(467) Evaluating renal outcomes in critically ill patients with drug-associated acute kidney injury

Objective : Acute kidney injury (AKI) frequently occurs among hospitalized individuals, elevating morbidity and mortality. Nephrotoxic medication use is common and can lead to drug-associated AKI (D-AKI). Disparities in outcomes between D-AKI and non D-AKI patients remain poorly understood. Thus, our aim was to assess major adverse kidney events (MAKE) within 30 (MAKE30) and 90 (MAKE90) days following discharge for critically ill patients.

Methods: We used a large integrated database that included electronic health record and administrative claims data from 2011 to 2020. Serum creatinine (SCr) values were used to identify baseline and subsequent levels to define AKI based on the KDIGO criteria. Drugs characterized by experts to have nephrotoxic potential by a modified Delphi method were used to define D-AKI patients. Propensity scores based on demographic and clinical variables were used to match patients. A primary composite outcome, MAKE30, consisted of death, receipt of renal replacement therapy (RRT), or persistent renal dysfunction and the other, MAKE90, consisted of death, new-onset or worsened chronic kidney disease, or receipt of RRT. These were assessed using Cox proportional hazards models.

Results: There were 574 patients in the D-AKI and non D-AKI groups, respectively. In the adjusted analysis, D-AKI patients had a 26% increased risk of experiencing MAKE30 compared to non D-AKI patients (95% CI: 1.01, 1.58), and D-AKI patients also had a 24% significantly higher chance of experiencing MAKE90 compared to non D-AKI patients (95% CI: 1.00, 1.54).

Conclusions: While one might assume D-AKI patients would face a reduced risk of experiencing MAKE since the nephrotoxic drug could be discontinued or dose-adjusted, it is unclear whether this occurs in practice. Additional studies are needed to confirm our results.