Medication & Treatment of CKD

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Treatment options for Chronic Kidney Disease (CKD)

The treatment of CKD can vary from case to case depending on the disease stage and other health problems a patient has. Your doctor may suggest the following depending on the cause of your CKD:

  • Control your blood pressure: You may be prescribed medicine to control your blood pressure. Other measures to control your blood pressure include maintaining a healthy weight and restricting intake of salt.
  • Keep your diabetes under control: It is very important to strictly control glucose level to prevent the advancement of CKD.
  • Follow the diet plan to control protein levels: Your doctor may recommend a nutritionist or dietician who will help you plan a healthy diet with the right amount of protien, and the correct calories to help maintain an acceptible weight for your body.
  • Improve anemia: By using medication to enhance the manufacturing of EPO (erythropoiesis) hormone, which is responsible for red cells production, in addition to iron supplements to maintain sufficient iron levels.
  • Protect bone diseases: Maintain calcium and phosphorus balance. While phosphorus is necessary for the blood, high levels of phosphorus in blood can weaken bones over time. To protect bones, you may be recommended to restrict food high in phosphorus, and your doctor may prescribe medicines called phosphorus binders to be taken with food or snacks to prevent absorption of phosphate into the bloodstream. In most cases, vitamin D supplements will also be recommended.
  • Exercise regularly: As recommended by your doctor.
  • Rule out your risk of heart disease: This includes controlling your diabetes, high blood pressure, anemia and high cholesterol.
  • Quit smoking if you still smoke: It only makes heart disease and kidney disease worse.
  • Avoid or stop using herbal remedies or herbal supplements: A study from Taiwan has shown that the people who regularly take herbal supplements have about 200–300 percent higher risk of developing kidney failure.
  • See the doctor regularly: Have your GFR, urine, and nutrition status checked on a determined schedule. Discuss, ask questions, and keep records of your health and test results.

Medicines used in chronic kidney disease

Patients may be given multiple medicines aimed at delaying progression and preventing complications of the kidney disease.

To delay progression of kidney disease

  • Control the causes of the disease, such as hypertension and diabetes mellitus. Patients with these diseases are known to be at risk of kidney problems. Blood pressure and fasting blood sugar should be less than 130/85 mmHg and 130 mg/dl.
  • Restrict dietary protein
  • Understand the use of medications to reduce protein in urine and control blood pressure

To prevent and treat complications

The main kidney functions are to control electrolytes and water balance in body, producing erythropoietin, a hormone that helps building up red blood cells and regulate calcium and phosphorus.  These play a key role in maintenance of bone mass. Decline in kidney functions may lead to various complications.

  • Cardiovascular disease: Blood pressure rises as the result of fluid overload and excessive production of vasoactive hormones, increasing one's risk of developing hypertension and/or suffering from congestive heart failure. Medicines for blood pressure control may be prescribed such as antihypertensive drugs, antilipidemic drugs, and antithrombotic drugs. Patients may be given more than one type of blood pressure medication to ensure optimal blood pressure control.
  • High blood potassium: Potassium can accumulate in the body when kidney function is not adequate to remove excessive amounts. Patients may show a wide range of symptoms including malaise and irregular heartbeat. Patients should avoid eating foods with high potassium, such as papaya, banana, lemon, plum, dried fruit, grapes, etc. Also, patients may be prescribed medicine which acts as a potassium binder and removes excessive potassium through the feces. A common side effect of these medicines is constipation.
  • Fluid volume overload: This condition happens when kidneys cannot excrete excessive water. Symptoms may range from mild edema and shortness of breath to life-threatening pulmonary edema. Water pills, such as a diuretic, may be prescribed in addition to daily restriction of salt and fluid intake.
  • Anemia: Erythropoietin stimulates the red blood cell formation. This hormone level drops due to the decline of kidney function and cause anemia. A doctor may prescribe an erythropoietin to be injected via subcutaneous route and an iron supplement to make sure that a patient’s body can generate red blood cells. Patients may receive iron pills if the amount of iron is very low.
  • High blood phosphate: Due to reduced phosphate excretion, this condition is associated with the phosphate deposition in blood vessel walls and lead to vascular obstruction later on. If this accumulation occurs at the main heart vessel, it can cause atherosclerotic heart disease and may impair heart function. Patients should limit their consumption of high-phosphate diets including meat, eggs, dried beans, dairy products, soft drinks, etc., and take a phosphate binder such as calcium carbonate, calcium acetate, or aluminium hydroxide.
  • High parathyroid hormone leading to impaired bone metabolism: High blood phosphate and low blood calcium levels can trigger parathyroid hormone secretion. This condition leads to the deterioration of bone density and bone abnormalities. To reduce parathyroid hormone, patients may be prescribed calcitriol, cinacalcet.
  • Blood acidosis: The acidified blood may occur because the kidney cannot excrete organic acid products adequate resulting in bone loss or reduced muscle mass. The patient may be prescribed the medicines for this condition.

Medication instructions

  • Patients or relatives should notify doctors or pharmacists about current medications including medications from outside the hospital, over-the-counter drugs, vitamins, herbal and dietary supplement.
  • Some drugs and herbs are harmful for the kidney. Also, they may interact with kidney medicines. Some vitamins may accumulate in your body, since the kidneys cannot process them normally. Consult your doctor or pharmacist before taking any medications.
  • For effectiveness and safety, ask your doctor and pharmacist about newly prescribed medicines, changing dosages and duration. If you have any old medications, make sure to update their labels.

You should be informed about ...

  • Drug name and dosage: Patient should know the drug's name, dosages and how they are administered. You can make your own medication list to help you manage all of your medications easily or bring all medicines with you every time you see a doctor. For kidney disease patients, dosage of some drugs should be adjusted based on creatinine clearance, the estimated kidney function calculated by creatinine measured from the blood. Common dosage may be inappropriate dosage for your kidney function.
  • Indication of medications: Some drugs can be used for many indications. Patients should understand the indication treated by their own medications, and the expected results from the medicines.
  • How to take medicines correctly: You can ask pharmacist how to take medicine correctly and suitably to your condition. Some drugs you may only take temporarily depending on your condition.

What you should do when you forget to take a medication

You should ask your pharmacist since there are different instructions for each medication. Normally, medicines should be taken as soon as you recall. But if it near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not “double-up” the dose to catch up.


 
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