In chronic renal failure (=CKD), your kidney no longer functions as it should. Therefore, all natural functions of the kidney have to be replaced. But what role do the drugs erythropoietin (=EPO), vitamin D, phosphate binders, potassium binders and water tablets play in this context? And when are ACE inhibitors and beta blockers used? To help you keep track of all these terms, let's go through everything step by step.
What is the role of medications in renal failure?
In chronic kidney disease, the filtering function of your kidney decreases. Over time, these circumstances can lead to your blood no longer being adequately cleaned of harmful substances. In this case (in the final stage of chronic kidney disease or when your kidneys suddenly stop working), hemodialysis or peritoneal dialysis takes over this job. Until transplantation, dialysis keeps the blood of people with end-stage renal disease clean and helps them remain as healthy and fit as possible. Dialysis prevents the accumulation of harmful substances and electrolytes such as potassium and phosphate, which can now no longer be kept in balance by natural means.
In addition to blood purification, your kidneys have other functions that need to be replaced and compensated for in kidney disease. These include, for example, the activation of vitamin D or the formation of the hormone erythropoietin (=EPO), which stimulates the formation of your red blood cells.
Ideally, underlying diseases such as high blood pressure or diabetes should also be treated in order to slow down the progression of kidney disease or prevent the onset of new symptoms. In addition to lifestyle adjustments, medications can often help, and today we will take a closer look at these.
Please note that this article is only intended to provide information about different groups of medications. This article does not contain any advertising or recommendations for medications. If you have any questions about your personal medications, please always consult your medical team.
How can I document my medications for kidney disease?
However, before we talk about the medication groups, you should also briefly consider the documentation of your medications. Especially with kidney disease, you are often confronted with many different medications, some of which take over important functions and can even contribute significantly to your health.
Therefore, it is especially important to keep track of your own medications and to take them regularly and on time, according to the schedule of your medical team. For this purpose, the Mizu app not only offers you the possibility to enter your own medication schedule in the app, but also to mark the intake of individual medications as completed. Additionally, it can also remind you to take your medication. This makes it easy for you to keep track of everything.
In the following section, we will provide you with a detailed overview of the most common medications for kidney disease. So that you don't lose track, we have divided the individual groups of medications into paragraphs. This way, you can go directly to the medication group that interests you, if necessary.
Blood pressure medication
Hypertension can be the cause and consequence of renal impairment. Regardless, the high pressure in your blood vessels can lead to long-term negative consequences and damage to your cardiovascular system. So it is important to manage your blood pressure in kidney disease and keep your cardiovascular system fit. This often requires medication, if prescribed by your healthcare team, in addition to physical activity to lower your blood pressure to the appropriate target level. This target value differs für the different phases of kidney disease up to transplantation:
The RAAS-System
ACE inhibitors, AT1 antagonists, or renin inhibitors interfere with what is called the renin-angiotensin-aldosterone system (=RAAS). This is a real tongue twister but not as complicated as it sounds. The RAAS is a regulatory circuit of different hormones that regulates the fluid balance in your body and thereby controls blood pressure throughout your body and in your glomeruli (=functional unit in your kidneys). As such, blood pressure can be lowered via drugs that target the RAAS.
Calcium channel blocker
Calcium channel blockers dilate blood vessels, lowering blood pressure by decreasing the resistance of the walls of your blood vessels. This class of drugs includes longer-acting agents such as amlodipine or lercanidipine and shorter-acting agents such as nitrendipine or nifedipine.
If the dose is too high, headaches, flushing, palpitations, facial flushing or water retention in the legs may occur.
Water pills
Diuretics are also known as “water pills” and, as the name suggests, help your kidneys excrete more water. However, if kidney function and therefore excretion decreases significantly, they can lose their effectiveness. Active ingredients include chlortalidone, hydrochlorothiazide, furosemide and torasemide. Possible side effects are blood salt changes (e.g., of potassium, sodium, or magnesium).
