Kidney Week

Abstract: FR-PO0398

Early Physical Rehabilitation Restores the Prognostic Utility of Creatinine in AKI

Session Information

• AKI: Biomarkers, Diagnostics, and Risk Prediction
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Martínez Gallardo González, Alejandro, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Alejandro Martínez Gallardo González

• Chavez, Jonathan, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Jonathan Chavez, MD, PhD

• Zaragoza, Jose Jesus, Hospital Q+, Queretaro, Mexico

Jose Jesus Zaragoza, MD

• Abundis Mora, Gabriela Jazmín, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Gabriela Jazmín Abundis Mora, MD

• Navarro Blackaller, Guillermo, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Guillermo Navarro Blackaller, MD

• Medina, Ramon, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Ramon Medina, MD

• Alcantar Vallin, Maria de la Luz, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Maria de la Luz Alcantar Vallin, MD

• Renoirte, Karina, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Karina Renoirte, PhD

• Mendoza Gaitán, Héctor Eduardo, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Héctor Eduardo Mendoza Gaitán, MD

• Garcia-Garcia, Guillermo, Universidad de Guadalajara, Guadalajara, Jal., Mexico

Guillermo Garcia-Garcia, MD, FASN

Background

In critically ill patients, serum creatinine (SCr) is an imperfect marker of renal function due to its dependence on muscle mass. Rapid declines in SCr are often misinterpreted as renal recovery when they may reflect acute sarcopenia, limiting their prognostic value. We hypothesized that Early Physical Rehabilitation (EPR), by preserving muscle mass, mitigates this paradox and restores the physiological association of SCr-based Acute Kidney Injury (AKI) recovery with improved clinical outcomes.

Methods

We conducted a single-center retrospective cohort study of adult ICU patients with AKI, excluding those with a length of stay <48 hours or end-stage renal disease. The primary predictor was "Percentage Change in SCr" (% Δ SCr), defined as the percentage decrease from peak to discharge or last SCr. The primary outcome was a composite of in-hospital mortality or initiation of RRT during the ICU stay. We used multivariable logistic regression with an interaction term (EPR × % Δ SCr) to determine if EPR modifies the predictive value of SCr-based renal recovery, adjusting for illness severity, comorbidities, mechanical ventilation, and length of ICU stay.

Results

The cohort included 304 patients (age 63 [47.5-77], male 184 [60.5%]); 98 (32.2%) received EPR and 206 (67.8%) received standard of care (non-EPR). Patients in the EPR group had significantly higher acute illness severity (Median SAPS-3: 24.8 vs. 12.0, p<0.001). In the multivariable model, EPR (aOR 0.74; 95% CI 0.16–3.40) and % Δ SCr (aOR 1.01; 95% CI 0.98–1.04) were not independently associated with the composite outcome. The formal statistical interaction did not reach significance (p=0.281). However, analysis of predictive margins revealed divergent clinical trajectories. In the non-EPR group, a greater decrease in SCr was paradoxically associated with a higher probability of the composite outcome, rising from ~13.5% to ~17.4%. Conversely, in the EPR group, SCr decline followed a restorative pattern, associated with a reduction in risk from ~14.7% to ~5.6%.

Conclusion

EPR impacts the relationship between SCr trajectory and the composite of in-hospital mortality or ICU-RRT initiation in patients with AKI. While decreasing SCr levels may represent a false signal of recovery in non-EPR patients due to muscle wasting, EPR appears to restore the prognostic value of SCr.