In CKD, what is the recommended approach to nephrotoxic medications?

• A. Continue current medications as usual
• B. Increase dosage to ensure efficacy
• C. Avoid nephrotoxins
• D. Only use nephrotoxins in dialysis

Answer: (C)

In CKD, the kidneys’ ability to filter and excrete drugs is impaired, so exposure to substances that can damage the kidney becomes a major risk. The safest and most appropriate approach is to avoid nephrotoxic medications whenever possible and choose safer alternatives. If a nephrotoxic drug is truly necessary, use the lowest effective dose, adjust for the patient’s level of kidney function, and monitor kidney function and drug levels closely. Hydration and avoiding other kidney stressors, like contrast exposure, also help protect remaining function. Keeping the patient on nephrotoxins or increasing the dose would raise the risk of further kidney injury, and relying on dialysis to make nephrotoxic drugs safe isn’t appropriate because many agents aren’t adequately cleared and can still cause harm.