Medicines for chronic kidney disease
The general goal of treatment for chronic kidney disease (CKD) is to reduce both disease progression and cardiovascular risk. Typically, this involves the use of medicines that treat comorbidities and risk factors and can offer protection against further kidney damage in the early stages of the disease. Managing existing conditions like diabetes, high blood pressure and cardiovascular disease before kidney disease develops and in the early stages of CKD is critical in protecting the kidneys in the long-term.
For more information, see Diabetes medicines and Medicines for cardiovascular disease.
Managing medications in chronic kidney disease
In stages 3–5 CKD, medicine use must be carefully managed. This is because medicines that are excreted through the kidneys have the potential to build up in the body and be toxic to the kidneys or other organs (Hartmann et al. 2010). To avoid this, clinical assessment and management of medication are important components of treating and managing later stages of CKD.
Management should be tailored to each individual and may involve stopping or lowering the dosage of certain medications or, when available, using alternatives that are not eliminated from the body through the kidneys (Faull and Lee 2007, Hartman et al. 2010, KHA 2020). In Australia, medication reviews are subsidised under Medicare and may be beneficial for people with CKD.
Potentially inappropriate medication use in clinical management of chronic kidney disease
Inappropriate prescribing in CKD involves the prescription of medications that are filtered or excreted through the kidneys and may potentially harm those taking them. As such, the types and dosages of medicines prescribed to people with CKD should be carefully monitored.
A potentially inappropriate prescription can include a contraindicated medicine, or too high a dose for a persons’ level of kidney function.
In Australia, between 1.5% and 2.6% of people with CKD were potentially inappropriately prescribed the combination of an ACE inhibitor, diuretic and non-steroidal anti-inflammatory drug (NSAID) (the ‘triple whammy’), according to estimates from 2016 and 2019 (Bezahbe et al. 2020, NPS MedicineWise 2020). Kidney Health Australia advises against using this combination of medicines in people with CKD, due to the increased risk of acute kidney injury.
Castelino and colleagues (2020) found that 35% of all Australians with CKD were given at least one potentially inappropriate prescription. The rate of potentially inappropriate prescribing increased with the stage of CKD, with 69% of people with stages 4–5 CKD receiving at least one potentially inappropriate prescription.
Bezabhe WM, Kitsos A, Saunder T, Peterson GM, Bereznicki LR, Wimmer B, Jose M and Radford J (2020) Medication prescribing quality in Australian primary care patients with chronic kidney disease, Journal of Clinical Medicine, 9(3):783, doi:10.3390/jcm9030783.
Castelino RL, Saunder T, Kitsos A, Peterson GM, Jose M, Wimmer B, Khanam M, Bezabhe W, Stankovich J and Radford J (2020) Quality use of medicines in patients with chronic kidney disease, BMC Nephrology, 21:216, doi:10.1186/s12882-020-01862-1.
Faull R and Lee L (2007) Prescribing in renal disease, Australian Prescriber, 30(1):17–20, doi:10.18773/austprescr.2007.008.
Hartmann B, Czock D and Keller F (2010) Drug therapy in patients with chronic renal failure, Deutsches Arzteblatt International, 107(37):647–655, doi:10.3238/arztebl.2010.0647.
Kidney Health Australia (KHA) (2020) Chronic kidney disease (CKD) management in primary care, 4th edn, KHA, Melbourne, accessed 11 April 2022.
NPS MedicineWise (2020) Clinical review, testing and management of renally cleared medicines among MedicineInsight patients with chronic kidney disease in 2018–2019, Sydney: NPS MedicineWise, accessed 11 April 2022.