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. If you have high blood pressure , hyperlipidemia , or diabetes , medications will likely be ordered to control these conditions. Leakage of protein from the urine is treated with two drugs used in the treatment of high blood pressure: angiotensin-converting enzyme (ACE) inhibitors and angiotensin 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

Cinacalcet HCL
  • Sensipar
Diuretics
  • Furosemide (Lasix)
  • Bumetanide (Bumex)
Sevelamer
  • Renagel
Recombinant human erythropoietin (epoetin alfa)
  • Epogen
  • Procrit

Over-the-Counter Medications

Sodium bicarbonateCalcium carbonate or calcium acetate

Prescription Medications

Cinacalcet HCL
  • Common name: Sensipar
In chronic renal disease, a disturbance in calcium, phosphate, and vitamin D metabolism leads to a condition called secondary hyperparathyroidism . It is characterized by abnormally high levels of parathyroid hormone (PTH) in the blood. The high PTH levels lead to uremic bone disease. 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
  • 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:
  • Lightheadedness
  • Mouth dryness
  • Weakness
  • Frequent urination
SevelamerCommon name: RenagelThis 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:
  • Epogen
  • Procrit
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 BicarbonateTypically 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 AcetateCalcium 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 ConsiderationsWhenever 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.
  • Ask 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 DoctorCall your healthcare provider if you develop side effects from the medications or you have:
  • Signs of infection, including fever and chills
  • Nausea or vomiting
  • Abdominal pain
  • Lightheadedness or weakness

References

Chronic kidney disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 22, 2013. Accessed July 2, 2013.

Coladonato JA. Control of hyperphosphatemia among patients with ESRD. J Am Soc Nephro. 2005;16:S107-114

Malluche HH, Mawad H, et al. 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 July 2, 2013.

Torres PU. Cinacalcet HCL: a novel treatment for secondary hyperparathyroidism caused by chronic kidney disease. J Ren Nutr. 2006;16:253-258.

Yu HT. Progression of chronic renal failure. Arch Int Med. 2003;163:1417-1429.

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