Medicines for Chronic kidney disease (CKD)

What it is

Chronic kidney disease means the kidneys have been working below par for some time, filtering waste and excess fluid from the blood less effectively than they should. It is common and usually silent in its earlier stages, causing few or no symptoms, which is why it is most often picked up on blood and urine tests rather than because someone feels unwell. The two key measurements are an estimate of filtering capacity (eGFR), worked out from a blood test, and the amount of protein leaking into the urine, which together place CKD into stages and indicate how quickly it might progress. The commonest causes in the UK are diabetes and high blood pressure, and CKD both raises cardiovascular risk and is made worse by it. As function declines further, complications such as anaemia, disturbances of bone-mineral chemistry and fluid retention can develop, and advanced disease may eventually need dialysis or a transplant — though most people with CKD never reach that stage.

How it is treated

Care has two broad aims: slowing the decline in kidney function, and treating the complications and risks that come with it. Slowing progression centres on controlling blood pressure and reducing protein in the urine, for which medicines that block the renin-angiotensin system are central, especially where there is protein leak. SGLT2 inhibitors are now an important addition that protect both the kidneys and the heart, and a further agent is available for selected people with diabetic kidney disease. Because cardiovascular disease is the biggest threat in CKD, lowering cholesterol and managing other risk factors matters as much as the kidney numbers. Complications are treated as they arise — fluid overload, anaemia, raised phosphate and iron deficiency each have their own treatments. An important safety principle is that many medicines are cleared by the kidneys and need their dose reviewed, or temporary pausing during illness, so prescribing is checked against kidney function.