AKI: medicines safety review โ ๏ธ ๐
Educational on-call framework โ not a treatment protocol. Review fluid/perfusion status and the cause of kidney injury before altering drugs; medication changes are individualised, with documented restart plans.
Immediate assessment
- Check haemodynamics, volume status, urine output, creatinine trend, potassium, obstruction and sepsis; escalate if oliguria, severe hyperkalaemia or pulmonary oedema.
- Cross-check severe hyperkalaemia and loop diuretic use where relevant.
Prescribing review
- Review ACEi/ARB (ramipril), SGLT2 inhibitor (empagliflozin), NSAIDs (ibuprofen) and metformin (metformin) according to hydration, perfusion and illness.
- Recalculate dosing/levels for renally cleared medicines including gentamicin, vancomycin, gabapentin and anticoagulants.
- Do not blindly stop every chronic drug; consider HFrEF congestion, seizure prevention and replacement hormones and document why any medicine is paused.
Before discharge
- Record who will repeat renal/electrolyte tests, and when; communicate temporary holds and explicit restart criteria to the patient/GP/pharmacist.
UK resources: NHS SPS ACEi/ARB monitoring ยท NICE NG28 sick day guidance
Editorial draft 4 November 2026; not formally clinically signed off. Use local policy and senior advice.