Goldstein SL, Dahale D, Kirkendall ES, et al. - Given that a frequent etiology for acute kidney injury (AKI) in hospitalized children is nephrotoxic medication (NTMx) exposure and by 62% reduction in NTMx associated AKI (NTMx-AKI) was reported at one center in relation to the implementation of the Nephrotoxic Injury Negated by Just-in time Action (NINJA) program, researchers attempted to further test the program and for this purpose, they included NINJA across nine centers, for decreasing NTMx exposure and, consequently, AKI rates across these centers. Under NINJA, all non-critically ill hospitalized patients were screened for high NTMx exposure (over three medications on the same day or an intravenous aminoglycoside over three consecutive days), and then a daily serum creatinine level was obtained in exposed patients for the duration of, and two days after, exposure ending. In addition, when possible, replacement of equally effective but less nephrotoxic medications for exposed patients starting the day of exposure was advised. By statistical process control analysis and by Autoregressive Integrated Moving Average modeling, a significant and sustained 23.8% reduction in NTMx-AKI rates was documented; similar to those of the pilot single center. So, reduced AKI rates were documented as a result of successful application of the NINJA program to multiple pediatric institutions in this study.