Chronic Kidney Disease - Medications

Medications

Although medicine cannot reverse chronic kidney disease, it is often used to help treat symptoms and complications and to slow further kidney damage.

Medication Choices

Medicines to treat high blood pressure

From 80% to 90% of people with chronic kidney disease have problems with high blood pressure at some time during their disease. Medicines to lower blood pressure (antihypertensives) are used to keep blood pressure in a safe range and slow the progression of kidney damage that is caused by high blood pressure. The target is to keep your blood pressure below 130/80. The type of blood pressure medicine used is thought to be less important than how well the medicine lowers blood pressure.

Common blood pressure medicines include:^{4, 5}

• Angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitors decrease blood pressure by opening (dilating) blood vessels. ACE inhibitors slow damage to the kidneys caused by diabetes and other kidney diseases.
• Angiotensin II receptor blockers. These medicines block the action of a hormone that causes blood vessels to narrow. As a result, blood vessels relax and open, reducing blood pressure. Angiotensin II receptor antagonists reduce blood pressure as effectively as ACE inhibitors but without some of the side effects, such as a cough.
• Diuretics. Diuretics help remove extra sodium and fluid from the body, decreasing the volume of circulating blood and lowering blood pressure.
• Beta-blockers. Beta-blockers decrease blood pressure by decreasing heart rate and cardiac output. They also relax blood vessels.
• Calcium channel blockers. Calcium channel blockers dilate blood vessels by relaxing the muscles in the vessel walls. This makes it easier for blood to flow through the vessels and helps lower blood pressure.
• Vasodilators. Vasodilators relax the smooth muscle of blood vessels, which opens (dilates) the blood vessels.
• Direct renin inhibitors block the enzyme renin from starting a process that helps regulate blood pressure. As a result, blood vessels relax and widen, making it easier for blood to flow through the vessels, which lowers blood pressure.

You may need to try several blood pressure medicines before you find the medicine that controls your blood pressure well without bothersome side effects. Most people need to take a combination of medicines to get the best results. Your doctor may order blood tests 3 to 5 days after starting or changing your medicines, to make sure they are working correctly.

Medicines to treat complications of chronic kidney disease

Other medicines may be used to treat complications of chronic kidney disease, such as:

• Erythropoietin (rhEPO) therapy and iron replacement therapy for anemia. Anemia occurs during chronic kidney disease, because as kidney function declines, the kidneys produce too little erythropoietin, which is needed to make new red blood cells.
• Medicines for electrolyte imbalances. Specific medicines are sometimes needed to treat imbalances of electrolytes, such as high potassium, high phosphate, and low calcium levels.
• Diuretics to treat fluid buildup caused by chronic kidney disease.
• ACE inhibitors for heart failure. Regular blood tests are required to make sure that these medicines do not raise potassium levels (hyperkalemia) or make kidney function worse. For more information, see the topic Heart Failure.

Medicines used during dialysis

Both erythropoietin (rhEPO) therapy and iron replacement therapy may also be used during dialysis to treat anemia, which often develops in advanced chronic kidney disease.

• Erythropoietin (rhEPO) stimulates the production of new red blood cells and may decrease the need for blood transfusions. This therapy may also be started before dialysis is needed, when anemia is severe and causing symptoms.⁶
• Iron therapy can help increase levels of iron in the body when rhEPO therapy alone is not effective.

What To Think About

Talk with your doctor about what types of immunizations you should have if you have chronic kidney disease. Also, be sure to discuss medication precautions. Make sure you tell your doctor about all prescription, over-the-counter, and herbal medicines you are taking.

Some complications of kidney failure are best treated with dialysis.