Abstract: SA-PO0303
Patterns of Nephrotoxic Medication Exposure and AKI Among Hospitalized Veterans
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
- Wang, Yaohua, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Shi, Qianyi, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Sarrazin, Mary Vaughan, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Yamada, Masaaki, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Swee, Melissa L., University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Lund, Brian C., Iowa City VA Medical Center, Iowa City, Iowa, United States
- Jalal, Diana I., University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Griffin, Benjamin R., University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
Background
Potentially nephrotoxic medications are commonly prescribed during hospitalization and may contribute to acute kidney injury (AKI), especially when multiple classes are used concurrently. However, large-scale descriptive data on inpatient nephrotoxic medication exposure patterns and corresponding short-term AKI rates are limited.
Methods
We conducted a descriptive analysis of patients admitted to VA hospitals from 2016 to 2025 with an admission lasting >48 hours. For each class evaluated, we calculated the proportion of patients who received this class and the proportion who developed AKI within 7 days of hospital admission. We also summarized the number of nephrotoxic drug classes prescribed per patient within the first 7 days of hospitalization.
Results
We included 3,889,252 eligible VA patient hospitalizations. Medication class exposure ranged from approximately 4% for antivirals to 41% for proton pump inhibitors (PPIs) (Figure 1A). About 18% of patients did not receive any medications within the evaluated classes, and concurrent medication exposure was common, with 54% of patients receiving ≥2 of these classes, 29% receiving ≥3, and 13% ≥4 classes. Unadjusted rates of AKI at one week ranged from 19.6% for PPIs to 30.5% for Piperacillin-Tazobactam. AKI rates were similar among patients receiving 0, 1, or 2 classes (~20%), increased among those receiving 3 classes (21.7%), and were highest among those receiving ≥4 classes (26.7%).
Conclusion
In this national VA inpatient cohort, potentially nephrotoxic medication exposure was common, concurrent exposure was frequent, and unadjusted 7-day AKI rates varied by medication class and number of classes received. These descriptive findings provide important baseline epidemiologic data on nephrotoxic medication exposure in hospitalized Veterans and support future interventions to reduce nephrotoxic AKI risk.
Funding
- Veterans Affairs Support