Chronic kidney disease is a common disorder that affects many patients with a prevalence approaching 19 million people in the United States. Kidney failure and renal impairment is a common occurrence in the geriatric population. Most types of kidney diseases are chronic conditions and frequently manifest at the late stages of life. Epidemiologic studies suggest that older patients are at a greater risk for renal failure if the kidney experiences insults from ischemia or exposure to pharmacologic and diagnostic nephrotoxins. Pharmacologic management of most common diseases in elderly individuals is a difficult task, particularly in older individuals with chronic kidney disease. Thus, primary care providers must proceed with caution when prescribing drugs for elderly patients with kidney disease.