What medications should be avoided in acute Kidney Injury (AKI)?

From the Guidelines

In acute kidney injury (AKI), it is crucial to avoid medications that can exacerbate kidney damage, and according to the most recent and highest quality study 1, ideally, nephrotoxic medications or combinations should be avoided in patients with AKD. When considering the management of AKI, several key points must be taken into account to prevent further kidney damage and improve patient outcomes in terms of morbidity, mortality, and quality of life. The following medications should be avoided or used with caution:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, and diclofenac, which can reduce renal blood flow and worsen kidney function.
• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) should be temporarily held as they affect renal autoregulation and can exacerbate AKI, especially in volume-depleted patients, as recommended by 1 and 1.
• Aminoglycoside antibiotics (gentamicin, tobramycin) are directly nephrotoxic and should be avoided or used with extreme caution with dose adjustments, as noted in 1.
• Contrast media for imaging studies should be postponed if possible due to contrast-induced nephropathy risk.
• Diuretics, particularly loop diuretics like furosemide, should be used cautiously as they may worsen volume depletion.
• Metformin should be discontinued due to the risk of lactic acidosis when kidney function is impaired.
• Phosphate-containing medications and certain herbal supplements with nephrotoxic properties should also be avoided. It is essential to weigh the benefits and risks of each medication in the context of AKI and to consider alternative treatments when possible, always prioritizing the reduction of morbidity, mortality, and improvement of the quality of life for the patient.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Medications to Avoid in Acute Kidney Injury

There are several medications that should be avoided or used with caution in patients with acute kidney injury (AKI). Some of these medications include:

• Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, which can cause renal failure and prolong the duration of AKI 2
• Aminoglycosides, which can be nephrotoxic and contribute to the development of AKI 3
• Cytostatic drugs, which can also be nephrotoxic and increase the risk of AKI 3
• Osmotic agents, which can cause renal vasoconstriction and worsen AKI 3
• Radiocontrast agents, which can cause contrast-induced AKI, although the risk may be overestimated in some cases 4

Prevention and Management of AKI

Prevention and early diagnosis of AKI are key to improving outcomes. This can be achieved through:

• Awareness campaigns and education for healthcare professionals on diagnosis and management of AKI 4
• Avoidance of volume depletion, hypotension, and nephrotoxic interventions 4
• Early identification and reversal of underlying causes of AKI 5
• Conservative management and avoidance of further insults 6
• Use of renal replacement therapy or hemodialysis if conservative management fails 6