OBJECTIVES: Acute kidney injury (AKI) is common in hospitalized patients and leads to increased risk of morbidity and mortality. A common cause is due to administration of nephrotoxic medications, also known as drug-associated AKI (D-AKI). Little is known on how outcomes differ between D-AKI and non D-AKI patients. Our objective was to compare post-discharge major adverse kidney events (MAKE) between D-AKI and non D-AKI patients at 30 (MAKE30) and 90 (MAKE90) days for non-critically ill patients.

METHODS: We used a large integrated database that included electronic health record and administrative claims data from the years 2011 to 2020. Serum creatinine (SCr) values were used to identify baseline SCr and to determine whether patients developed AKI. Drugs that were determined by experts to have nephrotoxic potential by a modified Delphi method were used to identify D-AKI patients. We used propensity score matching to control for confounding on demographic and clinical variables. MAKE30 was a composite outcome that consisted of death, receipt of renal replacement therapy (RRT), or persistent renal dysfunction and MAKE90 was a composite outcome of death, new-onset or worsened chronic kidney disease, or receipt of RRT. MAKE30 and MAKE90 were assessed by using Cox proportional hazards models.

RESULTS: There were 24,718 patients and 12,359 patients in the D-AKI and non D-AKI groups, respectively. In the adjusted analysis, D-AKI patients had a 33% increased risk of experiencing MAKE30 compared to non D-AKI patients (95% CI: 1.25, 1.42), and D-AKI patients also had a 25% higher chance of experiencing MAKE90 compared to non D-AKI patients (95% CI: 1.18, 1.32).

CONCLUSIONS: While conventional thought is that D-AKI patients would be at lower risk of MAKE since the nephrotoxic drug could be discontinued or dose-adjusted, it could be that these actions are not carried out quickly enough. Further research is needed to confirm these results.