Selected convenient dosing regimen for patient to enhance medication adherence (eg, pharmacist selected longer dosing interval that avoided need for the patient to split tablets as this be can confusing and difficult for patients)

Followed guideline recommendations for dose reduction

Selected a safer, reduced dose to account for patient’s older age, since older age is often associated with renal function decline

Reduced dose or frequency of a renally eliminated drug to minimise drug accumulation and thus, avoid adverse effects for the patient

Renal function was below a certain threshold (eg, CrCL<60 mL/min prompted HCP to discontinue nitrofurantoin; proteinuria prompted discontinuation of tenofovir)

Patient’s medication was not critically needed for therapy (eg, no apparent medication indication, medication was not effective for the patient)

Patient has other risk factors that can worsen renal function (eg, older age, diabetes mellitus, hypertension, dehydration)

The risks associated with stopping or temporarily withholding medication therapy were perceived as minimal (eg, low risk of antibiotic resistance with discontinuation of nitrofurantoin)

Alternative treatments existed that were not nephrotoxic or renally eliminated, were less expensive, or were non-pharmacological

It was not a viable option to discontinue medication therapy altogether (eg, still needed to treat the patient’s pain after discontinuing naproxen; manage hypertriglyceridaemia after discontinuing fenofibrate; manage hypertension after discontinuing lisinopril)

The need for original medication was not as critical (eg, switched from piperacillin/tazobactam to amoxicillin/clavulanic acid when bacterial culture was negative)

Renal function was still above a certain, acceptable threshold

Determined that the medication was needed for patient treatment, and HCP perceived that the benefits of continuing outweigh risks (eg, a combination pill containing tenofovir continued for a few weeks despite renal concerns, to prevent gaps in treatment. It was later discontinued due to worsening renal function)

Alternative medications were non-formulary (eg, gabapentin was continued to treat peripheral neuropathy rather than switched to duloxetine or pregabalin because they ‘require special approval’)

Suspected that another medication was the primary reason for renal injury (eg, HCP continued lisinopril/HCTZ because he believed that NSAIDs were more likely the cause of renal injury, since the patient had been on lisinopril/HCTZ for a long time. SCr continued to worsen, however, and HCP then discontinued lisinopril/HCTZ)

To assess whether renal function improved after the HCP took action to address the renal-drug problem (eg, on stopping, reducing dose or holding a dose of an offending drug)

To counsel the patient (eg, about fluid intake, to confirm that the patient has stopped the risky medication)

To follow-up on co-morbid conditions that can worsen renal function (eg, work on controlling diabetes mellitus and hypertension)

To monitor patients’ health condition after discontinuing medication therapy (eg, monitor triglycerides after discontinuing fenofibrate, monitor blood pressure after discontinuing lisinopril)

Patient’s impaired renal function

Their recommendations to reduce a medication dose or substitute a medication

Their decision to discontinue a medication and their associated reasoning

To add clarification about the patient’s medication list following hospital discharge (eg, to emphasise that lisinopril, which was nephrotoxic to the patient, is absent from the list)

Communication with, and counselling of, the patient regarding prescription and over-the-counter medications that should be avoided