Background An estimated 14% of U.S. adults are affected by CKD, of whom about 34% are aged 65 years or older. Certain prescribed or over-the-counter medications can exacerbate or help slow CKD progression. Objective To evaluate prescriptions or recommendations for potentially beneficial and harmful medications in patients with CKD. Design Retrospective, cross-sectional analysis of medical records from U.S. office-based physician visits. Setting National Ambulatory Medical Care Survey, visits made by patients with CKD, 2014-2019. Interventions Comparison of rates and predictors for potentially beneficial versus potentially harmful medications including both prescribed and recommended over-the-counter agents. Methods CKD and related comorbidities were identified using indicators collected from the record regardless of the reason for the sampled visit. Medication classification was based on current guidelines and studies. Analyses included descriptive statistics of patient characteristics and predictors of beneficial versus harmful medication prescriptions/ recommendations. Results A total of 2,805 adult patients with a diagnosis of CKD were sampled. A plurality were aged 75 years or older (47.4%); majorities were White non-Hispanic (64.0%) with comorbid hypertension (78.8%). Beneficial medications only were prescribed/ recommended to 12.2% of patients, harmful medications only to 20.6%, a mix of beneficial/ harmful medications to 26.7%, and neither to 40.5%. Strong positive predictors of potentially harmful medication prescriptions/recommendations included polypharmacy and diagnoses of cerebrovascular disease or congestive heart failure. Discussion Prescribing patterns for patients with CKD highlight the importance of medication optimization to balance therapeutic benefits and harms. Conclusion Pharmacists can educate providers to improve prescribing practices in patients with CKD.