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We evaluated the proportion of patients receiving nephrotoxic medications within 1 year overall and by baseline kidney function, ranked main contributors and examined the association between receipt of nephrotoxic medication and age, sex, CKD G-stages comorbidities and provider awareness of the patient's CKD using multivariable logistic regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During a 1-year period, 20% (SCREAM) and 17% (Geisinger) of patients with CKD received at least one nephrotoxic medication. Among the top nephrotoxic medications identified in both cohorts were non-steroidal anti-inflammatory drugs (given to 11% and 9% of patients in SCREAM and Geisinger, respectively), antivirals (2.5% and 2.0%) and immunosuppressants (2.7% and 1.5%). Bisphosphonate use was common in SCREAM (3.3%) and fenofibrates in Geisinger (3.6%). Patients &amp;lt;65\u2009years of age, women and those with CKD G3 were at higher risk of receiving nephrotoxic medications in both cohorts. Notably, provider awareness of a patient's CKD was associated with lower odds of nephrotoxic medication use {odds ratios [OR] 0.85[95% confidence interval (CI) 0.80\u20130.90] in SCREAM and OR 0.80 [95% CI 0.72\u20130.89] in Geisinger}.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>One in five patients with CKD received nephrotoxic medications in two distinct health systems. Strategies to increase physician's awareness of patients\u2019 CKD and knowledge of drug nephrotoxicity may reduce prescribing nephrotoxic medications and prevent iatrogenic kidney injury.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ckj\/sfab210","type":"journal-article","created":{"date-parts":[[2021,10,16]],"date-time":"2021-10-16T16:16:11Z","timestamp":1634400971000},"page":"442-451","source":"Crossref","is-referenced-by-count":49,"title":["Use of nephrotoxic medications in adults with chronic kidney disease in Swedish and US routine care"],"prefix":"10.1093","volume":"15","author":[{"given":"Alessandro","family":"Bosi","sequence":"first","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5946-2272","authenticated-orcid":false,"given":"Yunwen","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Gasparini","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f6rn","family":"Wettermark","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Disciplinary Domain of Medicine and Pharmacy, Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Barany","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rino","family":"Bellocco","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lesley A","family":"Inker","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Tufts Medical Center, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex R","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Geisinger Health System, Danville, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3013-925X","authenticated-orcid":false,"given":"Mara","family":"McAdams-DeMarco","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA"},{"name":"Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgan E","family":"Grams","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA"},{"name":"Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung-Im","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4763-2024","authenticated-orcid":false,"given":"Juan J","family":"Carrero","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,10,29]]},"reference":[{"key":"2022022210490966600_bib1","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1001\/jama.1997.03540280039031","article-title":"Adverse drug events in hospitalized patients. 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