Medications for End-stage Renal Disease (ESRD)

The information provided here is meant to give you a general idea about each of the medication categories listed below. Only the most general side effects are included, so ask your healthcare provider if you need to take any special precautions. Use each of these medications as recommended by your healthcare provider, or according to the instructions provided. If you have further questions about usage or side effects, contact your healthcare provider.

With progressive deterioration of kidney function, there needs to be an adjustment of either the dosage or the frequency of many drugs which depend on normal renal function for their elimination from the body. These drugs include the following:

  • Antibiotics and antiviral: 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

Cinacalcet HCL

  • Sensipar

Diuretics

  • Furosemide (Lasix)
  • Bumetanide (Bumex)

Sevelamer

  • Renagel

Recombinant human erythropoietin (epoetin alfa)

  • Epogen
  • Procrit

Prescription Medications

Cinacalcet HCL

  • Common name: Sensipar

In chronic renal disease, a disturbance in calcium, phosphate, and vitamin D metabolism lead to a condition called secondary hyperparathyroidism , which 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

  • Common name: Renagel

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:

  • Epogen
  • Procrit

This drug is injected and used to treat anemia associated with renal failure. It stimulates 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, which 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, since this medication will increase the sodium in your diet.

Calcium Carbonate or Calcium Acetate

Calcium supplements are given to bind phosphate in order 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 them as directed—not more, not less, not at a different time.
  • Do not stop taking them without consulting your healthcare provider.
  • Don’t share them with anyone else.
  • Know what effects and side effects to expect, and report them to your healthcare provider.
  • If you are taking more than one drug, even if it is over-the-counter, be sure to check with a physician or pharmacist about drug interactions.
  • Plan ahead for refills so you don’t run out.

When to Contact Your Healthcare Provider

Call your healthcare provider if you develop side effects from the medications or experience:

  • Signs of infection, including fever and chills
  • Nausea or vomiting
  • Abdominal pain
  • Dizziness or weakness

References:

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

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.

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.



Last reviewed April 2007 by David Juan, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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