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Patient education: Medicines for chronic kidney disease (The Basics)

Patient education: Medicines for chronic kidney disease (The Basics)

What kind of medicines are used to treat chronic kidney disease? — People with chronic kidney disease are usually treated with:

Blood pressure medicines – If you have chronic kidney disease, it's important to keep your blood pressure controlled. This will help protect your kidneys. Also, people with kidney disease have a higher chance of getting serious heart problems from high blood pressure. Blood pressure medicines can help prevent heart disease and slow down kidney disease.

Other medicines – These will depend on the kind of kidney disease you have, and if you have other medical problems.

Listed below are the medicines used to help control blood pressure or treat problems caused by chronic kidney disease. They are also listed in the table (table 1).

Medicines that treat high blood pressure and slow kidney disease — You might need more than 1 kind of blood pressure medicine to help your kidneys:

ACE inhibitors and ARBs – Angiotensin-converting enzyme inhibitors (called "ACE inhibitors") and angiotensin receptor blockers (called "ARBs") work in similar ways. These medicines lower the blood pressure by relaxing the blood vessels. They also lower the pressure inside the kidneys so that the kidneys can filter better.

Examples of ACE inhibitors include enalapril and lisinopril. Examples of ARBs include candesartan (brand name: Atacand) and valsartan (brand name: Diovan).

Diuretics (water pills) – Diuretics lower blood pressure by helping the body get rid of extra salt and fluid. They make people urinate a lot, especially at first. If this makes it difficult for you to take these medicines, work with your doctor or nurse to find a good time of the day to take them. Diuretics work better if you limit the amount of salt (sodium) you eat.

An example of a commonly used diuretic is furosemide (brand name: Lasix).

Other blood pressure medicines – Depending on your blood pressure and the type of kidney disease you have, your doctor might prescribe other types of blood pressure medicines, such as calcium channel blockers or beta blockers.

Other medicines — Your doctor might prescribe other medicines, depending on the kinds of problems caused by your kidney disease. These might include:

Phosphate binders – Phosphate is a mineral found in many foods. Having chronic kidney disease can increase the amount of phosphate in the body. This can be harmful. To lower the amount of phosphate in your body, doctors can prescribe medicines called "phosphate binders." You must take these medicines with meals and snacks for them to work. Your doctor might also recommend you eat foods that have low amounts of phosphate.

Vitamin D – Having chronic kidney disease can lead to having low levels of calcium in the blood. This can cause bone problems. To help prevent bone problems, doctors sometimes prescribe vitamin D.

Medicines to treat anemia – Anemia is the medical term for when a person has too few red blood cells. This condition can make you feel weak or tired. It is common in people with chronic kidney disease.

Doctors can treat anemia by giving you extra iron. They can also use medicines called erythropoiesis-stimulating agents (called "ESAs").

Sodium bicarbonate – When you have chronic kidney disease, the levels of acids in your body can become abnormal. This can lead to problems like weak bones and muscles. Your doctor might prescribe a sodium bicarbonate pill to help with this problem.

People who take sodium bicarbonate need to avoid eating too much salt. That's because sodium bicarbonate also has salt in it. Having too much salt in your body raises your blood pressure and can make your kidney disease worse.

Medicines for other conditions or symptoms — If your doctor prescribed medicines to treat diabetes, these are also important for treating your kidney disease. Your doctor might also suggest medicines for symptoms like pain, constipation, itching, or restless legs.

Adjusting the dose of your medicines — In people with chronic kidney disease, the kidneys cannot remove medicines from your body as well as they normally would. This can cause an unsafe buildup of medicines. Because of this, your doctor might tell you to take a lower dose of some medicines or switch to a different medicine.

Medicines that can harm your kidneys — Some medicines can harm your kidneys. These include "NSAIDs," such as ibuprofen (sample brand names: Advil, Motrin) or naproxen (sample brand name: Aleve). Before you take any new medicines, including over-the-counter medicines or supplements, ask your doctor and pharmacist how they can affect your kidneys.

What can I do to be safe? — To keep safe, it's important to take your medicines exactly as your doctor tells you, so you get the correct amount of each medicine. Using pill boxes and reminders can help (picture 1 and table 2).

Your doctor and pharmacist need to know all of the medicines you take. This includes any over-the-counter medicines, vitamins, and herbs. So it's a good idea to keep a list of the names and doses and bring it with you each time you visit any doctor. You can find an example of a list at this website: www.fda.gov/drugs/resources-you-drugs/my-medicine-record.

If your medicines cause troublesome side effects, or if you can't afford your medicines, talk to your doctor or nurse. There are often ways to deal with these problems. The first step is to let your doctor or nurse know.

For more detailed information about your medicines, ask your doctor or nurse for the patient handout from Lexicomp available through UpToDate. It explains how to use each medicine, describes its possible side effects, and lists other medicines or foods that can affect how it works.

More on this topic

Patient education: Chronic kidney disease (The Basics)
Patient education: Medicines for high blood pressure (The Basics)
Patient education: Side effects from medicines (The Basics)
Patient education: Coping with high drug prices (The Basics)
Patient education: Brand versus generic medicines (The Basics)
Patient education: Bone problems caused by kidney disease (The Basics)
Patient education: Low-sodium diet (The Basics)
Patient education: Anemia caused by low iron (The Basics)
Patient education: Anemia of inflammation (anemia of chronic disease) (The Basics)

Patient education: Chronic kidney disease (Beyond the Basics)
Patient education: High blood pressure in adults (Beyond the Basics)
Patient education: Protein in the urine (proteinuria) (Beyond the Basics)
Patient education: Low-sodium diet (Beyond the Basics)
Patient education: Anemia caused by low iron in adults (Beyond the Basics)
Patient education: Coping with high prescription drug prices in the United States (Beyond the Basics)

This topic retrieved from UpToDate on: Jan 02, 2023.
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