Protect Your Kidneys - Medications to Review

Some common prescription and over-the-counter medicines can strain the kidneys, especially for older adults and people who already have diabetes, high blood pressure, or chronic kidney disease (CKD). The good news is that most risks can be managed with the right monitoring, and newer treatments can now help slow kidney disease. This guide explains which medications are worth reviewing with your doctor, the signs and tests that show how your kidneys are doing, and the treatment options for chronic kidney disease.

Who Should Pay Closest Attention

Adults over 60, since kidney function naturally declines with age
People with diabetes or high blood pressure, the two leading causes of CKD
Anyone already diagnosed with CKD
People with heart failure, liver disease, or frequent dehydration
Anyone taking several medications, which raises the chance of interactions

Medications Worth Reviewing With Your Doctor or Pharmacist

These medicines are useful and often necessary. The point isn't to stop them, but to make sure the dose, combination, and monitoring are right for your kidneys.

Medication type	Examples	Why it matters for kidneys
NSAID pain relievers	Ibuprofen, naproxen, high-dose aspirin	Can reduce blood flow to the kidneys, especially with regular use, dehydration, or existing kidney disease.
Certain antibiotics	Aminoglycosides, vancomycin	Can be toxic to the kidneys; levels and kidney function are usually monitored.
Proton pump inhibitors (acid reducers)	Omeprazole, pantoprazole	Long-term use has been linked to kidney problems in some studies; ask whether you still need them.
Lithium	Lithium carbonate	Requires regular blood level and kidney function checks.
Imaging contrast dye	Contrast for CT scans and some X-ray procedures	People with reduced kidney function may need extra precautions.
Diuretics, ACE inhibitors, and ARBs	Furosemide, lisinopril, losartan	Often protective, but combining them with NSAIDs, or becoming dehydrated, can strain the kidneys.

Important: never stop a prescribed medicine on your own. Many medications simply need a different dose when kidney function is reduced, so ask your pharmacist to review your full list, including over-the-counter drugs and supplements. Some medicines can also raise blood pressure, which affects the kidneys; see medications that raise blood pressure.

Warning Signs and the Tests That Matter

Early kidney disease usually causes no symptoms, which is why testing matters. Later signs can include swelling in the legs or ankles, fatigue, changes in urination, itching, and trouble concentrating.

eGFR (blood test): estimates how well your kidneys filter. An eGFR below 60 for three months or more suggests chronic kidney disease; stage 3 CKD covers an eGFR of 30 to 59.
Urine albumin-to-creatinine ratio (urine test): detects protein leaking into the urine, an early sign of kidney damage.
Blood pressure and blood sugar: keeping these in range is one of the best ways to protect your kidneys. If you have diabetes, see what your A1C test shows.

If you have diabetes, high blood pressure, or take medications that affect the kidneys, ask how often you should have these tests.

Treatment Options for Chronic Kidney Disease

CKD treatment focuses on slowing damage, managing the causes, and protecting the heart. Options have expanded in recent years:

Blood pressure control: ACE inhibitors or ARBs are often prescribed because they help protect the kidneys as well as lower blood pressure.
SGLT2 inhibitors: medicines such as dapagliflozin (Farxiga) and empagliflozin (Jardiance), originally used for diabetes, are now also used to slow kidney disease in many people with CKD.
Finerenone (Kerendia): used for some people with CKD and type 2 diabetes to lower the risk of kidney and heart complications.
Semaglutide (Ozempic): in January 2025, the FDA approved Ozempic to reduce the risk of kidney disease worsening, kidney failure, and death from heart disease in adults with type 2 diabetes and CKD. In its main clinical trial, it lowered the risk of these outcomes by 24% when added to standard care.
Cholesterol medicines: statins are often recommended because people with CKD have higher heart disease risk.
Nutrition: limiting sodium and following personalized advice on protein, potassium, and phosphorus, ideally from a kidney dietitian.
Avoiding kidney stressors: limiting NSAIDs, staying hydrated in the amount your doctor recommends, and getting medication doses adjusted for your kidney function.
Advanced CKD care: a nephrologist can help plan for dialysis or transplant if kidney function declines significantly.

Not every treatment fits every person. Your doctor will consider your kidney function, diabetes status, other conditions, and medications. For more detail, see our guide to chronic kidney disease treatments.

A Note on Fluids

Staying hydrated helps healthy kidneys, but more water isn't always better. People with advanced kidney disease or heart failure may need to limit fluids, so ask your doctor how much is right for you.

Questions to Ask Your Doctor or Pharmacist

What are my eGFR and urine albumin results, and how have they changed?
Do any of my medications or supplements need a different dose for my kidney function?
Is it safe for me to take ibuprofen or naproxen, and what should I use for pain instead?
Would an SGLT2 inhibitor, finerenone, or another kidney-protective treatment help me?
Should I see a nephrologist or a kidney dietitian?

Medicare and Kidney Care

Medicare Part B covers kidney function tests ordered by your doctor and kidney disease education for people with stage 4 CKD, and Part D plans cover many kidney-protective prescriptions, often with prior authorization. If you have diabetes, see what Medicare covers for diabetes.

The Bottom Line

Some medications can affect your kidneys, but the fix is usually a review and adjustment, not stopping treatment on your own. Know your eGFR and urine albumin numbers, keep blood pressure and blood sugar in range, and ask whether newer kidney-protective treatments are right for you.

This article is general information, not medical advice. Talk with your doctor or pharmacist before changing any medication.