Chronic kidney disease (CKD) is the gradual loss of kidney function over time. The damage occurs slowly with few early symptoms. While there is no cure for CKD, treatment focuses on slowing the progression of kidney damage and managing related health issues. The goals are to control underlying causes, such as diabetes and high blood pressure, and to reduce the risk of complications like heart disease.
Medications to Control Blood Pressure and Slow Progression
A major focus of CKD management is controlling blood pressure to reduce strain on the kidneys. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are two classes of medications used for this. They work by relaxing blood vessels, which lowers overall blood pressure. This action decreases pressure inside the glomeruli, the kidneys’ tiny filtering units, helping to preserve their function.
Sodium-glucose cotransporter-2 (SGLT2) inhibitors are another class of medications. Originally for type 2 diabetes, these drugs benefit CKD patients, even those without diabetes. SGLT2 inhibitors cause the kidneys to remove more sugar, salt, and water from the body through urine. This process helps lower pressure within the kidneys and slows the decline of kidney function.
Finerenone offers another approach to protecting the kidneys. As a non-steroidal mineralocorticoid receptor antagonist (MRA), it targets inflammation and fibrosis (scar tissue formation) within the kidneys. By reducing these damaging processes, finerenone helps slow the progression of kidney disease. It also lowers the risk of cardiovascular events in patients with CKD and type 2 diabetes and is often used with other CKD therapies.
Managing Common CKD Complications
Anemia
Anemia is a frequent complication because damaged kidneys produce less erythropoietin (EPO), a hormone that signals bone marrow to make red blood cells. When EPO levels are low, the red blood cell count drops. Treatment involves Erythropoiesis-Stimulating Agents (ESAs), which are synthetic versions of EPO that stimulate red blood cell production.
Iron supplementation is also necessary alongside ESAs. Iron is a component of hemoglobin, the protein in red blood cells that carries oxygen. Patients with CKD may have difficulty absorbing iron or may lose it during dialysis. Iron can be administered orally as pills or directly into a vein through an intravenous (IV) infusion.
Mineral and Bone Disorder
CKD disrupts the body’s balance of minerals like calcium and phosphorus. Failing kidneys cannot effectively remove excess phosphorus or activate vitamin D. This imbalance triggers the parathyroid glands to release excess parathyroid hormone (PTH), which pulls calcium from the bones and weakens them. This cascade of events is known as CKD-mineral and bone disorder (CKD-MBD).
To manage this, doctors prescribe phosphate binders. These medications are taken with meals and attach to phosphorus from food in the gut, preventing its absorption. Patients are also treated with activated forms of Vitamin D. These supplements help the body absorb calcium, regulate PTH levels, and maintain bone health.
Fluid Overload
As kidney function declines, the body’s ability to remove excess salt and water diminishes, leading to fluid overload. This fluid retention can cause swelling (edema), particularly in the legs and ankles, and contributes to high blood pressure. Managing fluid balance is necessary to prevent discomfort and cardiovascular strain.
The medical treatment for fluid overload is diuretics, or “water pills.” These medications help the kidneys excrete more sodium and water into the urine, reducing the body’s total fluid volume. Loop diuretics are used for patients with advanced CKD because they remain effective even when kidney function is significantly impaired.
Medications Requiring Caution
Certain over-the-counter pain relievers can be harmful to individuals with CKD. Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and naproxen, can decrease blood flow to the kidneys. This can lead to further kidney damage or acute kidney injury, especially with long-term use or at high doses. Acetaminophen is often a safer alternative for pain relief for patients with kidney disease.
Because the kidneys clear many medications from the body, reduced function in CKD can cause standard doses of some drugs to build up to unsafe levels. This is true for certain antibiotics and diabetes medications. To prevent toxicity, physicians must adjust dosages based on the patient’s level of kidney function, which is monitored with the glomerular filtration rate (GFR). As GFR declines, dosages are often lowered to prevent accumulation and harmful side effects.
Imaging tests like CT scans and MRIs sometimes use contrast dyes, which can pose a risk to damaged kidneys. Iodinated contrast for CT scans can cause contrast-induced nephropathy, a further decline in kidney function. Gadolinium-based dyes for MRIs have been linked to a rare but serious condition in patients with advanced CKD. Patients must always inform imaging staff about their kidney condition before these procedures.
The Importance of Medication Adherence and Adjustments
Managing CKD requires strict adherence to prescribed medication regimens. Following the schedule is necessary for controlling blood pressure, managing complications, and slowing disease progression. Skipping doses or stopping a medication without consulting a healthcare provider can undermine the treatment plan and worsen kidney function.
Practical tools can help manage this process. A pill organizer can help ensure medications are taken correctly and on time. It is also important to maintain an up-to-date list of all prescriptions, over-the-counter drugs, and supplements. This list should be brought to every medical appointment to facilitate clear communication with doctors and pharmacists.