Medications continue to be prescribed inappropriately in acute kidney injury Shaw, S, Selby, N, Fluck, rj, Kolhe, n department of Renal Medicine, Royal Derby Hospital

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Medications continue to be prescribed inappropriately in acute kidney injury
Shaw, S, Selby, N, Fluck, RJ, Kolhe, N

Department of Renal Medicine, Royal Derby Hospital
Background: The management of acute kidney injury (AKI) is often dependent on risk factors being identified and reviewed. The 2009 NCEPOD report noted that not all AKI patients had nephrotoxic drugs stopped and drug doses were not commonly altered.
Purpose: To review the medicines optimization of patients with AKI in a District General Hospital regarding discontinuation of potentially nephrotoxic medications and drug dosing.
Design: All patients with new AKI occurring in a 7 day period were identified via an e-alert, excluding patients on dialysis. Using the patient’s medical notes and treatment chart, the renal pharmacist recorded data pertaining to the patient’s medication prior to the diagnosis of AKI and for the following 24hours, including whether each medication was reviewed and new medications prescribed were appropriate for altered renal function and AKI status.
Findings: 84 patients with AKI were identified; two were excluded (one suffered a cardiac arrest in primary care and died and the notes of another were lost). 55% of patients had AKI on admission, 45% of cases of AKI occurred as inpatients. The study identified that at AKI diagnosis, existing medications are continued and new ones started inappropriately.


AKI Stage 1

AKI Stage 2

AKI Stage 3

No. of patients receiving medication (no. reviewed)


2 (1)




24 (12)

4 (4)

1 (1)


30 (19)

3 (3)

3 (3)

Following AKI diagnosis, the majority of drugs prescribed were anti-infectives (74 prescriptions), analgesics (20) and low molecular weight heparins (41). Considering potentially nephrotoxic drugs, 1 patient was inappropriately prescribed a NSAID and 6 patients were appropriately prescribed gentamicin. Other drugs that were inappropriately prescribed or not reviewed included drugs that accumulate or had side effects in the presence of reduced renal function and ineffective drugs in AKI.
Conclusion: In this study, medications that require review or dose modification in AKI continued to be prescribed inappropriately.

Relevance: Since AKI is often preventable and occurs in approximately 20% of hospitalized patients, clinicians managing patients with AKI need to be aware of the appropriate action to take in optimizing medications as highlighted by NCEPOD.

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