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Medications for Chronic Kidney Disease
by Diane W. Shannon, MD, MPH
Medications are used to prevent further damage to the kidneys and to prevent and treat the complications of chronic kidney disease.
As kidney damage progresses, your body may respond in a different way to some medications. For this reason, your doctor may change to a new medication or change the dose of a current medication. Also, over-the-counter (OTC) products may contain substances that can change your blood chemistry and be harmful to your kidneys. Check with your doctor before you take any OTC drugs or dietary supplements.
There are several types of medications that are used in kidney disease, including:
Hypertension, also known as high blood pressure, is a common cause of chronic kidney disease. See your doctor to find out if you have high blood pressure. If you do, take the blood pressure medications your doctor prescribes. Two types of blood pressure medication—ACE inhibitors and ARBs—are especially good for treating people with chronic kidney disease because they help prevent further kidney damage. Diuretics help lower blood pressure in people with chronic kidney disease.
ACE inhibitors are effective at reducing blood pressure. Cough is a common side effect of ACE inhibitors. Other possible side effects include rash, lightheadedness, and fatigue. There are many available ACE inhibitors:
Angiotensin-II Receptor Blockers (ARBs)
Angiotensin-II receptor blockers (ARBs) reduce blood pressure without causing a cough, which occurs fairly often with ACE inhibitors. Possible side effects include fatigue and lightheadedness. Available ARBs include:
Diuretics are often used in combination with another blood pressure medication. Loop diuretics are commonly used in people with chronic kidney disease. Possible side effects of loop diuretics include muscle cramps, lightheadedness, increased blood glucose, and headache. Available loop diuretics include:
High blood glucose levels make chronic kidney disease worse. Simple tests can tell if you have diabetes. If you do, take the diabetes medications your doctor prescribes.
Glucose-lowering pills reduce blood glucose. Each of the five types works in a different way and has different side effects.
Sulfonylureas stimulate cells in the pancreas to release more insulin. They are usually taken once or twice a day. One important side effect of sulfonylureas is low blood glucose, which can cause confusion and even coma. These medications can sometimes interact with alcohol, so speak with your doctor about drinking alcohol. Four sulfonylureas are available:
Meglitinides also stimulate cells in the pancreas to release more insulin. They are taken three times a day before meals. Just like sulfonylureas, meglitinides can cause low blood glucose, which can cause confusion and even coma. There are two meglitinides:
Biguanides decrease the amount of blood glucose made by the liver and help muscle tissue better absorb insulin. Metformin (Glucophage) is the only available biguanide. Metformin, which is usually taken twice a day, can cause diarrhea.
Thiazolidinediones work by decreasing the amount of blood glucose made by the liver and by helping muscle and fat tissue better use insulin. They are usually taken once or twice a day. They are recommended only for people who cannot control their diabetes any other way. These medications can cause heart failure, weight gain, and may increase the risk of osteoporosis. If you take a thiazolidinedione, your doctor will order blood tests to make sure your liver stays healthy. Rosiglitazone can also increase the risk of heart attack and stroke.
Examples of thiazolidinediones include:
Alpha-glucosidase inhibitors prevent starches, such as bread and pasta, from being digested in the intestines. This slows the increase in blood glucose after a meal. These medications should be taken at the first bite of a meal. Side effects include gas and diarrhea. There are two available alpha-glucosidase inhibitors:
Your body needs insulin to use blood glucose properly. If you have diabetes, you may need to take insulin to keep your blood glucose in a normal range. There are five basic types of insulin:
Rapid-acting insulin — Rapid-acting insulin, such as insulin lispro or insulin aspart, start reducing blood glucose about five minutes after injection and are effective for two to four hours.
Regular or short-acting insulin — Regular or short-acting insulin usually starts working about 30 minutes after injection. It continues to work for about three to six hours.
Intermediate-acting insulin — This type of insulin generally reaches the bloodstream about two to four hours after injection. It is effective for about 12-18 hours.
Long-acting insulin —Long-acting insulin, or ultralente, reaches the bloodstream 6-10 hours after injection. It is usually effective for 20-24 hours.
Very long-acting insulin —Very long-acting insulin, such as glargine insulin, begins to lower blood glucose levels about one hour after injection. It works for 24 hours.
Insulin can lead to dangerously low blood glucose. If you are taking insulin, you need to carefully watch your diet and monitor your blood glucose at home.
Lipid Medications TOP
Chronic kidney disease causes high lipid (cholesterol and fats) levels in the blood. High lipid levels increase the risk of heart attack and stroke. One type of fat, triglyceride, is often elevated in people with chronic kidney disease. There are several different types of lipid medications, including:
Fibrates, or fibric acid derivatives, are effective at reducing triglyceride levels. Possible side effects include muscle damage, gallstones, and liver damage. Fibrate medications include:
Statins, or HMG-CoA reductase inhibitors, are effective at reducing the level of cholesterol and triglycerides in the blood. Possible side effects include headache, muscle damage, and liver damage. Available statins include:
Cholesterol Absorption Inhibitors
Cholesterol absorption inhibitors reduce the amount of cholesterol and fats absorbed in the intestine. These medications lower both cholesterol and triglycerides in the blood. Possible side effects include back pain, liver damage, and abdominal pain. The only available medication of this type is ezetimibe (Zetia).
Bone Medications TOP
Chronic kidney disease increases the phosphorus and parathyroid hormone in your blood, which can make your bones weak. Reducing the amount of phosphorus in your diet can help. Two types of medications can also help:
Taken with meals, phosphorus binders reduce the amount of phosphorus that enters your body. These medications can cause gastrointestinal discomfort. There are five types of phosphorus binders:
In chronic kidney disease, high parathyroid levels cause the bones to become weak. Vitamin D lowers the level of parathyroid hormone in your body. Possible side effects include high calcium and phosphorus levels. Three vitamin D medications are available:
Anemia Medications TOP
The kidneys make a hormone called erythropoietin. It helps your body make red blood cells. In chronic kidney disease, the level of this hormone decreases, causing anemia—low red blood cells. Depending on your blood tests, your doctor may suggest:
Erythropoietin (Epogen, Procrit) is an injectable medication used to treat some kinds of anemia. It prompts the body to make more red blood cells.
Possible side effects of erythropoietin include:
Some patients with chronic kidney disease have low levels of iron in the blood. If you do, your doctor may recommend iron supplements.
Possible side effects of iron supplements include:
Medications to Lower Potassium Levels TOP
Patients with chronic renal disease are at risk of having a high blood potassium level, also known as hyperkalemia. If you do, your doctor will use sodium polystyrene sulfonate in most cases. If your level is very high, insulin in dextrose is given in your veins.
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Last reviewed May 2015 by Michael Woods, MD
Last Updated: 5/20/2015
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