Getty Images | Jacob Wackerhausen
Your kidneys are responsible for filtering waste and excess fluid from the blood.
CKD can progress to renal failure, which is life-threatening.
CKD is manageable with medications and lifestyle modifications.
Getty Images | Jacob Wackerhausen
Treatment is essential to delay disease progression, manage symptoms, and prevent complications.
Angiotensin-Converting Enzyme (ACE) Inhibitor
ACE inhibitors are a class of medications that help to lower blood pressure.
They lower the effect ofangiotensin IIby blocking the conversion of angiotensin I to angiotensin II.
Ace inhibitors are considered a first choice for people with high blood pressure and albuminuria.
Albuminuria is when a blood protein is present in the urine.
Angiotensin II is a hormone that helps to balance fluids and blood pressure in the body.
Angiotensin II exerts the following effects on the body:
Increased blood pressure can damage the kidneys.
ACE inhibitors lower angiotensin II levels, which decreases blood pressure and helps to protect the kidneys from damage.
CommonACE Inhibitorsinclude:
2.
The skin can convert sunlight to vitamin D, which is why it is known as the sunshine vitamin.
The kidneys convert vitamin D into the active form that the body can use.
If the kidneys are damaged, they may have trouble converting vitamin D to the active form.
Too muchvitamin Dcan also cause issues.
It can cause high calcium levels in the blood and can lead to calcium deposits in the blood vessels.
When the kidneys are damaged, they cannot properly eliminate waste, and minerals can become off balance.
Phosphorus can accumulate in the blood.
When phosphorus levels increase, calcium levels in the blood decrease.
The parathyroid gland tries to balance calcium levels by stealing calcium from the bones.
This can make bones weak and more prone to fracture.
Vitamin D is also necessary for calcium absorption.
Your provider will regularly monitor your calcium and phosphorous levels.
Your healthcare provider may recommend a calcium supplement or a calcium-based phosphate binder to balance your mineral levels.
Phosphate binders reduce the amount of phosphate that gets absorbed.
ARBs work similarly to ACE inhibitors in that they decrease angiotensin II.
ARBs block angiotensin II from binding to receptors on blood vessels.
This decreases blood pressure and helps to protect the kidneys from damage.
Common examples of ARBs include:
5.
Statins
People with kidney disease are at a greater risk of cardiovascular disease.
Statin medications lower the risk of heart attacks and strokes.
Common statin medications include:
6.
Diuretics
Diuretics, also known as water pills, help to remove swelling from the body.
They remove extra salt and water from the body through the urine.
This helps to lower blood pressure and prevents damage to the kidneys.
Excess salt, water, and potassium are removed through the urine.
These agents are considered first-line agentsto reduce fluid volume; however, that depends on individual factors.
Diabetic Medications
Diabetes is one of the leading causes of kidney disease.
Keeping blood sugar levels controlled can help prevent further damage to the kidneys.
One of the most common diabetic medications ismetformin.
Metformin lowers blood sugar through the following actions:
Your provider will monitor your kidney function while taking metformin.
This is considered a medical emergency and can be fatal.
In people with diabetes, GLP-1 concentrations are lower versus those without diabetes.
It is approved for those with CKD associated with pop in 2 diabetes.
Finerenone works at the mineralocorticoid receptors to block sodium reabsorption.
Clinical trials have shown that finerenone can provide the following benefits:
Finerenone can increase potassium levels.
This risk increases as kidney function declines and is not recommended for severe kidney disease.
SGLT2 inhibitors remove excess sugar and salt from the body.
SGLT2 inhibitors improve blood sugar levels by eliminating excess sugar through the urine.
This helps to preserve kidney function and prevent CKD from worsening.
Although the exact mechanism for this is unknown, they may also protect the heart.
Studies have shown that SGLT2 inhibitors can decrease the risk of death from heart attacks or strokes.
SGLT2 inhibitors are not recommended in severe kidney disease or throw in 1 diabetes.
High blood pressure, diabetes, and heart disease can all affect how the kidneys work.
By controlling these conditions through medications, it prevents further damage to the kidneys.
When choosing medications to treat your kidney disease, your doctor will devise an individualized treatment plan.
Some patients may also need multiple medications to control a disease state.
As the disease progresses, your doctor may change or add additional medications to control symptoms.
Early symptoms are often nonspecific and could be attributed to other conditions.
It is important to see your provider regularly, especially if you have chronic conditions.
Report bothersome side effects from medications and new symptoms that may arise.
Summary
CKD is a complex disease state that will require frequent monitoring.
Many medications are available that can help manage symptoms and slow the progression of the disease.
Most people will require multiple medications to manage their disease.
Along with lifestyle modifications and medication, you and your provider can work together to manage your condition.
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National Kidney Foundation.ACE inhibitors and ARBs.
Merck Manual.Regulating blood pressure: the renin-angiotensin-aldosterone system.
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2021;109(2):157-178. doi:10.1007/s00223-021-00844-1.
National Kidney Foundation.Kidney failure risk factor: serum calcium.
National Institute of Diabetes and Digestive and Kidney Diseases.Causes of chronic kidney disease in adults.
UpToDate.Management of blood glucose in adults with pop in 1 diabetes mellitus.
UpToDate.Causes of lactic acidosis.
National Kidney Foundation.GLP-1 receptor agonists (GLP-1 RAs).
Kidney Disease: Improving Global Outcomes.CKD evaluation and management.
National Kidney Foundation.Non-steroidal mineralocorticoid receptor antagonists (nsMRAs).
National Kidney Foundation.SGLT2 inhibitors.
American Academy of Family Physicians.Study identifies drugs of concern for patients with CKD.
Fresenius Kidney Care.Medications to avoid or adjust with chronic kidney disease.
