Abstract: TH-PO0696
AKI Prevention and Outcomes Using International Society of Nephrology (ISN) AKI Toolkit Risk Screening and the AKI/STOP Bundle in Adults at Moderate-to-High Risk
Session Information
- AKI: Prevention, Diagnostics, and Management
October 22, 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
- Claure-Del Granado, Rolando, Universidad Mayor de San Simon Facultad de Medicina, Cochabamba, Bolivia, Plurinational State of
- Torrico-Moreira, Diego, Universidad Mayor de San Simon Facultad de Medicina, Cochabamba, Bolivia, Plurinational State of
- Rodriguez Ferrufino, Sergio, Division of Nephrology, Hospital Obrero No 2 - Caja Nacional de Salud, Cochabamba, Bolivia, Plurinational State of
- Macedo, Etienne, University of California San Diego School of Medicine, La Jolla, California, United States
- Mehta, Ravindra L., University of California San Diego School of Medicine, La Jolla, California, United States
Background
The ISN AKI Toolkit promotes risk-based screening and care bundles to prevent acute kidney injury (AKI). We evaluated AKI prevention and outcomes in hospitalized adults identified as moderate-to-high risk using the ISN AKI Toolkit and managed with the AKI/STOP bundle.
Methods
We analyzed 103 consecutive adults with ISN AKI Toolkit risk score ≥3 receiving AKI/STOP. AKI was classified using the KDIGO 2026 functional/structural framework. C0B1 at enrollment was defined as no serum creatinine-defined AKI (C0) with a positive structural marker, using Perazella urine microscopy score ≥2. Exposures analyzed were sepsis, medication-related nephrotoxins, major/cardiac surgery, vasopressors, mechanical ventilation, and contrast. The primary outcome was remaining free of AKI among patients without C0B1 at enrollment. Secondary outcomes included incident AKI, progression, persistent AKI/AKD at day 7/discharge, kidney replacement therapy (KRT), mortality, renal recovery, and etiology among affected patients.
Results
Median age was 68 (IQR 59–74) years; 55 (53.4%) were female. Exposures were sepsis (89.3%), mechanical ventilation (68.0%), vasopressors (43.7%), major/cardiac surgery (22.3%), nephrotoxins (14.6%), and contrast (3.9%). At enrollment, 39 patients (37.9%) were C0B1. Among the remaining 64 patients, 54 (84.4%) remained free of AKI/AKD and 10 (15.6%) developed incident AKI. Overall, 49/103 (47.6%) had C0B1 or incident AKI/AKD. Progression occurred in 30/49 (61.2%) and persistent AKI/AKD in 27/49 (55.1%). KRT was required in 5/49 affected patients (10.2%). Mortality was higher in affected than unaffected patients (21/49 [42.9%] vs 5/54 [9.3%]; P<0.001). Etiologies were ischemic injury (38.8%), hypoperfusion (32.7%), nephrotoxicity (14.3%), and cardiorenal syndrome (2.0%). Recovery to ≤1.5× baseline at 3 months occurred in 16/19 (84.2%).
Conclusion
In moderate-to-high-risk adults screened with the ISN AKI Toolkit and managed with AKI/STOP, most patients without C0B1 at enrollment remained free of AKI/AKD. C0B1 or incident AKI/AKD was associated with progression, KRT use, and higher mortality, supporting protocolized prevention, early escalation, and post-AKI follow-up.
Acknowledgment
The authors acknowledge the International Society of Nephrology (ISN) for its support in developing the ISN AKI Toolkit and AKI/STOP care bundle used in this work.