Chronic kidney disease: Which medications can protect the kidneys, heart and blood vessels?

Whether drugs designed to lower blood pressure (also called antihypertensive drugs or simply antihypertensives) are an option for treating your chronic kidney disease will mostly depend on

• how high your blood pressure is, and
• how much protein is in your urine.

If you have chronic kidney disease, but normal levels of blood pressure and no protein (albumin) in your urine, you can get by without antihypertensive drugs. If you have high blood pressure or a lot of albumin in your urine, therapy with an ACE (angiotensin-converting enzyme) inhibitor or a sartan (angiotensin receptor blocker, or ARBs) is recommended if you also have diabetes, even if the albumin level is low.

Studies have shown that ACE inhibitors or sartans can lower high blood pressure levels in people with chronic kidney disease, decreasing the risk of complete kidney failure. Also, the therapy can lower the risk of cardiovascular disease, which is higher because of the kidney disease. These medications so not seem to help though if the kidney disease is already at a very advanced stage and dialysis is needed.

If in addition to chronic kidney disease you also have diabetes or your blood pressure is still too high even after taking ACE inhibitors or sartans, then doctors can give you an extra antihypertensive called a mineralocorticoid receptor antagonist (MRA or MCRA).

SGLT inhibitors, which were originally developed to lower blood sugar levels in people with diabetes, can slow the progression of chronic kidney disease and prevent complications. That is why they are also recommended, regardless of whether you have diabetes or not.

Statins are medications that lower cholesterol levels in the blood. They can help prevent heart and blood vessel problems. These medications are recommended because if you have chronic kidney disease, you also have a higher risk of those kinds of complications. They are probably most effective when the treatment is started early on. It is not known whether the medications can also prevent cardiovascular complications once you already need dialysis. But experts recommend that you continue taking the medications anyway.

It is also still not clear whether statins can slow down the progression of kidney disease as well.

Anti-clotting medication – also described as blood thinners – such as acetylsalicylic acid (ASA, the drug found in Aspirin) reduce the blood's capacity to clot, so they can prevent a heart attack or stroke. They are used to treat chronic kidney disease if you also have a high risk of those kinds of complications, for example if you have already had a heart attack once.

Anti-clotting medication can also increase the risk of bleeding though, and ASA may make the kidneys work even worse, especially in advanced chronic kidney disease. So the pros and cons of these medications always need to be weighed carefully.

Uric acid salts can build up in the blood as a result of poor kidney function. If that ends up causing gout, medications like allopurinol are used to lower the levels of uric acid in your blood. The side effects of these drugs include rash and nausea.

It is not clear whether medication for lowering uric acid levels have additional advantages in the treatment of chronic kidney disease, such as slowing the progression of the disease.