What are common CKD drugs?

What are common CKD drugs?

In this article, we will describe what are common CKD drugs. . They are in alphabetical order.

For each drug (or group) we will give one example, and the normal dose range in CKD. All drugs are oral unless stated.

1. Alkali

E.g. Sodium bicarbonate (500mg 2x, to 2g 2x/day)

This is an alkali tablet. Some patients have high levels of acid in their blood, and need these tablets will control that. Alkalis are the ‘opposite’ of acids.

2. Blood pressure (BP) tablets

E.g. Ramipril (2.5-10mg 1x/day)
Losartan (25-100mg 1x)
Bisoprolol (2.5-10mg 1x)
Amlodipine (2.5-10mg 1x)
Doxazosin (2mg 1x, to 8mg 2x)
Hydralazine (12.5mg 2x, to 100mg 3x).

Having normal (or better low) BP is the single most useful treatment for CKD. Aim for under 130/80 all the time (at home, GP or hospital)”

3. Calcimimetic

E.g. Cinacalcet (30mg 1x/day initially)

This is in an example of a calcimimetic. It is used to treat renal bone disease. It works by telling the parathyroid glands (in the neck, in front of the thyroid gland) to produce less parathyroid hormone (PTH) in order to decrease the amount of calcium in the blood.

4. Cholesterol tablets

E.g. Atorvastatin (10-80mg 1x/day)

This is a HMG-CoA reductase inhibitor (or ‘statin’). They control cholesterol. They may not be necessary if dietary means can achieve control.

5. Diabetes

There is now a large range of tablets and injection used to treat diabetes in patients with CKD. There is more information on them here on the Diabetes UK website.

Note. Metformin (a biguanide) – is commonly used for Type 2 Diabetes. But you should stop metformin if the eGFR is below 30 ml/min (CKD3B) (or a creatinine >200 mcml/L) – because of the risk of lactic acidosis.

6. Diuretics (‘water tablets’)

E.g. Bendroflumethazide (2.5-10 mg 1x/day)
Furosemide (20 1x/day to 120 mg 2x day, or 250 mg 1x/day; 40 mg 1x/day is a typical dose)
Bumetanide (1mg 1x, to 5mg 2x/day)

Many patients have too much water in the body (shown by ankle swelling and shortness-of-breath). If so, diuretics, which stimulate the kidneys to make more urine, will help.

7. Erythropoeitin (EPO)

Many patients with CKD4-5 have anaemia which means a lack of blood in the body which can make you tired. This is easy to treat with an EPO injection once a week, or tablets to stimulate EPO, which will give you more energy.

Darbepoetin alfa (e.g. 30mcg subcut 1x week)

This is an erythropoiesis-stimulating agent (ESA).

Roxadustat (e.g. 100mg 3x/week)

This is a hypoxia-inducible factor–prolyl hydroxylase (HIF-PH) inhibitor.

When the haemoglobin (‘HB’; marker of anaemia) falls below 100 g/L, EPO should be considered. The target haemoglobin is 110-120 g/L in men and women.

Iron supplementation

These can be given as tablets or injections – might also be necessary, as iron deficiency is common in CKD patients. It will help EPO to work.

8. Phosphate binders 

E.g. Calcium Acetate (475mg 3x/day, with food)

This is used to treat renal bone disease by increasing the calcium, and lowering phosphate and parathyroid hormone (PTH) levels in the blood.

9. ‘Renoprotective’ (kidney protective’ tablets)

ACE inhibitors (e.g. Ramipril) and ARB antagonists (e.g. Losartan)

These are blood pressure tablets that have a special effect on the kidneys as they reduce protein levels in the urine, which is damaging. Ask your doctor to be considered for one, if you are not on one.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors (e.g. Dapagliflozin 10mg 1x/day)

These are a newish class of drugs that reduce blood glucose levels by increasing the amount of glucose lost in the urine. But they have also been shown to be useful for many patients with CKD, especially if there is alot of protein in your urine (with or without diabetes). Again, ask your GP if you are not on one.

10. Vitamin D

E.g. Alfacalcidol (0.25-1.0mcg 1x/day)

This is used to treat renal bone disease by increasing the calcium, and lowering parathyroid hormone (PTH) levels in the blood.

Other drugs

Gout (prophylaxis, i.e. prevention)

E.g. Allopurinol (100mg 1x day (not 300mg))

Allopurinol is from a class of medication called xanthine oxidase inhibitors. It works by reducing the production of uric acid in the body.

Yes, this will be alot of tablets, sorry

But they are necessary, to keep you well. But as they may contribute to not getting to the next stage of CKD, they are worth it.

Lifestyle and diet

This includes keeping your weight down (if overweight), regular exercise, quitting smoking, and limiting alcohol intake. These changes can help manage CKD and may slow its progression.

A low sodium diet will help BP and water tablets to work better. A low protein diet may improve the symptoms of CKD. Talk to your dietitian about these diets.

Summary

We have described what are common CKD drugs. We hope it has been helpful.

Other resources

Kidney Care UK has alot of useful information about medication in CKD.
10 best water tablets (diuretics)
Best medication for congestive heart failure
10 top tips for good prescribing

Last Reviewed on 11 May 2024