Abstract: FR-PO0411
Clinical Phenotyping of Nonsteroidal Anti-Inflammatory Drug-Associated Kidney Injury Using Large Electronic Health Data
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
- Awdishu, Linda, University of California San Diego, La Jolla, California, United States
- Zhuang, Yonghua L., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Brasher, Maizy S., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Yousif, Zaid, University of California San Diego, La Jolla, California, United States
- Cole, Joanne B., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Joy, Melanie S., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
Background
Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with AKI in approximately 1–5% of hospitalized patients. Using a published DI-AKI clinical risk model, we modified and applied a phenotyping tool and adjudication dashboard within the University of Colorado Health Data Compass to characterize NSAID-associated AKI.
Methods
Electronic health record study of adults (1/1/2013–7/1/2023) receiving ibuprofen or ketorolac in-hospital. DIRECT definitions were modified to include Stage 1 AKI: reference SCr within 90 days pre-drug start; qualifying SCr (≥1.5x reference) within 14 days post-start. Cases required SCr at admission, drug start, AKI day, and discharge in valid temporal sequence. Variables included demographics, SCr, KDIGO staging, AKI risk factors, drug dosing/concentrations, dialysis, and recovery.
Results
Interim results from 1018 cases: median age 58 years (IQR 41–69), 56.2% female, median BMI 28.4. SCr rose 1.68x reference; median reference SCr 0.73 mg/dL and AKI-day SCr 1.3 mg/dL (IQR 1.00–1.70). KDIGO staging: 78.4% Stage 1, 15.1% Stage 2, 6.5% Stage 3. Comorbidities: hypertension 54.3%, diabetes 27%, malignancy 21.1%, liver disease 15.1%, CKD 11.5%, prior AKI 50%. Admission AKI risk factors: hypoalbuminemia 75.8%, anemia 68.4%; in-hospital: contrast 39.1%, hypotension 13.4%, sepsis 5.4%, surgery 3.8%. Median drug-to-AKI onset 1 days (IQR 1–3); 95.5% within 7 days. Median daily ibuprofen dose 600 mg; ketorolac 15 mg. Discharge outcomes: complete recovery 40.3%, partial 24.6%, no recovery 35.1%.
Conclusion
NSAIDs were temporally associated with predominantly Stage 1 AKI early during therapy, with most cases occurring within 24 hours of drug start. The burden of baseline comorbidities and prior AKI history underscore the importance of patient selection when prescribing inpatient NSAIDs. A DI-AKI phenotyping model was successfully used to identify temporally consistent cases of NSAID kidney injury.