{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:50:33Z","timestamp":1787028633197,"version":"build-2736575974"},"reference-count":36,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,5,8]],"date-time":"2023-05-08T00:00:00Z","timestamp":1683504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The aim of this study is to assess the use of high-risk medications in patients with community-acquired acute kidney injury (CA-AKI) and the differences in the characteristics and outcomes of CA-AKI based on the use of these medications. This is a retrospective audit of adults (\u226535 years) with CA-AKI admitted to a large tertiary care hospital over a two-year period. We investigated the prevalence of SADMANS (sulfonylureas; angiotensin converting enzyme inhibitors; diuretics; metformin; angiotensin receptor blockers; nonsteroidal anti-inflammatory drugs; and sodium glucose co-transporter 2 inhibitors) medications use in people with CA-AKI prior to hospitalisation. Outcomes including CA-AKI severity, kidney function recovery and in-hospital mortality were examined and stratified by use of SADMANS medications. The study included 329 patients, with a mean (SD) age of 75 (12) years and a 52% proportion of females, who were hospitalised with CA-AKI. Most patients (77.5%) were taking at least one regular SADMANS medication upon admission. Overall, 40% of patients (n = 132) and 41% of those on SADMANS (n = 104) had hypovolaemia or associated symptoms such as vomiting and diarrhoea during admission. Over two-thirds (68.1%) had mild AKI on admission and patients who were taking SADMANS medications were more likely to have mild AKI. Patients on SADMANS had more comorbidities and a higher medication burden, but there were no differences in AKI severity on admission or outcomes such as length of hospitalisation, ICU admission, need for dialysis, recovery rates and mortality between the two groups. However, the high prevalence of SADMANS medications use among patients with CA-AKI indicates a potential for preventability of CA-AKI-led hospitalisations. Future studies are needed to gain better insights into the role of withholding this group of medications, especially during an acute illness.<\/jats:p>","DOI":"10.3390\/jcm12093347","type":"journal-article","created":{"date-parts":[[2023,5,9]],"date-time":"2023-05-09T01:34:26Z","timestamp":1683596066000},"page":"3347","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Hospitalisation Due to Community-Acquired Acute Kidney Injury and the Role of Medications: A Retrospective Audit"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2936-8058","authenticated-orcid":false,"given":"Henna","family":"Duong","sequence":"first","affiliation":[{"name":"School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7208-2330","authenticated-orcid":false,"given":"Wubshet","family":"Tesfaye","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Connie","family":"Van","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7648-007X","authenticated-orcid":false,"given":"Kamal","family":"Sud","sequence":"additional","affiliation":[{"name":"Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia"},{"name":"Nepean Kidney Research Centre, Department of Renal Medicine, Nepean Hospital, Kingswood, NSW 2747, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5128-7115","authenticated-orcid":false,"given":"Ronald L.","family":"Castelino","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia"},{"name":"Pharmacy Department, Blacktown Hospital, WSLHD, Blacktown, NSW 2148, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"C179","DOI":"10.1159\/000339789","article-title":"Kdigo Clinical Practice Guidelines for Acute Kidney Injury","volume":"120","author":"Khwaja","year":"2012","journal-title":"Nephron Clin. Pract."},{"key":"ref_2","first-page":"85","article-title":"Acute Kidney Injury: Definition, Pathophysiology and Clinical Phenotypes","volume":"37","author":"Makris","year":"2016","journal-title":"Clin. Biochem. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1482","DOI":"10.2215\/CJN.00710113","article-title":"World Incidence of Aki: A Meta-Analysis","volume":"8","author":"Susantitaphong","year":"2013","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_4","unstructured":"National Confidential Enquiry into Patient Outcome and Death (2022, September 22). Adding Insult to Injury: A Review of the Care of Patients Who Died in Hospital with a Primary Diagnosis of Acute Kidney Injury (Acute Renal Failure). A Report by the National Confidential Enquiry into Patient Outcome and Death. Available online: https:\/\/www.ncepod.org.uk\/2009report1\/downloads\/aki_report.pdf."