Chronic kidney disease (CKD) is common among cancer patients and complicates anticancer drug dosing due to altered pharmacokinetics and increased risk of nephrotoxicity. This narrative review summarizes current strategies for safe and effective therapy in CKD, emphasizing accurate renal function assessment, personalized dose adjustment, and ongoing monitoring. The CKD-EPI equation is preferred for dosing decisions, while direct GFR measurement remains crucial in borderline cases. The ADDIKD guideline offers a standardized framework for kidney function–based dosing, although evidence is limited for patients with advanced CKD and those on dialysis. Practical considerations across different drug classes highlight agents that require renal-guided dosing, monitoring only, or no adjustment. Multidisciplinary collaboration and including CKD patients in future trials are vital to improving cancer care outcomes.
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