Abstract: TH-PO0697
Assessing Hypotension and Medication Exposures in Patients at Risk of Severe AKI
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
- Koyner, Jay L., The University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States
- Fatima, Aiman, The University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States
- Anjorin, Ola, The University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States
- Carey, Kyle, The University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States
- Weber, Michael J., University of Wisconsin-Madison, Madison, Wisconsin, United States
- Oguss, Madeline K., University of Wisconsin-Madison, Madison, Wisconsin, United States
- Singh, Tripti, University of Wisconsin-Madison, Madison, Wisconsin, United States
- Churpek, Matthew M., University of Wisconsin-Madison, Madison, Wisconsin, United States
Group or Team Name
- ESTOP Investigators
Background
The implementation of AKI care guidelines improves patient outcomes. Documented compliance with KDIGO AKI guidelines has been variable in the clinical trials, and little is known about the real-world guideline compliance in patients at high risk for severe AKI.
Methods
We enrolled hospitalized patients across 2 academic centers who were at high risk for severe AKI (≥KDIGO Stage 2) as determined by a multimodal deep learning model (ESTOP2.0 >0.044). Patients were enrolled within 8 hours of elevated risk, and their charts were reviewed to determine compliance with AKI Guideline-based care (monitoring for exposure to low mean arterial pressures and nephrotoxins over 7 days). We examined the incidence of KDIGO AKI, need for RRT, and inpatient mortality. We excluded patients with ≥Stage 2 AKI at the time of the high-risk score, as well as those with ESKD and kidney transplants.
Results
We enrolled 396 patients at risk for Stage 2 AKI; their median(IQR) age was 65(53-73) years. Their median baseline creatinine (mg/dL) was 0.93(0.71-1.13). Patients were enrolled on median hospital day 1(1-3), and 47% were in the ICU. 128(32%) patients developed Stage 2 or 3 AKI and 24(6%) received RRT and 88(22%) died in the hospital. On the day of enrollment, patients spent a median(IQR) of 1.9(0.7-4.6) hours with a mean arterial pressure (MAP) <65 mmHg. The table describes the cumulative exposure rate to nephrotoxins and other medications over the first 7 days of enrollment in those with and without severe AKI. Patients who developed severe AKI were more likely to receive IV diuretics, vancomycin, and PPIs, and less likely to receive ARBs and SGLT2i
Conclusion
Decreased ARBs and SGLT2i exposure and increased hypotension (MAP<65mmHg) and nephrotoxin exposures are common in patients at high risk for severe AKI. Several opportunities exist to improve the implementation of guideline-based care before the development of severe AKI
Drug Exposure Rates in Those With and Without Severe AKI
| Drug Exposure Over the 7 Days Post-Enrollment | No Severe AKI (n=265) | Severe AKI (n=128) | p-value |
| Intravenous (IV) Diuretics | 131 (49%) | 83 (64%) | 0.005 |
| Aminoglycoside Antibiotics | 19 (7%) | 14 (11%) | 0.24 |
| Vancomycin | 74 (28%) | 56 (44%) | 0.002 |
| Non-steroidal Anti-Inflammatory Drugs (NSAIDs) | 41 (15%) | 15 (12%) | 0.44 |
| Proton Pump Inhibitors (PPIs) | 127 (48%) | 77 (60%) | 0.024 |
| Angiotensin II Receptor Blockers (ARB) | 45 (17%) | 10 (8%) | 0.02 |
| Angiotensin-Converting Enzyme Inhibitors (ACE-i) | 21 (8%) | 7 (6%) | 0.41 |
| Sodium-Glucose Co-transporter 2 inhibitors (SGLT2i) | 37 (14%) | 9 (7%) | 0.064 |
Funding
- NIDDK Support