi Mei Medical Center","place":["Tainan, Taiwan"]},{"name":"School of Medicine, College of Medicine, National Sun Yat-sen University","place":["Kaohsiung, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Kai","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Chi Mei Medical Center","place":["Tainan, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Chen","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Chi Mei Medical Center","place":["Tainan, Taiwan"]},{"name":"School of Medicine, College of Medicine, National Sun Yat-sen University","place":["Kaohsiung, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jheng-Yan","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Chi Mei Medical Center","place":["Tainan, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I-Wen","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Chi Mei Medical Center","place":["Liouying, Tainan, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1038\/s41581-018-0052-0","article-title":"Global epidemiology and outcomes of acute kidney injury","volume":"14","author":"Hoste","year":"2018","journal-title":"Nat Rev 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