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

What kind of medicines are used to treat chronic kidney disease? — The medicines include:

●Blood pressure medicines – If you have chronic kidney disease, it's important to keep your blood pressure controlled. This helps 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 depend on the kind of kidney disease you have, and if you have other medical problems.

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 ("ACE inhibitors") and angiotensin receptor blockers ("ARBs") work in similar ways. They lower blood pressure by relaxing the blood vessels. They also lower the pressure inside the kidneys so 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) – These lower blood pressure by helping the body get rid of extra salt and fluid. They make you urinate a lot, especially at first. If this makes it hard 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.

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 phosphate in the 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 that you eat foods with 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 when you have too few red blood cells. It 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 ("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.

If you take sodium bicarbonate, you 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 — If you have chronic kidney disease, your 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 medicine, including an over-the-counter medicine or supplement, ask your doctor and pharmacist how they could affect your kidneys.

How do I stay safe? — 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. 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 at this website: www.fda.gov/drugs/resources-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.

For more detailed information about your medicines, ask your doctor or nurse for the patient drug information handout from 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.

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