Abstract: SA-PO1122
Nephrotoxic Prescription Patterns Among Children and Adults in Nephrology Care: Analysis of the Kidney Research Network
Session Information
- CKD: Progression, Drugs, Modalities, and Environmental Factors
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Rahimi, Ashley E., University of Michigan, Ann Arbor, Michigan, United States
- Putnam, Nathaniel, University of Michigan, Ann Arbor, Michigan, United States
- Robinson, Bruce M., University of Michigan, Ann Arbor, Michigan, United States
- Adler, Sharon G., Harbor-UCLA Medical Center, Torrance, California, United States
- Courtlandt, Cheryl D., Levine Children's Hospital, Charlotte, North Carolina, United States
- Massengill, Susan F., Levine Children's Hospital, Charlotte, North Carolina, United States
- Modi, Zubin J., University of Michigan, Ann Arbor, Michigan, United States
Background
Despite the risk of nephrotoxic medications in the progression for patients with chronic kidney disease (CKD), wide use of these therapies persists. In this context, we aimed to describe current trends in nephrotoxic medications before and after CKD diagnosis using the electronic health record (EHR) database from the Kidney Research Network (KRN). The KRN cohort includes comprehensive health system data inclusive of all patients ever experiencing a nephrology ambulatory encounter at participating centers.
Methods
EHR data were extracted for all patients within KRN. Data variables include all vital signs, diagnosis/ICD billing codes, medication orders, laboratory data, CPT codes, and encounter data within the KRN center’s electronic health record system. CKD was identified by established ICD codes or KDIGO eGFR criteria using CKD-EPI and U25 estimating equations for adults and children, respectively . Children were defined as age > 18. Descriptive analyses were generated.
Results
Among the total study population of 142,253 patients, 47.1% (66,988) were female with mean age of 40 at first encounter. The study cohort was 14.6% Black, 8.1% Asian, and 59.9% White. 13.5% were Hispanic. Among both children and adults, the proportion of patients with nephrotoxic medication prescription increased after diagnosis of CKD. In children, nephrotoxic antimicrobial medications increased by 6% and NSAIDs by 10.3% (Table). Among adults, prescriptions increased by 16.6% and 6% for antimicrobial and NSAID medications, respectively.
Conclusion
In a multicenter cohort of patients under nephrology care, the use of potentially nephrotoxic medications remains high. Concerningly, many nephrotoxic medications increase following CKD diagnosis. Further evaluation, including regression analysis, is needed to understand the risk factors for and appropriate use of nephrotoxic medications, as well as eGFR progression trends, and the value of health-center-based data to capture potentially deleterious exposures and uptake of best practices.
| Pediatric (Age <18 years), n = 7,300 | Adult (Age ≥ 18), n = 43,434 | |||
| Nephrotoxic Medication | Use Before CKD Diagnosis | Use After CKD Diagnosis | Use Before CKD Diagnosis | Use Before CKD Diagnosis |
| Antimicrobials | 1,690 (23.3%) | 2,133 (29.2%) | 11,607 (26.7%) | 18,325 (43.3%) |
| Iodinated Contrast | 653 (9.0%) | 963 (13.2%) | 2,583 (5.9%) | 5,142 (12.1%) |
| NSAIDs | 1,943 (26.8%) | 2,710 (37.1%) | 10,788 (24.8%) | 13,048 (30.8%) |
| Other | 557 (7.7%) | 935 (12.8%) | 3,489 (8.0%) | 4,481 (10.6%) |
Funding
- Private Foundation Support