Objective: To summarize current evidence about mechanisms, clinical features, diagnostic issues, and
strategies for prevention of medication-induced nephrotoxicity among older people.
Methods: A Pubmed search was performed, and studies concerning age-related changes in kidney structure and
function predisposing to nephrotoxicity, pathophysiological mechanisms, kidney drug metabolism enzymes, clinical
epidemiology of medication-induced kidney damage, biomarkers for early identification of nephrotoxicity and strategies for prevention
of medication-induced nephrotoxicity among older people were selected. Finally, 245 papers were included in the review.
Results: Medications may induce nephrotoxicity through several pathophysiological mechanisms. People aged 75 or more are especially
exposed to potential nephrotoxic medications or combinations of medications in the context of complex polypharmacy regimens. Estimated
glomerular filtration rate (eGFR) may be useful to identify medication-induced alterations in kidney function, but creatinine-based
methods have important limitation in older patients. Several innovative biomarkers have been proposed to identify AKI but these methodologies
are not standardized and older people have not been evaluated systematically. Factors related to patient, medication, and interactions
should be taken into account for effective prevention.
Conclusions: Medication-induced nephrotoxicity is a relevant problem in older populations. Nevertheless, several areas of uncertainty
remain to be explored, including the impact of nephrotoxicity on functional outcomes relevant to older patients, the reliability of currently
recommended methods for diagnosing and staging AKI, the use of innovative biomarkers in such a heterogeneous population, the
effectiveness of preventing strategies and treatments and their impact on functional outcomes.