Chronic Kidney Disease (CKD) is the pathological condition where the kidney function is impaired due to a specific reason. As kidney function declines and the disease progresses the patients’ CKD stages progress from stage 1 to 5 and finally to the End Stage Renal Disease (ESRD). The development of CKD and ESRD can cause various disturbances in the serum electrolyte (e.g., phosphorus, calcium) and hormonal levels (e.g., parathyroid hormone, erythropoietin) and therefore, require treatment with specific medications. Patients with CKD and ESRD who are on dialysis may require more of these medications based on the severity of the serum electrolyte and hormonal level disturbances. The dose requirements are also depended on these levels. Each of these medication families has its specific mechanism of action, adverse effect profile, contraindications
The following sections provide a summary of the secondary conditions that develop in CKD and ESRD patients and their corresponding treatments.
CKD-MBD (MINERAL BONE DISEASE)
HIGH SERUM PHOSPHATE (Hyperphosphatemia)
Purpose of Phosphate Binders: To control serum phosphate levels in Chronic Kidney Disease (CKD) patients. These medications need to be consumed with the meals in order to be effective.
Phosphate Based Phosphate Binders
Calcium Based Phosphate Binders
Calcium acetate: Drug information
Iron Based Phosphate Binders
Sucroferric oxyhydroxide: Drug information
Lanthanum carbonate: Drug information
HIGH SERUM PARATHYROID HORMONE
Patients with CKD develop hyperparathyroidism as an outcome (Secondary Hyperparath
Cinacalcet: Drug information
Patients who have anemia secondary to CKD are treated by intravenous iron and/or intravenous erythropoiesis-stimulating agents (ESAs). The treatment is based on the serum levels of Hemoglobin (being the most important factor), transferrin saturation (TSAT), ferritin as well as red blood cell (RBC) count, reticulocyte count, serum iron, total iron-binding capacity (TIBC), serum folate and vitamin B12. The ultimate goal is to prevent the Hemoglobin dropping which may require blood transfusion(s).
HIGH SERUM URIC ACID (Hyperuricemia)
LOW SERUM CALCIUM (Hypocalcemia)
One of the main causes of hypocalcemia in CKD patients is Vitamin D Deficiency. This is especially true in late CKD stages or patients with ESRD who are on dialysis. These patients require intravenous active vitamin D analogs more so than they require oral calcium.
HIGH BLOOD PRESSURE (Hypertension)
Hypertension can be a condition of its own, or can be caused by another disease/syndrome. Since patients with hypertension can have many other coexisting conditions such as Diabetes and prostate enlargement hypertensive medications should be prescribed by their physicians by taking these factors into consideration. Here is a list of frequently prescribed anti-hypertensive medications with their generic and brand names:
Diuretics are a group of medications that enable the kidneys produce urine by filtering unnecessary amount of fluids, electrolytes (ex: sodium, potassium) the blood circulation has. The following are oral diuretic agents that are used by CKD patients:
Disclaimer: The UCLA Health System cannot guarantee the accuracy of such information. The information is provided without warranty or guarantee of any kind. Please speak to your Physician before making any changes.