Patient-related risk factors vary somewhat depending on the offending drug. However, some risk factors are common to all nephrotoxins and include age older than 60 years, underlying renal insufficiency (., GFR of less than 60 mL per minute per m 2 ), intravascular volume depletion, exposure to multiple nephrotoxins, diabetes, heart failure, and sepsis ( Table 2 ) . 1 – 3 , 7 , 34 , 35 There are conflicting reports about the influence of race and genetic variation, as well as whether men are at greater risk of developing acute renal failure compared with women. 34 The risk of acute renal failure increases with the presence of each additional risk factor. Patients with any of these risk factors, especially those who have more than one risk factor (., a patient with diabetes and heart failure), should be closely monitored for changes in renal function when a medication is added or a dosage is increased.