Phosphate binders
Many people with kidney disease struggle with high phosphate levels. In addition to dietary changes, phosphate binders, if prescribed by your medical team, can help. They are used to bring your phosphate towards the reference range of 1.45 mmol/l (or 4.5 mg/dl). Phosphate binders, as the name suggests, bind phosphate in the body, causing excess phosphate to be excreted in the stool and not absorbed by the body. However, there are different forms of phosphate binders. Your medical team is very familiar with phosphate binders and can help you with any questions you may have about how they work, how to take them correctly, and about the different types.
EPO & Iron
As you already know, your kidney not only purifies your blood, but also makes other hormones. One of these hormones is erythropoietin (EPO), which regulates the formation of new red blood cells in your body. As a result, if your kidney fails, your blood level (Hemoglobin or Hb level) often drops, which is called renal anemia. KDIGO, an organization dedicated to improving the care of people with kidney disease, recommends a target Hb level of no more than 11.5 g/dL for chronic kidney disease, if it needs to be raised through therapy. However, you will set your individual target together with your medical team. A Hb value of 13 g/dL should not be exceeded, however, unlike in healthy people.
If the Hb level is less than 10 g/dL, administration of artificial EPO may be considered by your &customer team. Your ¨medical team will help you determine the most appropriate form of therapy for you.
Potassium binders
Potassium is a water-soluble mineral that is found in varying amounts in all plant and animal foods. Potassium also plays an important role in our body. In the case of kidney insufficiency, many people experience an increase in potassium in the blood, which can lead to potentially dangerous cardiac arrhythmias.
Similar to phosphate binders, potassium binders bind the potassium in food and excrete it via the intestine. In the case of diarrhea, potassium is often lost through the intestines on its own. This is relevant for the dosage of potassium binders and should be discussed with your medical team. If you have diarrhea it is best to discuss your specific case with your medical team so that you can find the optimal dosage for your body.
Vitamin D
Unlike other vitamins, our bodies can make vitamin D on their own with the help of sunlight. Vitamin D is then converted to its active form in our kidneys (with an intermediate step in the liver). With a kidney insufficiency, our body often also lacks active vitamin D, which can lead to problems for your calcium and phosphate balance, as well as the health of your bones.
As a someone living with kidney insufficiency you will usually get a form of vitamin D that is already fully activated. Natural activation of vitamin D in the kidney is – as already mentioned - is no longer possible.
SGLT2 Inhibitors
SGLT2 inhibitors are drugs that can be used to slow the progression of kidney disease. They also cause more sugar to be excreted in the urine, which can have an additional positive effect on possible diabetes mellitus. Your treating team will tell you exactly if and how you should take this medication.
However, sometimes these medications can increase urinary tract infections (these medications lead to a lot of sugar in the urine and like everyone, bacteria also like sugar a lot).
Non-steroidal mineralocorticoid receptor antagonists (nsMRAs)
nsMRAs are used to slow down the progression of chronic kidney disease (=CKD) in people who also have type II diabetes. Type II diabetes is a disease that in most cases is caused by a combination of genetic predispositions and unhealthy lifestyle habits (e.g. poor diet, low physical activity). Past research has shown that inflammatory processes play an important role in the development and progression of CKD. It is these processes that can be positively influenced by nsMRAs and thus lead to positive effects not only on your kidneys, but also on your entire cardiovascular system. Of course, your doctor will decide whether this group of medications is suitable for you.
Sodium bicarbonate
Your kidneys also control how acidic or alkaline your blood is. When they can no longer do this, your blood usually becomes more and more acidic and your potassium rises. In end-stage renal disease, the dialysis machine takes over this balancing act. After a kidney transplant there seems to be no advantage in using medications to make the blood more alkaline.
But if your own kidneys are still functioning but slowly losing function, supportive therapy with sodium bicarbonate may be prescribed by your treating medical team.
Now that was quite a bit of information all at once. But don't worry, if you have any questions or are unclear, you can always contact your treating medical team. The Mizu app can also help you keep track of everything.
