Kidney Week

Abstract: SA-PO0301

Low-Fall Identifies a Frailty-Enriched High-Risk Phenotype in Older Adults Hospitalized with AKI

Session Information

• AKI: Epidemiology and Risk Factors
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Bhullar, Jasjot K., Loma Linda University, Loma Linda, California, United States

Jasjot K. Bhullar, MD

• Nguyen, Thanh N., Loma Linda University Health, Loma Linda, California, United States

Thanh N. Nguyen, MD, MS

• Steed, Robert James, Spartanburg Regional Healthcare System, Spartanburg, South Carolina, United States

Robert James Steed, MBA, CPHQ

• Vakhshoori, Mehrbod, AdventHealth Centra Care Central Florida, Altamonte Springs, Florida, United States

Mehrbod Vakhshoori, MD

• Kyzer, Elizabeth, Prisma Health, Greenville, South Carolina, United States

Elizabeth Kyzer, DO

• Beagle, Rebecca, Spartanburg Regional Healthcare System, Spartanburg, South Carolina, United States

Rebecca Beagle, RN

• Powers, Christopher R., Spartanburg Regional Healthcare System, Spartanburg, South Carolina, United States

Christopher R. Powers, MD

Background

Frailty is associated with poor outcomes in older adults with acute kidney injury (AKI), yet frailty assessment remains inconsistently implemented in inpatient nephrology care. A low fall from standing/ground level fall (<0.5 m; “Low-Fall”) has been associated with mortality in geriatric trauma populations and may represent a pragmatic marker of physiologic vulnerability. We evaluated whether Low-Fall identifies a frailty-enriched population among elderly patients hospitalized with AKI.

Methods

In this IRB-approved retrospective study at Spartanburg Regional Healthcare System, patients aged ≥75 years hospitalized between October 2016 and May 2023 with ICD-10-coded fall present on admission, AKI, and death within one year were identified. Hospital Frailty Risk Score (HFRS) was calculated using ICD-10 codes. AKI classification incorporated review of pre-admission and inpatient creatinine values. Demographic, dialysis, hospitalization, and mortality data were analyzed descriptively. A secondary analytic cohort compared dialysis-requiring AKI (AKI-D) versus non-dialysis AKI (AKI-ND) among patients meeting Low-Fall criteria.

Results

The descriptive cohort included 370 patients (mean/median age 84 years). Frailty burden was markedly elevated, with mean HFRS 18.4 and median 16.9; 64% met high-risk frailty criteria (HFRS >15), while none were low-risk (<5), supporting Low-Fall as a marker of a frailty-enriched cohort rather than isolated trauma. In-hospital mortality was 31%, with survival declining to 40% at 30 days, 32% at 60 days, and 25% at 90 days after discharge. Median time from discharge to death was 12 days. Only 4% of encounters involved hemodialysis, suggesting poor outcomes were associated with broad physiologic vulnerability rather than dialysis-requiring AKI alone. The secondary analytic cohort (n=65) demonstrated worse short-term outcomes among AKI-D patients, including higher in-hospital mortality (61% vs. 25%, p=0.004) and prolonged hospitalization.

Conclusion

Low-Fall identified an overwhelmingly frailty-enriched, high-mortality population among elderly patients hospitalized with AKI, as corroborated by near-universal elevated HFRS scores. Because Low-Fall/ground-level fall is identifiable through ICD-10 coding at hospital admission, it may serve as a pragmatic, low-cost EHR-visible signal for frailty-informed AKI care in older adults.

Funding

• Clinical Revenue Support