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IOANNIS GRIVEAS

MD,PhD

Chapter 5 - Medications

23 January 2022

What medicines must I take?
It’s your right and responsibility to understand what medicines you’re taking, why you’re taking them and how to take them. For example, some medicine' should be taken with meals and other medicines should be taken on an empty stomach. It’s important to tell your medical team if you have stopped or changed your medicines. Always let your pharmacist know you have CKD and be sure to ask if there is anything you should know about the medication. Stopping or changing medicines may affect other areas of your treatment. When you have CKD, medications may be prescribed to: help your body make red blood cells, control blood pressure, help replace vitamins and minerals, keep your bones strong, gc: get rid of phosphorus that builds up when your kidneys aren’t working fully well and treat infection or other illnesses you may have.

Some common medications you may be prescribed include:

  • Iron is used to help your body make red blood cells.
  • Erythropoietin is a hormone that helps stimulate red blood cell production. It’s identical to the naturally occurring erythropoietin manufactured in the kidney.
  • Blood pressure medicine is used to keep your blood pressure under control. If it’s not controlled, you could have heart failure, a stroke or cause further damage to you kidneys.
  • Corticosteroids (steroids) are often given to reduce inflammation or provide relief from pain. When your kidneys aren’t working as well as they should, you may have some pain or swelling of the kidneys. Discuss any side effects of corticosteroids with your healthcare provider.
  • Vitamins and minerals enhance your health and supplement your diet.
  • Calcium helps keep your bones strong and your heart muscles healthy.
  • Phosphorus binders help your body “tie up” the phosphorus in your stomach so it cannot build up in your body. Not taking your binders can lead to long-term bone disease.
  • Antibiotics help your body fight infections. However, when your kidneys aren’t working as well as they should, antibiotics dose and blood levels need to be carefully monitored. Thus, if another doctor gives you an antibiotic, be sure to ask your nephrologist if the dose is OK.

What medicines should I avoid?
Many people take over the counter medicine, herbal remedies, vitamins or supplements, to help them to feel better. When you have CKD, some of these medicines or remedies may actually make you sick or could even be life threatening. Make sure you tell your medical team about all medicines and remedies you’re taking.

There are some common medicines to avoid:

  • NSAIDS are anti-inflammatory medications like Advil, Nuprin, Ibuprofen or Aleve can damage the kidneys.
  • Vitamins or food supplements may have potassium and magnesium in them.
  • Any "cure all" remedies and over-the-counter medicines that have not first been discussed with your doctor.
  • Herbal medicines. What is alternative or complementary medicine? In recent years, there has been a growing trend to use alternative or complementary medicine. These are treatments that are used in addition to traditional western medicine. Common kinds of these treatments include acupuncture, herbal remedies, chiropractic therapies, over-the- counter medicines, mind-body techniques and others. Some mind and body techniques such as breathing exercises and visualization are safe and effective to help manage stress. Although some people find benefit in these types of treatments and medicines, there may be harmful side effects. Tell your doctor about all the medical treatments you’re using. Before trying any complementary therapies or medicines, please check with your doctor.

Are there any herbal products that may cause further damage to my kidneys?
It’s important to understand that pharmaceutical drugs and herbs are not regulated in the same way. Herbs and a number of other biologically active substances are classified as dietary supplements. Regulations of these supplements are based solely upon adverse events, i.e., they are considered safe until proven harmful. Unfortunately, since herbs are not regulated with kwon ways they can be potentially very dangerous. In contrast, drugs must prove they are safe through clinical trials before they are allowed on the market. As a result, herbals can contain pesticides, heavy metals and/or poisonous plants.

Another aspect of herbal supplementation use to consider is drug interaction. People with CKD are on a number of medications. Herbals can boost or decrease the effectiveness of prescribed medications.

It’s critical to mention to your doctor any herbals, over-the-counter medications and products purchased from health food stores you may be using.