The following medications MAY OR MAY NOT be advised by nephrologist to kidney patients depending upon their health condition, stage and degree of damage to the kidney. The following medications only suggest the role that they play in managing kidney health and in no way to be treated as prescription. Kidney patients SHOULD NOT take any medicine, even for fever or acidity, without prescription of doctor. Wrong medication can prove fatal and even lead to death of patient.
Anti-hypertensives (blood pressure tablets): Patient might need anti-hypertensive tablets to lower blood pressure of kidney patient. Prolonged high blood pressure can damage blood vessels, heart and kidneys. This might lead to a transplant or dialysis sooner. Reducing blood pressure will not make one feel better in the short-term. However, in the long-term, the tablets will help the patient stay healthy. Adequate blood pressure control may be the single most important intervention in slowing the progression of renal disease. Angiotensin-converting enzyme (ACE) inhibitors have been shown to be of benefit beyond their antihypertensive action in established diabetic and nondiabetic nephropathy, and more recently, angiotensin II receptor blockers (ARB) have been shown to be beneficial for delaying progression of kidney disease. The choice of other anti-hypertensive medications should take into consideration co-existing conditions, albuminuria, potential side effects, and the predisposition of the elderly to orthostatic hypotension, since all available antihypertensives are potentially effective. For CKD patients, blood pressure goal should be <140/90. If albumin creatinine ratio (ACR)>300, blood pressure target may be <130/80. Dietary sodium should be restricted to <2000 mg/day. CKD patients taking antihypertensive drugs should be monitored for potassium build up in the body and should follow a low potassium diet.
Diabetes: For CKD patients with diabetes mellitus, target HbA1c < 7%. In addition to cardiovascular risk reduction, the benefits of glycemic control in chronic kidney disease include reduced progression of albuminuria and reduced loss of kidney function over time. It is suggested that along with medication, low glycemic food be taken by patient and high glycemic food be given up. Low glycemic food are fruits and vegetables, cereals, pulses, whole wheat (atta), parboiled rice (mota chawal)/ brown rice (dheki chhata chaal in bengali), unrefined oil for cooking, etc. (High glycemic food are refined rice, flour, refined oil, processed and preserved food products, canned food, fruit juice, processed milk, processed butter, etc).
Diuretics (water tablets): Healthy kidneys are very good at producing the right amount of urine to match the fluid intake into the body when one eats and drinks. Damaged kidneys are not so good at producing urine. This may mean that fluid builds up inside the body, causing swollen ankles, difficulty breathing and high blood pressure. Diuretics are tablets which encourage kidneys to produce more urine. This makes one go to the toilet more. When taking diuretics it is important not to drink too much fluid because the medication will be less effective and one may need higher doses. Diuretics are generally necessary to manage extracellular fluid volume expansion and blood pressure control in chronic kidney disease. Thiazides are used especially for patients with stages G1-3b chronic kidney disease. A second-line option is a loop diuretic when the thiazide does not achieve volume control goals. Most patients with stage G4 chronic kidney disease will require a loop diuretic, and furosemide, the most common drug, to be dosed twice daily for effective diuresis.
Erythropoietin (EPO): Erythropoietin is often known as EPO. It is a hormone which is produced by healthy kidneys. EPO stimulates the bone marrow to make red blood cells. When kidneys are not working properly body does not make enough EPO leading to anaemia. Anaemia makes one feel tired, weak, cold and generally unwell. In this situation doctor may prescribe EPO injections. There are several brands of EPO available. One may stay in touch with local nurse or injection administrator to give EPO injection.
Vaccination: Anyone needing dialysis is at a slight risk of getting hepatitis B. This is a viral infection spread through infected blood or bodily fluids. Therefore patient may be advised to have an hepatitis B vaccination. Vaccination for pnumonia and influenza should be given to patient with doctor’s advise.
Iron supplements: Iron is essential for making red blood cells to prevent anaemia. One may require iron supplement tablets. The most commonly prescribed tablet is ferrous sulphate. People with CKD are often unable to absorb iron from their stomach and sometimes they might need iron injections.
Phosphate binders: These help to control blood phosphate levels. The medication may be called Calcichew®, Adcal®, Fosrenol®, Renagel® or Phosex®. If prescribed, these need to be taken up to 15 minutes before, or with, food. Reducing phosphate levels can help to prevent itchiness and bone weakness. It may also help reduce risk of heart problems.
Sodium Bicarbonate: This is given to help prevent the build up of acid in the body. If kidney function decreases there is less acid in the urine. This causes bicarbonate level to drop. A low bicarbonate level can be bad for heart and can hasten the deterioration of kidney function. Treatment of chronic kidney disease associated metabolic acidosis with oral alkali to achieve a normal serum bicarbonate level has been shown in observational studies to slow chronic kidney disease progression. When the bicarbonate level is less than 22 mmol/L, sodium bicarbonate (650 mg) should be prescribed 3 times daily. This dose corresponds to approximately 23 mEq daily of sodium and bicarbonate. Sodium citrate (30 mL daily) is an alternative, corresponding to 30 mEq of sodium and bicarbonate each day. If this does not result in a serum bicarbonate level of at least 22 mmol/L, a nephrology referral is indicated.
Statins (cholesterol tablets): A patient might need statins to lower blood cholesterol level as high cholesterol can lead to heart disease. There are many different brands of statins available including simvastatin, pravastatin and atorvastatin. A healthy diet and exercise can also help to lower cholesterol.
Vitamin D: This helps control calcium in the body and protects one’s bones. The medication may be called alfacalcidol which is taken this daily or weekly depending on the dosage and instructions.
Over the counter medicines and herbal remedies: Some medications that one can buy from a pharmacy or supermarket without a doctor’s prescription are not suitable for people with CKD. One should talk to their doctor before taking any of OTC medication or any herbal remedies.
Pain Killers or NSAIDS: Nonsteroidal anti-inflammatory inhibitors can cause acute kidney injury by inhibiting vasodilatory prostaglandins, especially in the context of other factors that impair renal perfusion, such as dehydration and congestive heart failure. Long-term use of NSAIDs can also increase the rate of progression of chronic kidney disease. These drugs are available over the counter, so patients must understand potential harms from their doctor. Other potential adverse effects of NSAIDS include allergic interstitial nephritis with or without minimal change disease, hyperkalemia, hypertension, and edema. These medications should be totally avoided with an estimated glomerular filtration rate <30 mL/min/1.73 m2 and limited with an estimated glomerular filtration rate <60 mL/min/1.73 m2. Furthermore, they should be used with extreme caution in
patients with chronic kidney disease and concomitant RAAS blocking agents and/or diuretic therapy.
The point to be made here is that no kind of medication should be given to CKD patient without consulting a doctor, even if it is simple headache or acidity or other trivial ailment as the same may interfere with other medicines and cause fatal/ life threatening consequences for the patient.