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Medications for Chronic Kidney Disease

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by Shannon DW
Medications are used to prevent further damage to the kidneys and to prevent and treat the complications of chronic kidney disease.
As kidney damage progresses, your body may respond in a different way to some medications. For this reason, your doctor may change to a new medication or change the dose of a current medication. Also, over-the-counter (OTC) products may contain substances that can change your blood chemistry and be harmful to your kidneys. Check with your doctor before you take any OTC drugs or dietary supplements.
There are several types of medications that are used in kidney disease, including:

Blood Pressure Medications

Hypertension , also known as high blood pressure, is a common cause of chronic kidney disease. See your doctor to find out if you have high blood pressure. If you do, take the blood pressure medications your doctor prescribes. Two types of blood pressure medication—ACE inhibitors and ARBs—are especially good for treating people with chronic kidney disease because they help prevent further kidney damage. Diuretics help lower blood pressure in people with chronic kidney disease.
ACE Inhibitors
ACE inhibitors are effective at reducing blood pressure. Cough is a common side effect of ACE inhibitors. Other possible side effects include rash, lightheadedness, and fatigue. There are many available ACE inhibitors:
  • Benazepril (Lotensin)
  • Captopril (Capoten)
  • Enalapril (Vasotec)
  • Fosinopril (Monopril)
  • Lisinopril (Prinivil, Zestril)
  • Moexipril (Univasc)
  • Perindopril (Aceon)
  • Quinapril (Accupril)
  • Ramipril (Altace)
  • Trandolapril (Mavik)
Angiotensin-II Receptor Blockers (ARBs)
Angiotensin-II receptor blockers (ARBs) reduce blood pressure without causing a cough, which occurs fairly often with ACE inhibitors. Possible side effects include fatigue and lightheadedness. Available ARBs include:
  • Candesartan (Atacand)
  • Eprosartan (Teveten)
  • Irbesartan (Avapro)
  • Olmesartan (Benicar)
  • Telmisartan ( Micardis)
  • Valsartan (Diovan)
  • Losartan (Cozaar)
Diuretics are often used in combination with another blood pressure medication. Loop diuretics are commonly used in people with chronic kidney disease. Possible side effects of loop diuretics include muscle cramps, lightheadedness, increased blood glucose, and headache. Available loop diuretics include:
  • Bumetanide (Bumex)
  • Furosemide (Lasix)
  • Torsemide (Demadex )

Diabetes Medications

Glucose-lowering Pills
Glucose-lowering pills reduce blood glucose. Each of the five types works in a different way and has different side effects.
Sulfonylureas stimulate cells in the pancreas to release more insulin. They are usually taken once or twice a day. One important side effect of sulfonylureas is low blood glucose, which can cause confusion and even coma. These medications can sometimes interact with alcohol, so speak with your doctor about drinking alcohol. Four sulfonylureas are available:
  • Chlorpropamide (Diabinese)
  • Glipizide (Glucotrol)
  • Glyburide (Micronase, Glynase, and Diabeta)
  • Glimepiride (Amaryl)
Meglitinides also stimulate cells in the pancreas to release more insulin. They are taken three times a day before meals. Just like sulfonylureas, meglitinides can cause low blood glucose, which can cause confusion and even coma. There are two meglitinides:
  • Repaglinide (Prandin)
  • Nateglinide (Starlix)
Biguanides decrease the amount of blood glucose made by the liver and help muscle tissue better absorb insulin. Metformin (Glucophage) is the only available biguanide. Metformin, which is usually taken twice a day, can cause diarrhea.
Alpha-glucosidase inhibitors
Alpha-glucosidase inhibitors prevent starches, such as bread and pasta, from being digested in the intestines. This slows the increase in blood glucose after a meal. These medications should be taken at the first bite of a meal. Side effects include gas and diarrhea. There are two available alpha-glucosidase inhibitors:
  • Acarbose (Precose)
  • Miglitol (Glyset)
Insulin Injections
Your body needs insulin to use blood glucose properly. If you have diabetes, you may need to take insulin to keep your blood glucose in a normal range. There are five basic types of insulin:
Rapid-acting insulin — Rapid-acting insulin, such as insulin lispro or insulin aspart, start reducing blood glucose about five minutes after injection and are effective for two to four hours.
Regular or short-acting insulin — Regular or short-acting insulin usually starts working about 30 minutes after injection. It continues to work for about three to six hours.
Intermediate-acting insulin — This type of insulin generally reaches the bloodstream about two to four hours after injection. It is effective for about 12-18 hours.
Long-acting insulin —Long-acting insulin, or ultralente, reaches the bloodstream 6-10 hours after injection. It is usually effective for 20-24 hours.
Very long-acting insulin —Very long-acting insulin, such as glargine insulin, begins to lower blood glucose levels about one hour after injection. It works for 24 hours.
Insulin can lead to dangerously low blood glucose. If you are taking insulin, you need to carefully watch your diet and monitor your blood glucose at home.

Lipid Medications

Chronic kidney disease causes high lipid (cholesterol and fats) levels in the blood. High lipid levels increase the risk of heart attack and stroke . One type of fat, triglyceride, is often elevated in people with chronic kidney disease. There are several different types of lipid medications, including:
Fibrates, or fibric acid derivatives, are effective at reducing triglyceride levels. Possible side effects include muscle damage, gallstones, and liver damage. Fibrate medications include:
  • Fenofibrate (Lofibra, Antara, Tricor)
  • Gemfibrozil (Lopid)
Statins, or HMG-CoA reductase inhibitors, are effective at reducing the level of cholesterol and triglycerides in the blood. Possible side effects include headache, muscle damage, and liver damage. Available statins include:
  • Atorvastatin (Lipitor)
  • Fluvastatin (Lescol XL)
  • Lovastatin (Altoprev, Mevacor)
  • Pravastatin (Pravachol)
  • Rosuvastatin (Crestor)
  • Simvastatin (Zocor)
Cholesterol Absorption Inhibitors
Cholesterol absorption inhibitors reduce the amount of cholesterol and fats absorbed in the intestine. These medications lower both cholesterol and triglycerides in the blood. Possible side effects include back pain, liver damage, and abdominal pain. The only available medication of this type is ezetimibe (Zetia).


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