Medications for Chronic Kidney Disease
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 (such as, antibiotics, NSAIDs, seizure medications, digoxin, H2 blcokers). Also, over-the-counter (OTC) products may contain substances that can change your blood chemistry and be harmful to your kidneys. Therefore, 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:
- ]]>Blood pressure medications]]>
- ]]>Diabetes medications]]>
- ]]>Lipid medications]]>
- ]]>Bone medications]]>
- ]]>Anemia medications]]>
- ]]>Medications to lower potassium levels]]>
Hypertension]]> (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, dizziness, and fatigue. There are many available ACE inhibitors:
- Benazepril (Lotensin)
- Captopril (Capoten)
- Enalapril (Vasotec)
- Fosinopril (Monopril)
- Lisinopril (Prinivil, Zestril)
- Moexipril (Univasc)
- Perindopril (Aceon)
- Quinapril (Accupril)
- Ramipril (Altace)
- Trandolapril (Mavik)
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 dizziness. Available ARBs include:
- Candesartan (Atacand)
- Eprosartan (Tevetan)
- Irbesartan (Avapro)
- Olmesartan (Benicar)
- Telmisartan (Micardis)
- Valsartan (Diovan)
- Losartan (Cozaar)
Diuretics are often used in combination with another blood pressure medication. One type—loop diuretics—are commonly used in people with chronic kidney disease. Possible side effects of loop diuretics include muscle cramps, dizziness, increased blood glucose, and headache. Available loop diuretics include:
- Bumetanide (Bumex)
- Furosemide (Lasix)
- Torsemide (Demadex)
High blood glucose (blood sugar) 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 before drinking any alcohol. Four sulfonylureas are available:
- Chlorpropamide (Diabinese)
- Glipizide (Glucotrol)
- Glyburide (Micronase, Glynase, and Diabeta)
- Glimepiride (Amaryl)
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:
- Repaglinide (Prandin)
- Nateglinide (Starlix)
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. These medications can cause a rare but serious liver problem. If you take a thiazolidinedione, your doctor will order blood tests to make sure your liver stays healthy. There are three thiazolidinediones, including:
- Rosiglitazone (Avandia)
- Troglitazone (Rezulin)
- Pioglitazone (ACTOS)
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:
- Acarbose (Precose)
- Meglitol (Glyset)
Your body needs insulin to use blood glucose (blood sugar) 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 2-4 hours.
Regular or short-acting insulin— Regular or short-acting insulin usually starts working about 30 minutes after injection and continues to work for about 3-6 hours.
Intermediate-acting insulin— This type of insulin generally reaches the bloodstream about 2-4 hours after injection and is effective for about 12-18 hours.
Long-acting insulin —Long-acting insulin, or ultralente, reaches the bloodstream 6-10 hours after injection and is usually effective for 20-24 hours.
Very long-acting insulin —Very long-acting insulin, such as glargine (pronounced GLAR-jeen) insulin, begins to lower blood glucose levels about one hour after injection and works for 24 hours.
Insulin can lead to dangerously low blood glucose. For this reason, if you’re taking insulin you need to carefully watch your diet and monitor your blood glucose at home.
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:
- Fenofibrate (Lofibra, Antara, Tricor)
- Gemfibrozil (Lopid)
Statins, or HMG-CoA reductase inhibitors, are effective at reducing the level of cholesterol and triglycerides in the blood. Possible side effects include headache, liver damage, and muscle damage. Available statins include:
- Atorvastatin (Lipitor)
- Fluvastatin (Lescol XL)
- Lovastatin (Altoprev, Mevacor)
- Pravastatin (Pravachol)
- Rosuvastatin (Crestor)
- Simvastatin (Zocor)
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).
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:
- Calcium-containing medications—Calcium carbonate (TUMS, Oscal, Caltrate), calcium acetate (PhosLo), and calcium citrate (Citracal)
- Magnesium carbonate (MagneBind)
- Aliuminum hydroxide (AlternaGEL, Alu-Cap, Dialume)
- Aluminum carbonate (Basaljel)
- Sevelamer hydrochloride (Renagel)
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:
The kidneys make a hormone called erythropoietin that 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 injection medication used to treat some kinds of anemia. It works by triggering 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:
- Abdominal discomfort
The basics of insulin. American Diabetes Association website. Available at: http://www.diabetes.org/type-1-diabetes/basics.jsp . Accessed July 31, 2005.
Farbakhsh K, Kasiske BL. Dyslipidemias in patients who have chronic kidney disease. Med Clin N Am. 2005;89:689-699.
Luke RG. Chronic renal failure. In: Goldman L, Ausiello D, eds. Cecil Textbook Of Medicine. 22nd ed. Philadelphia, PA: Saunders; 2004.
National Heart, Lung, and Blood Institute. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Institutes of Health Publication No. 04-5230; 2004.
National Kidney Foundation. NKF-K/DOQI clinical practice guidelines for anemia of chronic kidney disease: update 2000. Am J Kidney Dis. 2001; 37(1 Suppl 1): S182-238.
National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kid Dis. 2003:42: S52-S140.
Other diabetes medications. American Diabetes Association website. http://www.diabetes.org/type-2-diabetes/oral-medications.jsp . Accessed July 31, 2005.
Snively CS, Gutierrez C. Chronic kidney disease: prevention and treatment of common complications. Am Fam Phys. 2004;70:1921-1930.
Last reviewed November 2008 by ]]>Adrienne Carmack, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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