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1111\/nep.12036","article-title":"Characteristics and Outcomes in Community-Acquired Versus Hospital-Acquired Acute Kidney Injury","volume":"18","author":"Schissler","year":"2013","journal-title":"Nephrology (Carlton)"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"35","DOI":"10.2147\/CIA.S286660","article-title":"The Incidence, Characteristics, and Use of Suspected Nephrotoxic Drugs in Elderly Patients with Community-Acquired Acute Kidney Injury","volume":"6","author":"Hu","year":"2021","journal-title":"Clin. Interv. Aging"},{"key":"ref_7","unstructured":"Think Kidneys Board (2022, September 25). \u201cSick Day\u201d Guidance in Patients at Risk of Acute Kidney Injury: A Position Statement from the Think Kidneys Board. Available online: https:\/\/www.thinkkidneys.nhs.uk\/aki\/wp-content\/uploads\/sites\/2\/2018\/01\/think-kidneys-sick-day-guidance-2018.pdf."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"E3674","DOI":"10.1097\/MD.0000000000003674","article-title":"Incidence, Outcomes, and Risk Factors of Community-Acquired and Hospital-Acquired Acute Kidney Injury: A Retrospective Cohort Study","volume":"95","author":"Hsu","year":"2016","journal-title":"Medicine"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Canadian Diabetes Association (2018). Sick-Day Medication List. Can. J. Diabetes, 42, S316.","DOI":"10.1016\/j.jcjd.2017.10.045"},{"key":"ref_10","unstructured":"Kidney Health Australia (2022, September 02). How to Prevent Acute Kidney Injury if You Are Sick or Dehydrated. Available online: https:\/\/kidney.org.au\/uploads\/resources\/acute-kidney-injury-sick-day-plan-for-healthcare-professionals-sheet.pdf."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"617","DOI":"10.2215\/CJN.14021118","article-title":"Stopping Ras Inhibitors to Minimize Aki: More Harm Than Good?","volume":"14","author":"Tomson","year":"2019","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Duong, H., Tesfaye, W., Van, C., Sud, K., Truong, M., Krass, I., and Casteino, R.L. (2022). Sick Day Management in People with Chronic Kidney Disease: A Scoping Review. J. Nephrol., online ahead of print.","DOI":"10.1007\/s40620-022-01497-5"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"100491","DOI":"10.1016\/j.xkme.2022.100491","article-title":"Sick Day Medication Guidance for People with Diabetes, Kidney Disease, or Cardiovascular Disease: A Systematic Scoping Review","volume":"4","author":"Watson","year":"2022","journal-title":"Kidney Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"E012674","DOI":"10.1136\/bmjopen-2016-012674","article-title":"What Are the Risks and Benefits of Temporarily Discontinuing Medications to Prevent Acute Kidney Injury? A Systematic Review and Meta-Analysis","volume":"7","author":"Whiting","year":"2017","journal-title":"BMJ Open"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.2215\/CJN.13381019","article-title":"Defining Early Recovery of Acute Kidney Injury","volume":"15","author":"Duff","year":"2020","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_16","unstructured":"IBM Corp (Ibm Spss Statistics for Windows (Version 28.0), 2021). Ibm Spss Statistics for Windows (Version 28.0), Computer Software."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2616","DOI":"10.1016\/S0140-6736(15)60126-X","article-title":"International Society of Nephrology\u2019s 0by25 Initiative for Acute Kidney Injury (Zero Preventable Deaths by 2025): A Human Rights Case for Nephrology","volume":"385","author":"Mehta","year":"2015","journal-title":"Lancet"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Stucker, F., Ponte, B., De La Fuente, V., Alves, C., Rutschmann, O., Carballo, S., Vuilleumier, N., Martin, P., Perneger, T., and Saudan, P. (2017). Risk Factors for Community-Acquired Acute Kidney Injury in Patients with and without Chronic Kidney Injury and Impact of Its Initial Management on Prognosis: A Prospective Observational Study. BMC Nephrol., 18.","DOI":"10.1186\/s12882-017-0792-2"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1111\/bcp.13216","article-title":"The Drugs That Mostly Frequently Induce Acute Kidney Injury: A Case \u2212 Noncase Study of a Pharmacovigilance Database","volume":"83","author":"Gras","year":"2017","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2105","DOI":"10.2147\/CIA.S217567","article-title":"Community-Acquired Acute Kidney Injury Induced by Drugs in Older Patients: A Multifactorial Event","volume":"14","author":"Robert","year":"2019","journal-title":"Clin. Interv. Aging"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1016\/j.ekir.2017.03.015","article-title":"Prevention and Therapy of Acute Kidney Injury in the Developing World","volume":"2","author":"Kher","year":"2017","journal-title":"Kidney Int. Rep."