**3.4 Avoidance of nephrotoxic insults**

Avoiding the use of radiocontrast agents or nephrotoxic drugs such as non-steroidal antiinflammatory drugs or aminoglycosides is an important approach in protecting RRF. Aminoglycoside nephrotoxicity can be decreased by once-daily dosing, avoidance of concomitant nephrotoxins, monitoring of drug levels, and choice of the least nephrotoxic aminoglycoside used (Baker, Senior et al, 2003). Recent trials that used either adequate hydration, low-osmolar radiocontrast agents (Dittrich, Puttinger et al, 2006) as well as prophylactic acetylcysteine (Tepel, van der Giet et al, 2000) did not show long-term decline after contrast exposure despite a temporary decline in GFR immediately after contrast exposure.

### **3.5 Antihypertensive medications**

ACE-inhibitors and calcium channel blockers were associated with preservation of RRF in both PD and HD patients (Tepel, van der Giet et al, 2000). In a prospective study by Li PK et al (Li PK, Chow et al, 2003), PD patients treated with ramipril had a slower rate of RRF loss

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