Kidney Week

Abstract: TH-PO1290

Early Medication-Specific Recommendations for AKI from the KAT-AKI Trial

Session Information

• Late-Breaking Research Posters
  October 22, 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

• Aklilu, Abinet Mathias, Yale School of Medicine, New Haven, Connecticut, United States

Abinet Mathias Aklilu, MD, MPH

• Vasanthraman, Jayashimman, Yale School of Medicine, New Haven, Connecticut, United States

Jayashimman Vasanthraman

• Shvets, Kristina, Yale New Haven Health, New Haven, Connecticut, United States

Kristina Shvets, PharmD

• Jones, Charles, Yale New Haven Health, New Haven, Connecticut, United States

Charles Jones, PharmD

• Menez, Steven, Johns Hopkins University, Baltimore, Maryland, United States

Steven Menez, MD

• Yamamoto, Yu, Yale School of Medicine, New Haven, Connecticut, United States

Yu Yamamoto, MS

• O'Connor, Kyle D., Yale School of Medicine, New Haven, Connecticut, United States

Kyle D. O'Connor

• Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States

Chirag R. Parikh, MD, PhD, FASN

• Wilson, Francis Perry, Yale School of Medicine, New Haven, Connecticut, United States

Francis Perry Wilson, MD, MS

Group or Team Name

• Clinical and Translational Research Accelerator (CTRA)

Background

Medications used in the care of hospitalized patients may independently worsen kidney function or have extra-renal side effects in AKI. Timely recommendations to adjust patients' medications may improve AKI best practice implementation and clinical outcomes.

Methods

A randomized investigator-blinded trial was conducted at 2 US hospital systems(10/2021-2/2024) to evaluate the effect of recommendations made by a Kidney Action Team for management of AKI on AKI care and clinical outcomes. The team of nephrologist and pharmacists received real-time EHR alerts when adult inpatients met KDIGO AKI criteria and, within 1hr, reviewed charts and made detailed medication-specific recommendations (recs) for all eligible patients prior to randomization. Recs were entered into the charts of those randomized to intervention along with other AKI management recs. We compared implementation of medication recs within 24h and a clinical composite (AKI progression/dialysis/death in 14days).

Results

Of 4003 study patients, 52% had medication-specific recs. Compared to patients without a medication rec, those with medication recs were more often on antibiotics, NSAIDs, other analgesics, statins, RAASi, had more stage2/3 AKI, p<0.05. The median(IQR) age was 74(63-83) yrs and 42% had CKD. Recs to discontinue/switch were made for 52%, change dose/monitor for 71%, both for 23%.(Fig 1) Recs implementation within 24h occured for a significantly higher proportion in the intervention vs usual care arm.(Fig 2) The process outcome (total implemented in 24h / total recommended) was significantly higher in the intervention arm: 41% vs 26%, p<0.001.(Fig 2) While there was no difference in the composite outcome, subgroup analyses suggest heterogeneity of treatment effect.

Conclusion

Early medication-specific recommendations for AKI were common & improved implementation of renal adjustment of medications. Fulldata-10/1/26

Acknowledgment

Data presented on results from 5 of 6 hospitals (n=3200 with complete detailed medication outcomes data, 1882/3200 with medications recommendations). Full results for the full cohort will be available on 10/1/2026.

Figure 1. Recommendations Made

Figure 2. Care process and Clinical Outcomes

Funding

• Other U.S. Government Support