Introduction
AKI, nephrotoxic, Acute kidney injury, abrupt decline in kidney function
ACUTE KIDNEY INJURY
Acute kidney injury (AKI)—an abrupt decline in kidney function—is a major cause of morbidity and mortality among hospitalized patients, associated with an increased hospital length of stay and a 10-fold increase in inpatient mortalityDespite current international best practice guidelines for management of AKI focusing on avoidance of nephrotoxic exposures, studies have shown that AKI, often asymptomatic in presentation, frequently goes unnoticed, and appropriate workup and treatment is inconsistently performedMedications that affect kidney function are common contributors to AKI in hospitalized patients. However, international guidelines vary with respect to discontinuation of non-steroidal anti-inflammatory drugs (NSAIDs), renin-angiotensin-aldosterone system inhibitors (RAASi), and proton pump inhibitors (PPIs). Observational studies have shown that NSAIDs, potentially by increasing kidney vasoconstriction, increase the risk of AKI both in and out of the hospitalClinical decision support and best practice alerts have proliferated with the adoption of the electronic health record (EHR), often without rigorous evidence-based support. Trials of alerts for patients with AKI, including our own, have led to mixed results, though the most successful efforts couple alerts to specific, actionable information