Which medications can protect the kidneys, heart and blood vessels?
Medication can stop chronic kidney disease from getting worse. Blood-pressure-lowering medicine is particularly important.
Medication can help to stop or slow down the progress of chronic kidney disease and prevent consequences of kidney disease (complications) such as heart attacks. The medication options for someone with chronic kidney disease will be influenced by things like other medical conditions that they have and their individual risk of complications.
The decision of whether to reduce blood pressure levels in someone who has chronic kidney disease will depend on
- how high their blood pressure is (when untreated),
- whether they have diabetes, and
- how much protein is in their urine (albumin level).
A person with normal blood pressure who doesn’t have diabetes and hardly has any albumin in their urine will be able to get by without using any blood-pressure-lowering medication. But people who have high blood pressure, diabetes or high levels of albumin in their urine are advised to have treatment with ACE inhibitors (angiotensin-converting enzyme inhibitors) or sartans (angiotensin receptor blockers). In people who have diabetes, blood-sugar-lowering medication is also important.
An analysis of 119 studies involving over 64,000 participants with advanced kidney disease has shown that ACE inhibitors and sartans offer several advantages: Compared with other blood-pressure-lowering medications (like beta blockers), ACE inhibitors or sartans were more effective at reducing the risk of complete kidney failure. They also reduced the risk of cardiovascular diseases such as heart attacks or strokes.
There is no proof that taking an ACE inhibitor together with a sartan offers any advantages in people with chronic kidney disease. This combination may be more likely to do harm.
Cholesterol-lowering medications (statins)
Statins are medications that lower cholesterol levels in the blood. They may be prescribed after a heart attack, for example, because they can then help prevent more problems affecting the heart or blood vessels and increase life expectancy. Studies suggest that this may also be the case in people with chronic kidney disease who do not yet need dialysis. So these people are usually advised to start taking statins. They will usually carry on taking statins if dialysis becomes necessary later on.
It’s still not clear whether statins can also slow down the progression of kidney disease. It’s also not absolutely clear whether statins have any benefits if people only start taking them once dialysis has already begun.
Anti-clotting medication such as ASA
Medications that reduce the blood’s ability to clot are called anticoagulants or blood thinners. They include acetylsalicylic acid (ASA – the drug in medicines like Aspirin). Anti-clotting medication can prevent heart attacks and strokes, but it can also cause bleeding.
So the benefits and harms of anti-clotting medications always need to be considered carefully. Taking anti-clotting medications may do more harm than good in some people with mild kidney disease. But these medications can be a good idea in patients who have a high risk of heart attack, for example if they also have coronary artery disease.
Uric acid salts (urate) can build up in the blood as a result of poor kidney function. This may lead to bouts of gout. Medications like allopurinol lower the levels of uric acid to help prevent gout, but they may also cause side effects like rashes or nausea. Initial studies suggest that allopurinol can slow down the progression of chronic kidney disease and prevent cardiovascular complications. More research is needed to confirm this, though.
Do dietary supplements help?
It is highly questionable whether over-the-counter dietary supplements can help people with chronic kidney disease. For instance, it has been proven that antioxidants such as vitamin E supplements can neither increase life expectancy in people with chronic kidney disease nor prevent complications like heart attacks or strokes. There is also no proof that these medications can slow down the progression of the disease or help in certain people (such as dialysis patients). This is true for fish oil and omega-3 fatty acid supplements, too.
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Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (CKD). January 2013.
Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO 2012 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. December 2012.
Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO 2013 Clinical Practice Guideline for Lipid Management in Chronic Kidney Disease. November 2013.
Palmer SC, Di Micco L, Razavian M, Craig JC, Perkovic V, Pellegrini F et al. Antiplatelet agents for chronic kidney disease. Cochrane Database Syst Rev 2013; (4): CD008834.
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