by Wood D
Medications for End-stage Renal Disease (ESRD)
The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included. Ask your doctor if you need to take any special precautions. Use each of these medications only as recommended by your doctor, and according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
With progressive deterioration of kidney function, there needs to be an adjustment of either the dosage or the frequency of many drugs that depend on normal renal function for their elimination from the body. These drugs include the following:
- Antibiotics and antiviral medicine:
acyclovir
,
amantadine
,
ampicillin
,
cefazolin
,
cephalexin
, ciprofloxacinpenicillin,
tetracycline
- Drugs to lower stomach acid:
ranitidine
,
cimetidine
If you have
high blood pressure
,
hyperlipidemia
, or
diabetes
, medications will likely be ordered to control these conditions. Leakage of protein from the urine (proteinuria) is treated with two drugs used in the treatment of high blood pressure: ACE inhibitors and angitensin receptor blockers (ARBs). In addition, medications may be needed to treat complications of kidney disease. There are no medications to cure or reverse kidney failure.
Prescription Medications
Diuretics
- Furosemide (Lasix)
- Bumetanide (Bumex)
Over-the-Counter Medications
Prescription Medications
Cinacalcet HCL
In chronic renal disease, a disturbance in calcium, phosphate, and vitamin D metabolism lead to a condition called secondary
hyperparathyroidism
. It is characterized by abnormally high levels of parathyroid hormone (PTH) levels in the blood. The high PTH levels lead to uremic bone disease. A recently approved drug, Cinacalcet HCL is effective in lowering the elevated PTH levels in chronic renal failure patients. It is taken by mouth.
Possible side effects include:
- Nausea
- Vomiting
- Transient low blood calcium level
Diuretics
Common names include:
- Furosemide
(Lasix)
- Bumetanide
(Bumex)
Diuretics help rid the body of excess fluid. These medications are sometimes referred to as water pills. Diuretics may be taken by mouth or, in some cases, by injection.
Possible side effects include:
- Dizziness
- Mouth dryness
- Weakness
- Frequent urination
Sevelamer
This agent, which is taken by mouth, binds phosphate to prevent increased blood phosphate levels that can lead to weakening of bones. The medication does not contain calcium, aluminum, or magnesium.
Possible side effects include:
- Nausea
- Diarrhea
- Upset stomach
Recombinant Human Erythropoietin (Epoetin Alfa)
Common names include:
This drug is injected and used to treat anemia associated with renal failure. It stimulates the production of red blood cells.
Possible side effects include:
- Headache
- Increased blood pressure
- Joint aches
- Nausea
Over-the-Counter Medications
Sodium Bicarbonate
Typically taken orally, sodium bicarbonate may be ordered if you develop a condition called metabolic acidosis. This is an excess of acid in the blood due to alterations in metabolism from kidney failure.
If you need to use sodium bicarbonate, you should review your dietary sodium intake with your physician or dietician. This medication will increase the sodium in your diet.
Calcium Carbonate or Calcium Acetate
Calcium supplements are given to bind phosphate to maintain phosphate levels within a range that will not increase bone loss. These drugs are taken orally.
Possible side effects include:
- Constipation
- Loss of appetite
- Slow heart rate
Special Considerations
Whenever you are taking a prescription medication, take the following precautions:
- Take your medication as directed. Do not change the amount or the schedule.
- Do not stop taking them without talking to your doctor.
- Do not share them.
- Know what the results and side effects may be. Report them to your doctor.
- Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medication and herb or dietary supplements.
- Plan ahead for refills so you do not run out.
When to Contact Your Doctor
Call your healthcare provider if you develop side effects from the medicines or experience:
- Signs of infection, including fever and chills
- Nausea or vomiting
- Abdominal pain
- Dizziness or weakness
References
Brenner, BM et al.
Brenner & Rector’s The Kidney
. 9th ed. Philadelphia, PA: Saunders, 2011.
Chronic kidney disease. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
. Updated October 12, 2012. Accessed October 16, 2012.
Coladonato JA. Control of hyperphosphatemia among patients with ESRD.
J Am Soc Nephro.
2005;16:S107-114
Ferri, Fred, ed.
Ferri’s Clinical Advisor 2010
. 1st ed. Philadelphia, PA: Mosby Elsevier, 2009.
Goldman L, Ausiello D., eds.
Cecil Textbook of Internal Medicine
. 23rd ed. Philadelphia, PA: Saunders, 2008.
Malluche HH, Mawad H, Monier-Faugere MC. The importance of bone health in end-stage renal disease: out of the frying pan, into the fire?
Nephrol Dial Transplant.
2004;19:9-13.
End-stage renal disease. National Institute of Diabetes & Digestive & Kidney Diseases website. Available at:
http://www2.niddk.nih.gov/Research/ScientificAreas/Kidney/KEB.htm
Updated September 15, 2010. Accessed October 16, 2012.
Rakel, R.
Textbook of Family Medicine 2007
. 7th ed. Philadelphia, PA: Saunders Elsevier, 2009.
Rakel, RE, Bope, ET
Conn's Current Therapy
. 60th ed. Philadelphia, PA: Saunders Elsevier, 2009.
Torres PU. Cinacalcet HCL: a novel treatment for secondary hyperparathyroidism caused by chronic kidney disease.
J Ren Nutr.
2006;16:253-258.
Wein, AJ et al.
Campbell-Walsh Urology
. 9th ed. Philadelphia, PA: Saunders, 2007.
Yu HT. Progression of chronic renal failure.
Arch Int Med.
2003;163:1417-1429.