The ‘nephrotoxins’ were stopped: what is in a name and its impact on kidney and cardiac health?

Abstract

The term ‘nephrotoxin’ is often imprecisely applied to medications that are not inherently toxic to the kidneys, including renin-angiotensin-aldosterone system inhibitors, sodium-glucose co-transporter 2 inhibitors, diuretics and metformin. These drugs are frequently included in ‘sick day rules’ and may be prematurely discontinued during acute illness or acute kidney injury (AKI). However, these medications offer substantial benefits, such as preserving cardiac and kidney function and reducing mortality. Discontinuing them without appropriate clinical judgement can lead to unintended harm. Clinicians should adopt a patient-specific, evidence-based approach when managing medications in AKI and chronic kidney disease, informed by pharmacology and individualised risk assessment. Patients may overinterpret advice to ‘stop nephrotoxic medications’ as a permanent measure, leading to hesitation in restarting necessary treatments. This misconception can create barriers to optimal care and complicate decision-making, as patients may prioritise avoiding perceived harm over addressing their full medical needs. This manuscript emphasises the need for nuanced and informed decision-making in the management of medications in kidney-related conditions.