},{"key":"ref_22","first-page":"12","article-title":"Preventing Acute Kidney Injury: Assessing Awareness to Temporarily Discontinue \u201cat-Risk\u201d Medicines During Acute Illness in a New Zealand Cohort","volume":"133","author":"Vicary","year":"2020","journal-title":"N. Z. Med. J."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Faber, S.J., Scherpbier, N.D., Peters, H.J.G., and Uijen, A.A. (2019). Preventing Acute Kidney Injury in High-Risk Patients by Temporarily Discontinuing Medication\u2014An Observational Study in General Practice. BMC Nephrol., 20.","DOI":"10.1186\/s12882-019-1636-z"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1111\/jch.12795","article-title":"Acute Kidney Injury in Elderly Patients with Chronic Kidney Disease: Do Angiotensin-Converting Enzyme Inhibitors Carry a Risk?","volume":"18","author":"Chaumont","year":"2016","journal-title":"J. Clin. Hypertens."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1007\/s40620-020-00863-5","article-title":"Is Metformin Associated with Acute Kidney Injury? A Case-Control Study of Patients with Type 2 Diabetes Admitted with Acute Infection","volume":"34","author":"Schytz","year":"2021","journal-title":"J. Nephrol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"5605634","DOI":"10.1155\/2017\/5605634","article-title":"Are There Modifiable Risk Factors to Improve Aki?","volume":"2017","author":"Nie","year":"2017","journal-title":"Biomed. Res. Int."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2087","DOI":"10.1007\/s40620-022-01323-y","article-title":"The Effect of Different Consensus Definitions on Diagnosing Acute Kidney Injury Events and Their Association with in-Hospital Mortality","volume":"35","author":"Haredasht","year":"2022","journal-title":"J. Nephrol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1038\/s41572-021-00284-z","article-title":"Acute Kidney Injury","volume":"7","author":"Kellum","year":"2021","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1016\/j.kint.2016.07.018","article-title":"The Risk of Chronic Kidney Disease and Mortality Are Increased after Community-Acquired Acute Kidney Injury","volume":"90","author":"Soto","year":"2016","journal-title":"Kidney Int."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1681\/ASN.2009060636","article-title":"Acute Kidney Injury Associates with Increased Long-Term Mortality","volume":"21","author":"Lafrance","year":"2010","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Hirayama, A., Goto, T., and Hasegawa, K. (2020). Association of Acute Kidney Injury with Readmissions after Hospitalization for Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Population-Based Study. BMC Nephrol., 21.","DOI":"10.1186\/s12882-020-01780-2"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Scott, J., Jones, T., Redaniel, M.T., May, M.T., Ben-Shlomo, Y., and Caskey, F. (2019). Estimating the Risk of Acute Kidney Injury Associated with Use of Diuretics and Renin Angiotensin Aldosterone System Inhibitors: A Population Based Cohort Study Using the Clinical Practice Research Datalink. BMC Nephrol., 20.","DOI":"10.1186\/s12882-019-1633-2"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1053\/j.ajkd.2015.10.011","article-title":"Renin-Angiotensin System Inhibitors and Kidney and Cardiovascular Outcomes in Patients with Ckd: A Bayesian Network Meta-Analysis of Randomized Clinical Trials","volume":"67","author":"Xie","year":"2016","journal-title":"Am. J. Kidney Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1007\/s40620-020-00712-5","article-title":"Sglt2 Inhibitor Therapy in Patients with Type-2 Diabetes Mellitus: Is Acute Kidney Injury a Concern?","volume":"33","author":"Baker","year":"2020","journal-title":"J. Nephrol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Morris, R.L., Ashcroft, D., Phipps, D., Bower, P., O\u2019donoghue, D., Roderick, P., Harding, S., Lewington, A., and Blakeman, T. (2016). Preventing Acute Kidney Injury: A Qualitative Study Exploring \u201cSick Day Rules\u201d Implementation in Primary Care. BMC Fam. Pract., 17.","DOI":"10.1186\/s12875-016-0480-5"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1053\/j.ajkd.2011.11.034","article-title":"Incidence and Consequences of Acute Kidney Injury in Kidney Transplant Recipients","volume":"59","author":"Mehrotra","year":"2012","journal-title":"Am. J. Kidney Dis."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/9\/3347\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:31:36Z","timestamp":1760124696000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/9\/3347"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,8]]},"references-count":36,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["jcm12093347"],"URL":"https:\/\/doi.org\/10.3390\/jcm12093347","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,8]]}}}