(B-181) Impact of Serum Creatinine Trajectories Associated with Drug-Related Acute Kidney Injury and Major Adverse Kidney Events in Critically Ill Patients

Background: Critically ill patients with acute kidney injury (AKI) have varying recovery patterns and outcomes, with underlying AKI etiology likely contributing to this heterogeneity. While nephrotoxic drugs contribute significantly to the occurrence of AKI, how drug-related AKI differs in terms of recovery patterns and clinical outcomes remains unclear.

Objectives: To evaluate the associations between drug-related AKI, serum creatinine (SCr) recovery trajectories, and major adverse kidney events within 7 days (MAKE7) in critically ill patients.

Methods: A retrospective cohort study was conducted using MIMIC-IV (2008–2019) to identify AKI patients via KDIGO criteria. AKI patients were classified into drug-induced (D-AKI), drug-associated (DA-AKI), and non-drug-related (no-D AKI) groups based on nephrotoxic drug exposure. Latent class mixed modeling (LCMM) determined SCr recovery trajectories from 24 to 96 hours post-AKI. The primary outcome, MAKE7 (death, dialysis, or worsening SCr within 7 days), was analyzed using a survey-weighted logistic regression model (svyglm) with inverse probability treatment weighting (IPTW) for confounder adjustment.

Results: Among 2,907 ICU patients with AKI, 2,141 had no-D AKI, 628 had DA-AKI, and 138 had D-AKI. Using LCMM, we identified five SCr recovery trajectories: sustained early reversal (n = 1,871, 64.4%), severe early reversal (n = 91, 3.1%), sustained no reversal (n = 550, 18.9%), progressive no reversal (n = 263, 9.0%), and severe no reversal (n = 132, 4.5%). A total of 940 patients (32.3%) experienced MAKE7, including 627 in no-D AKI (29.3%), 261 with DA-AKI (41.6%), and 52 with D-AKI (37.7%). Compared to the sustained early reversal group, patients in the severe early reversal group had the highest MAKE7 risk (OR = 6.82, 95% CI: 5.44–8.55). Patients in severe no reversal (OR = 4.23, 95% CI: 3.37–5.32), progressive no reversal (OR = 2.19, 95% CI: 1.82–2.63), and sustained no reversal (OR = 1.39, 95% CI: 1.21–1.59) groups also had significantly higher risks. Regarding AKI etiology, DA-AKI was associated with a significantly higher MAKE7 risk than No-D AKI (OR = 1.89, 95% CI: 1.57–2.28). D-AKI also had a significantly elevated risk of MAKE7 compared to No-D AKI (OR = 1.49, 95% CI: 1.10–2.04) but showed a non-significant lower MAKE7 risk relative to DA-AKI.

Conclusions: AKI etiology and recovery trajectory significantly impacted the risk of MAKE7. In this short-term recovery assessment, drug-related AKI was associated with worse outcomes, especially with severe early reversal and severe no reversal groups. These findings support enhanced nephrotoxic stewardship to improve early trajectory-based recovery. Future research should focus on longer-term MAKE outcome assessments.