Patients with end-stage renal disease have kidneys that no longer remove waste and excess fluid from the body. These patients require dialysis or transplantation to survive. The most commonly prescribed medications to treat patients with end-stage renal disease include blood pressure medications, phosphorus-lowering medications, anemia medications and vitamin D. Medication intake for end-stage renal disease is specific to each patient.
Blood Pressure Medications
Kidneys control blood pressure. When kidneys fail they can no longer perform this function properly. Therefore, most patients with kidney disease end up taking blood pressure medications. All types of blood pressure medications are shown to be effective in lowering blood pressure in end-stage renal disease. The most commonly prescribed blood pressure medications are angiotensin-converting enzyme, or ACE, inhibitors and angiotensin-receptor blockers, or ARBs. ACEs and ARBs not only reduce blood pressure but slow down the loss of kidney function as well. Diuretics are also commonly used for lowering blood pressure. People with end-stage renal disease retain fluid leading to swelling in the arms and legs. Diuretics help maintain the balance of fluids in the body.
Hyperphosphatemia, a condition accompanied by high phosphorus levels is common in patients with end-stage renal disease. High phosphorus levels lead to bone disease. According to a study published in Kidney International, having high phosphorus levels also increases the risk of death. Phosphorus-lowering medications, known as phosphate binders work by absorbing phosphorus from ingested foods. There are many different types, some contain calcium and some do not. Newer phosphate binders such as sevelamer and lanthanum claim less side effects but are much more expensive.
Nearly all patients with end-stage renal disease have anemia. A lack of red blood cells defines anemia. Anemia due to end-stage renal disease is treated with drugs called erythropoiesis-stimulating agents, or ESAs. ESAs mimic the natural hormone erythropoietin that helps the body make red blood cells. The body needs extra iron to make red blood cells. Patients taking ESAs need extra iron. ESAs may not work if the patient doesn’t have enough iron.
Abnormalities of vitamin D are common in patients with end-stage renal disease. These abnormalities can lead to bone disease. Under normal circumstances people get vitamin D from the sun. Kidneys convert vitamin D to an active type that the body can use. Damaged kidneys fail to do this and patients with end-stage renal disease may need to take an active form of vitamin D. According to the doctors from the division of Nephrology, Washington University School of Medicine, Saint Louis, research suggests that the administration of vitamin D confers a survival benefit to patients with end-stage renal disease.