A CKD patient arrives at the dialysis center after her nephrology visit. Since her eGFR is now in the 20s, which changes in her prescriptions should the dialysis nurse anticipate? SELECT ALL A. Avoiding ibuprofen for pain. B. Using metformin with dose monitoring at 50% dose. C. Discontinuing bisphosphonates for osteoporosis. D. Increasing intake of iron supplements.

### A. Avoiding ibuprofen for pain. C. Discontinuing bisphosphonates for osteoporosis

## Step1: Understanding the impact of eGFR on medication### The eGFR (estimated Glomerular Filtration Rate) is a measure of kidney function. A decrease in eGFR indicates a reduction in kidney function, which can affect the metabolism of certain medications. This can lead to increased toxicity or decreased efficacy of these medications.## Step2: Analyzing the impact of ibuprofen### Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can be nephrotoxic, especially in patients with reduced kidney function. Therefore, it is advisable to avoid ibuprofen in patients with eGFR in the 20s to prevent potential kidney damage.## Step3: Analyzing the impact of bisphosphonates### Bisphosphonates are used to treat osteoporosis and prevent bone fractures. However, they can cause renal calculi (kidney stones), especially in patients with reduced kidney function. Therefore, it is advisable to discontinue bisphosphonates in patients with eGFR in the 20s to prevent the formation of kidney stones.