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Medications are amazing if used prudently– they save lives, improve well-being and allow one to enjoy life despite illness. However, it can be easy to overlook their risks and side effects, especially if you don't think they apply to you.
Chronic kidney disease (CKD) is a common but silent and often under-recognised condition. It is a condition in which the kidneys lose some of their ability to remove waste products and excess fluid from the bloodstream. As waste products and fluids build up in the body, other body systems are affected, which can be harmful to your health.
Secretion and reabsorption of various substances throughout the nephron, the single unit in the kidney. OpenStax College, CC BY 3.0, via Wikimedia Commons
According to a population-based study of 15,147 Malaysians,, 9.07% of respondents have CKD, but only 4% of them were aware of the diagnosis! The number of Malaysians with CKD are projected to significantly increase in the future mainly due to the increasing prevalence of diabetes, hypertension and the aging population.
CKD should not be ignored because having CKD puts you at higher risks for death and heart diseases, among many other health problems. When CKD progresses to the end stage, you would have no choice but to undergo dialysis, which in itself has many health complications and brings economic burden.
Medications enter our body to do their jobs, and they ought to leave eventually, or else they might cause toxicity to our body.
There are two ways the medications can be eliminated from our bloodstream:
through kidneys in urine
by excretion in the bile (a greenish yellow fluid secreted by the liver and stored in the gallbladder).
The majority of the medications –prescription and over-the-counter alike – are filtered by your kidneys. This means that your kidneys degrade and remove medications from the body. When your kidneys aren't working properly, medications can build up and cause you harm.
Many CKD patients have other long-term illnesses that require them to take prescription medications for life. Therefore, if you have CKD, besides having to deal with the health effects it brings you, you also have to watch out for the medications you take.
In CKD, you experience a deterioration in your kidney function. When we say ‘kidney function’, what we really mean is the eGFR measurement. You can determine your level of kidney function with a blood test for serum creatinine to calculate an eGFR measurement. An eGFR estimates how well your kidneys are filtering wastes from the blood. It is also what informs your doctor about the stage of your CKD.
Image credit: https://www.kidney.org/atoz/content/gfr
On the other hand, when a doctor or a pharmacist needs to decide if your kidney can safely eliminate a certain medication after you take it, he or she would calculate your creatinine clearance (CrCl). It is very closely correlated to eGFR. The healthcare provider would then adjust the dose of your medications (if necessary) based on your CrCl or eGFR measurements. When we say ‘dose adjustment’, it usually means reducing the amount of medications you take; it could also mean increasing your interval of taking the medications. You should not adjust the dose of your medications on your own without a doctor’s supervision.
Some medications should be avoided altogether in CKD; while some medications are safe to consume as regular doses even in CKD. We can’t talk about all of them in this article, and that’s why you are encouraged to speak to your doctor or pharmacist to determine whether the medications that you're taking should be adjusted based on your kidney function.
There are various types of cholesterol medications, the most commonly prescribed one is known as statins, e.g. atorvastatin and simvastatin. If you have CKD, the dose of your statins may need to be adjusted, as they are cleared by your kidneys. Note: We did not say that you should avoid your cholesterol medication. In fact, you should not stop taking your cholesterol medication unless your doctor asks you to. If you have CKD and are taking a statin, discuss this with your doctor to see if dose adjustment is needed.
NSAIDs are a group of painkillers, and are one of our favourite topics to write. NSAIDs are not recommended in CKD patients because they can reduce blood flow to the kidney, which worsens the kidney’s function. Because you don’t need a doctor’s prescription to get NSAIDs, many CKD patients have the habit to purchase NSAIDs from pharmacies and use them without prudence. If you have long-term body pain and need NSAIDs as a result, talk to a healthcare provider and explore other treatment options which may do less harm to your kidneys.
Many antifungal, antibiotic and antiviral medications are cleared by the kidneys. If you have CKD, it's important that you and your doctor are aware of your level of kidney function so that a kidney-safe medication can be prescribed for your treatment.
CKD and diabetes are good pals. People with diabetes are at a higher risk for CKD, partly because high blood sugar level can damage the blood vessels in the kidneys. We wrote an article on diabetic kidney disease, check it out here. Certain diabetes medication, such as metformin, is cleared by the kidney and may require a dose adjustment in certain cases of CKD. Again, if you have CKD and diabetes, your first instinct after reading this should not be: “Omg I need to quit taking my diabetes medication!”. Rather, you should have a discussion with your doctor to see if dose adjustment is needed for your diabetes medications. If anything, you should strictly adhere to your diabetes treatment, because if your diabetes is poorly controlled, your kidney’s function is going to get even worse!
We mention this group of medications for a slightly different reason than the previous ones: if you have CKD and you take over-the-counter antacids, they may disrupt your body’s electrolyte balance. These antacids contain high amounts of sodium or potassium, which may pose some health problems to people with CKD. Check with your doctor to see if these are safe for you to use.
Kidney is such an important organ. In conjunction with the World Kidney Day 2021, we would like to urge everyone to start taking care of that little precious! If you have CKD, make sure you do the following to preserve its functions before it’s too late:
Follow strictly your treatment regimen for diabetes and high blood pressure.
Always attend your appointment with the doctor to check on your kidney.
Do not buy over-the-counter products without consulting your doctor first. An over-the-counter product does not mean it is safe for your kidney.
If you have any questions related to medications usage in kidney disease, you can consult our professional doctors and healthcare professionals on Doc2Us. Doc2Us is a mobile application that allows you to talk to a doctor or any healthcare professionals via text chat at any time and from anywhere. For better communication, you can even send our online doctor images or voice messages related to your medical inquiry.
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UpToDate - Patient education: Chronic kidney disease (Beyond the Basics)
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