The kidneys are a pair of bean-shaped organs, each roughly the size of a fist, located below the ribcage on either side of the spine. In healthy individuals, the kidneys filter about 200 liters of fluid every day. They remove waste, toxins, and extra water from the blood to make urine. Besides regulating the fluid levels in the body, the kidneys also release hormones, control blood pressure, maintain a balance in electrolytes like sodium and potassium, make red blood cells, and help maintain strong and healthy bones. When the kidneys are diseased, it can lead to a host of medical problems, such as high blood pressure, heart disease, heart attack, stroke, nerve damage, weak bones, anemia, and kidney failure.

Some of the key risk factors for kidney disease include diabetes, high blood pressure, heart disease, obesity, and a family history of kidney disease. Also, people over the age of 60 and those with prolonged use of NSAIDs (non-steroidal anti-inflammatory medications like naproxen and ibuprofen) are at risk of kidney disease. Kidney disease is also more likely in individuals with lupus and other autoimmune diseases as well as those with chronic urinary tract infections or kidney stones.

Stages of Chronic Kidney Disease (CKD)

In people with kidney disease, the damage can range from very mild, where the kidneys are still working relatively well, to severe, where there is complete kidney failure. To help manage patients and decide on the appropriate treatment plan, kidney disease is categorized into stages based on how well the kidneys are working to filter waste and extra fluid out of the body. Doctors use a number called the eGFR (estimated glomerular filtration rate) that measures creatinine, a waste product in the blood. The higher the eGFR number, the better your kidney function.

• eGFR of 90 or higher is stage 1 CKD

• eGFR between 60 and 89 is stage 2 CKD

• eGFR between 30 and 59 is stage 3 CKD

• eGFR between 15 and 29 is stage 4 CKD

• eGFR less than 15 is stage 5 CKD

Dialysis

Patients with stage 5 chronic kidney disease (eGFR less than 15) are in end-stage kidney failure. They have lost up 90% of their kidney function and their kidneys can no longer remove waste materials or prevent water from building up in the body. The levels of electrolytes such as potassium and sodium reach unsafe levels as a result of poor kidney function. Blood pressure goes out of control because the kidneys are not working as they should. In such individuals, a treatment called dialysis may need to be performed to remove waste and extra fluid from the body. Dialysis is often performed while a patient awaits a kidney transplant.

There are two types of dialysis – hemodialysis in which the blood is passed through a hemodialyzer machine (artificial kidney) to clean it – and peritoneal dialysis in which a solution called dialysate is filled into the peritoneal (abdominal) cavity to draw out the extra fluid and waste from the blood.

Medications for Kidney Health

Dianeal is a sterile solution used for peritoneal dialysis. It contains dextrose as an osmotic agent which creates a gradient between the peritoneal membranes of the body and the dialysis solution, causing filtration to occur. The solution also contains electrolytes to correct imbalances. A buffer (lactate) is present to normalize abnormalities in acid-base balance. Dianeal is available in three concentrations – 1.5%, 2.5%, and 4.25%.

Extraneal (icodextrin) is a peritoneal dialysis solution for use in end-stage renal disease patients undergoing continuous ambulatory peritoneal dialysis (CAPD).

Antihypertensive medications like aliskiren (Tekturna) are used alone or in combination with other medicines to treat high blood pressure in patients with kidney disease. The medication works by blocking an enzyme called renin which is needed to make a substance that narrows blood vessels. Treatment with aliskiren, therefore, makes blood vessels relax and widen, leading to a decrease in blood pressure. It is an oral medication available in tablet form.

Over-the-Counter Medications for Kidney Health

Patients with chronic kidney disease and those who are on dialysis treatments may be limited in eating certain food groups in their diet. They may, therefore, not be getting sufficient amounts of essential vitamins and minerals and could therefore require supplements. A healthcare provider can determine which vitamins and minerals are deficient – they can do this by looking at a patient’s blood test reports. Some of the supplements that patients with CKD may require include B vitamins, vitamin C, vitamin D, iron, and calcium. On the other hand, certain vitamins like vitamins A, E, K may need to be avoided because they can build up in the bodies of patients with CKD. In general, people with kidney disease should avoid taking over-the-counter nutritional supplements without talking to a healthcare provider or pharmacist.

Common Side Effects of Kidney Medications

The use of peritoneal dialysis solutions like Dianeal can lead to infections and infestations (catheter-related infections). Other potential side effects include fluid retention, dehydration, hypervolemia or hypovolemia (high or low fluid levels in the body), hypokalemia (low potassium), hyponatremia (low sodium), and hypochloremia (low chloride). Use of Dianeal may also cause blood pressure fluctuations, shortness of breath, peritonitis (inflammation of the abdominal lining), and abdominal discomfort. Allergic reactions like urticaria, rash, and itching have also been reported. Some patients experience muscle aches and pains, malaise, swelling, or pain at the infusion site.

Renin-inhibitors like aliskiren cannot be used in pregnant women as they can harm the unborn baby. The potential side effects of aliskiren include allergic reactions with rash, itching, swelling of the lips, face, and tongue, and trouble breathing. Other possible side effects are lightheadedness or dizziness, nausea, vomiting, and diarrhea.

Common Questions

How common is kidney disease?

According to the National Kidney Foundation, an estimated 37 million American adults (15% of the population or 1 in 7 adults) have chronic kidney disease. Approximately 100,000 people are waiting for a kidney transplant in the U.S. at any given time. It may surprise you to learn that 90% of people with chronic kidney disease are not aware they have the condition and 1 in 3 are at risk.

What can I do to reduce my risk of kidney disease?

You can help keep your kidneys healthy by keeping blood sugar levels and blood pressure under control – diabetes and high blood pressure are leading causes of chronic kidney disease. Stay active and eat a balanced diet to maintain a healthy body weight. Drink plenty of fluids. Get regular check-ups if you have a family history of kidney disease or believe you are at higher risk.

Can I get a discount on renal (kidney) medications with BuzzRx?

Yes, you can get discounts on some medicines—including renal medications—as long as you have a signed prescription from your doctor.

References:

1.       https://www.kidney.org/atoz/content/sixstepshealthprimer

2.       https://www.nhs.uk/Livewell/Kidneyhealth/Documents/kidney%20guide.pdf

3.       https://www.niddk.nih.gov/health-information/kidney-disease/kidneys-how-they-work

4.       https://www.kidneyfund.org/kidney-disease/chronic-kidney-disease-ckd/stages-of-chronic-kidney-disease/

5.       https://www.kidney.org/atoz/content/dialysisinfo

6.       https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/020183s024lbl.pdf

7.       https://www.mayoclinic.org/drugs-supplements/aliskiren-oral-route/description/drg-20070895

8.       https://www.kidney.org/atoz/content/vitamineral

9.       https://www.kidney.org/news/newsroom/factsheets/KidneyDiseaseBasics