Acute kidney injury (AKI) is becoming increasingly common. Patients at greatest risk are the elderly with chronic kidney disease (CKD) and other long-term conditions such as hypertension, diabetes and cardiovascular disease. AKI carries a poor prognosis yet 30% of cases are preventable. In primary care we can help prevent AKI by empowering patients to take drug holidays—that is, temporarily stopping medications that become harmful to the kidneys during episodes of acute illness.