Acute kidney injury (AKI) is a common and severe complication in hospitalized patients. Nephrotoxic drugs significantly contribute to AKI. Diagnosis and prevention of drug-induced AKI (d-AKI) could be improved, but little is known about its occurrence despite preventive efforts. Therefore, the objective of this study was to investigate hospital physicians’ reasoning about d-AKI and gain insight into the challenges they encounter, including identifying unmet information needs surrounding d-AKI. We conducted semi-structured interviews with hospital physicians from diverse specialties and experience levels at one Dutch academic hospital. Two interviews were independently open coded by 3 researchers and the resulting codes/themes organized by consensus. Using the resulting code tree, we conducted thematic analysis of the interviews. Thirteen interviews were conducted (6 women, 7 men), with physicians’ professional experience ranging from 3 to 36 years. The group comprised 9 specialists and 4 residents. For many of these physicians, managing AKI takes priority over diagnosing d-AKI. AKI cases with multifactorial etiology and limited d-AKI awareness were mentioned as reasons for delay in or lack of d-AKI diagnosis. Physicians emphasized monitoring and risk assessment with regards to d-AKI prevention. While kidney function is generally well-monitored during hospitalization, there are circumstances where the urgency of treatment may result in less weight on nephrotoxic potential. Physicians expressed the need for an up-to-date home medication overview, monitoring guidance around nephrotoxic drugs, and better prediction of d-AKI. This study highlights key aspects of current hospital practices surrounding d-AKI. Diagnosing d-AKI often has a low priority, which may explain why it is often underdiagnosed and not registered. Prevention is limited by gaps in monitoring and the need for nephrotoxic drugs in urgent situations. We emphasize the need for improved d-AKI diagnosis and clinical awareness, and providing personalized d-AKI prevention strategies. Not applicable.
Lieverse et al. (Wed,) studied this question.