P-869. Acute Kidney Injury Related to Trimethoprim-Sulfamethoxazole Treatment of Pneumocystis jirovecii Pneumonia: A Retrospective Cohort Analysis

Abstract Background High-dose oral trimethoprim-sulfamethoxazole (TMP/SMX) for 21 days is the standard dose to treat Pneumocystis jirovecii pneumonia (PJP). There has been scant data assessing morbidity due to adverse renal events from TMP/SMX after hospital discharge, despite known adverse effects of TMP on renal function. We evaluated renal function outcomes and health care utilization in a cohort of non-bone marrow transplant, non-HIV (NTNH) patients with PJP. Electrolyte (Na, K, CO3) values for patients on discharge from initial hospitalizations, readmission, and day 3 of readmission Methods We conducted a retrospective chart review of NTNH patients diagnosed with PJP at the University of Colorado Hospital (UCH) system over 2016-25 who were admitted for PJP and discharged on high-dose oral TMP/SMX ( >10 mg/kg/day of TMP). We assessed readmission rates due to acute kidney injury (AKI), hyperkalemia, or hyponatremia and compared lab values from discharge, readmission, and 3 days after re-admission by paired t-tests. We used the TriNetX database for national validation with linear mixed models applied to creatinine, sodium, and potassium trajectories by readmission status. Renal function markers (sCr, eGFR, BUN) for patients on discharge from initial hospitalizations, readmission, and day 3 of readmissionPotassium Trajectory for Patients Who Were Re-admitted and not Re-admitted p