Abstract: FR-PO0409
Clinical Phenotyping of Tacrolimus-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
Tacrolimus is a recognized nephrotoxin and a frequent cause of AKI in treated patients, contributing to downstream CKD and increased morbidity. 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 tacrolimus-associated AKI.
Methods
Electronic health record study of adults (1/1/2013–7/1/2023). 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. Patients with a previous bone marrow or kidney transplant were excluded.
Results
Interim results from 153 cases: median age 58 years (IQR 44–66), 45.1% female, median BMI 26.1. SCr rose 1.72x reference; median reference SCr 0.90 mg/dL (IQR 0.72–1.21) and AKI-day SCr 1.95 mg/dL (1.42–2.60). KDIGO staging: 62.1% Stage 1, 22.9% Stage 2, 15.0% Stage 3. Comorbidities: hypertension 50.3%, diabetes 29.4%, liver disease 64.1%, CKD 30.1%. Admission AKI risk factors: hypoalbuminemia 81.8%, anemia 87.1%; in-hospital: contrast 23.5%, hypotension 13.7%, surgery 3.3%. Median drug-to-AKI onset 2 days (IQR 1–2.5); 88.9% within 7 days. Median daily tacrolimus dose 2 mg; Median pre-AKI trough 6.3 mg/L (IQR 4.8–9.5). Supratherapeutic pre-AKI troughs (>15 ng/mL): 4.9% Stage 1, 3.5% Stage 2, 11.1% Stage 3. Among patients with >2 pre-AKI troughs, 49.2% showed a rising trend. Discharge outcomes: complete recovery 52.9%, partial 31.4%, no recovery 15.7%.
Conclusion
Tacrolimus was temporally associated with less severe AKI early during therapy with majority complete recovery by hospital discharge. Supratherapeutic concentrations occurred more frequently in Stage 3 AKI. A DI-AKI phenotyping model was successfully used to identify temporally consistent cases of tacrolimus kidney injury.