Medicines and Kidney Disease

When you take medicines, your kidneys or liver break them down, so they can do their job. This process is called drug metabolism. When you have kidney disease, your kidneys don’t work as well as they should, and this can change how your body responds to some medicines.

This is why you may need to change or stop some medicines or take them at a different dose. It is important to check with your doctor or pharmacist before you start taking any new medicines, to find out if they are ok for your kidneys. This includes any medicines you may buy over the counter at the supermarket or pharmacy.

The medicines your doctor prescribes will depend on your overall health, the stage of your chronic kidney disease (CKD), and which treatment options will help you best. The medicines you take are likely to change over time, as your overall condition and health changes.

If you are seeing a new health professional, it is important that you tell them about your kidney disease, as this may influence their choice of medicines and other treatments. This includes health professionals such as your dentist, who may also prescribe medicines for you.

There are several medicines that you may take to help your kidneys. Some of these medicines may also help with other health conditions. For example, there are medicines that help with lowering your blood pressure and your kidneys to work better for longer.

If you are living with CKD, you may take medicines to:

• control high blood pressure, called anti-hypertensives.
• keep your heart healthy, for example cholesterol tablets.
• control other health conditions such as diabetes, pain, and arthritis.
• remove excess fluid, called diuretics.
• control your phosphate levels.
• maintain strong bones, muscles, and overall health, such as vitamin D tablets.
• help with anaemia (low red blood cells).

Talking to your doctor of pharmacist can be helpful to understand which medicines you take, what they are used for, and how they work. Before starting any new medicines, ask your doctor about getting:

• a blood test to check your current kidney function and potassium levels
• a urine test to check for albumin (uACR test)

After starting medicines, be sure to get any repeat blood tests, urine tests, and blood pressure readings. These tests help your doctor to see if your new medicines are working and not causing any other problems.

There are several medications that are approved for use in Australia that can help slow the progression of CKD.  Some of these medications have studies showing delayed progression of the disease by 15 years or more. 

Most people with CKD should be on an ACE inhibitor or ARB and a SGLT2 inhibitor to treat their kidney disease. There are other medicines that are used to help treat kidney disease. If you are not on these medications, ask your healthcare team if they are right for you.  You can also ask your local pharmacist for a medicine review. 

Your medicines have very important benefits for your kidneys, but some come with side-effects. Your doctor or pharmacist should let you know what side-effects to look out for. If you think your medicine is causing a side-effect, be sure to alert your doctor.

To get the full benefits, it is important to:

• take your medicines as agreed with your doctor, at the correct time and dose.
• discuss with your doctor if you have any problems with your medicines.
• talk to your doctor first before stopping any medicines.
• check with your doctor before starting any new medicines, including over-the-counter medicines, e.g., vitamins, herbal and complementary medicines.
• see your doctor regularly and complete any tests that are recommended, e.g. blood tests.

• Ask your doctor for a printout of your medicines. We recommend that you keep an up-to-date list in your purse, wallet, or phone so that it is always on hand.
• Talk to your healthcare team to learn about your medicines and what they do. You could also ask if there are any new medicines that might help improve your health.
• Making sure your family or carer is aware of your medicines can also be helpful.
• Know which over-the-counter medicines you should avoid.
• Talk with your doctor, nurse, or pharmacist if your medicines are causing you side effects or if you are unable to afford them.
• It can be useful to arrange a Home Medicines Review with your pharmacy, through a referral from your doctor. A Home Medicines Review may involve a check of all your medicines, advice on how to best take and store them.
• All people with CKD should make a Sick Day Action Plan with their doctor, which includes a list of medicines that you should temporarily stop taking if unwell or dehydrated, e.g., if you have gastro (runny poo) or a fever. This can help to protect your kidneys from injury. You can print out the Sick Day Action Plan and complete it with your doctor.