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Canadian Med Center

Medications for Chronic Kidney Disease

Wednesday 13 March 2024
Chronic Kidney Disease
7 minute(s) read

Table of Contents

I. Diabetes and CKD

II. High Blood Pressure and CKD

III. Heart Disease and CKD

IV. Anemia and CKD

V. Bone Disease and CKD

VI. Secondary Hyperparathyroidism and CKD

VII. Conclusion

While there is currently no cure for CKD, various treatment options are available to help relieve symptoms and delay further damage to the kidneys. [1]

Medications are vital to managing CKD. They work by reducing symptoms, slowing the progression of kidney damage, and preventing other health issues related to CKD. The medicines your doctor prescribes will depend on the underlying cause of your CKD and how well your kidneys function. [1]

In this article, we'll explore some of the most common health issues tied to CKD and review the medications used for each.

Diabetes and CKD

Diabetes is the most common cause of chronic kidney disease (CKD) and, ultimately, kidney failure. When the kidneys fail, they no longer filter waste and excess fluid from the blood. At this point, dialysis or a kidney transplant is needed to survive. [2]

The good news is we now have new treatment options available for managing diabetes and slowing the progression of kidney disease. Recently approved medications include SGLT2 inhibitors, Finerenone, and glucagon-like peptide-1 receptor agonists (GLP-1 RAs). [3]

SGLT2 Inhibitors

The FDA has approved SGLT2 inhibitors to lower blood sugar in adults with type 2 diabetes and chronic kidney disease. They can even help protect kidney function in people without diabetes who have protein in their urine. [3]

SGLT2 inhibitors prevent your kidneys from reabsorbing glucose, leading to higher glucose levels in your urine. This provides several benefits: [3]

  • Slowing progression of CKD
  • Reducing heart failure hospitalization
  • Lowering the risk of kidney failure
  • Reducing the risk of death [3]

Medications in the SGLT2 inhibitor class include:


Finerenone (brand name Kerendia) blocks the harmful effects of a hormone called aldosterone. Aldosterone causes inflammation and scarring in the kidneys, which worsens kidney disease. By preventing this damage, finerenone helps keep your kidneys healthier for longer. [3]

The FDA approved finerenone for moderately reduced kidney function in adults with type 2 diabetes and kidney disease. Specifically, it’s for those with an estimated glomerular filtration rate (eGFR) above 25 and a urine-albumin creatinine ratio above 30. [3]

Clinical trials showed finerenone reduces the risk of serious kidney outcomes, including:

  • Kidney function decline
  • Kidney failure
  • Hospitalization for heart failure [3]

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs)

GLP-1 RAs are FDA-approved for type 2 diabetes and may benefit those on dialysis. These medications are particularly recommended for people with kidney disease, heart disease, or who have had a heart attack. [3]

GLP-1 RAs work by stimulating the production of insulin and reducing the production of glucagon. They also promote the feeling of fullness by slowing food movement through the stomach. The beneficial effects of GLP-1 RAs include lowering: [3]

  • A1C levels
  • Blood pressure
  • Cardiovascular risks
  • Blood sugar [3]

Two common GLP-1 RAs include:

  • Ozempic (semaglutide injection)
  • Rybelsus (oral semaglutide) [3]

High Blood Pressure and CKD

a doctor taking a patient

High blood pressure can be both a cause and consequence of chronic kidney disease (CKD). This creates a vicious cycle where high blood pressure causes kidney damage, and kidney damage leads to even higher blood pressure. If left uncontrolled, it can eventually lead to kidney failure. [4]

  • Effect of high blood pressure on kidneys: When blood pressure is elevated, it strains the blood vessels throughout the body, including those in the kidneys. Over time, high blood pressure damages and weakens the blood vessels, causing them to narrow and restricting blood flow.
  • Effect of kidneys on high blood pressure: With reduced blood flow, the kidneys cannot effectively filter wastes and excess fluid. Fluids build up, leading to higher blood pressure and further damaging the blood vessels and kidneys. [4]

The good news is that this cycle can be broken with proper treatment. For people with CKD, the goals of treatment are to:

  • Lower blood pressure below 130/80 mmHg
  • Prevent further kidney damage
  • Reduce the risk of heart disease [4]

To help achieve these goals, doctors may prescribe medications like:

  • ACE inhibitors relax blood vessels and lower blood pressure.
  • ARBs (like Diovan) widen blood vessels and reduce strain on kidneys.
  • Beta-blockers slow heart rate and reduce blood pressure
  • Diuretics flush out excess fluid and sodium, lowering blood pressure [2]

Heart Disease and CKD

Chronic kidney disease (CKD) and heart disease often go hand in hand. When you have CKD, you are more likely to develop heart disease. And if you have heart disease, it can lead to CKD. In fact, heart disease is the leading cause of death for people on dialysis. [5]

Heart disease refers to any issue with the heart or blood vessels that prevents the heart from pumping blood as efficiently as it should. It's also known as cardiovascular disease (CVD). [5]

If you have both CKD and heart disease, your doctor may prescribe certain medications to help control your heart condition, including:

  • Diuretics (also called "water pills”) help your kidneys flush extra salt and water from your body by making you urinate more. Aldosterone receptor blockers are a type of diuretic used to treat congestive heart failure (CHF). They help your body get rid of excess fluid.
  • ACE inhibitors: These medications lower blood pressure by relaxing your blood vessels. This allows your kidneys to eliminate extra water and reduces the levels of hormones that can raise your blood pressure.
  • Beta-blockers: These drugs lower blood pressure by blocking the effects of adrenaline. This allows your heart to beat more slowly and with less force.
  • Potassium binders remove excess potassium from the blood. When the kidneys aren't working properly, they can't eliminate enough potassium, which can cause heart and muscle problems. [2]

Anemia and CKD

Anemia is a common complication of chronic kidney disease. When your kidneys are damaged or diseased, they cannot produce enough of a hormone called erythropoietin that stimulates your body to make red blood cells. Red blood cells carry oxygen throughout your body, so you can feel exhausted and run down without enough of them. [2]

The good news is there are treatments for anemia from chronic kidney disease.

  • Erythropoiesis-stimulating agent (ESA): These injections help boost your red blood cell production. ESA injections are effective at relieving anemia.
  • Iron supplements: Iron is essential for your body to make new red blood cells. Without adequate iron stores, your ESA injections won't work as well. Iron supplements can be taken as pills, given intravenously through an injection, or even added to your dialysis treatments. [2]

Bone Disease and CKD

Bone disease is a common complication of chronic kidney disease (CKD). When CKD damages the kidneys, they cannot properly filter blood and regulate hormone levels. This leads to an imbalance of hormones and minerals like calcium and phosphorus, resulting in bone damage. [6]

There are a few ways that damaged kidneys contribute to bone disease:

  • The kidneys stop converting vitamin D into its active form, known as calcitriol. This leads to improper calcium absorption and imbalance.
  • The kidneys cannot adequately remove excess phosphorus from the blood. This triggers the blood to pull calcium from the bones, weakening them over time. [6]

The good news is that treatments are available to prevent further bone and blood vessel damage from CKD-related bone disease. These treatments focus on controlling mineral and hormone levels. Your doctor may prescribe:

  • Phosphate binders: These medications bind to phosphorus in your digestive tract so that your body does not absorb it into your bloodstream. This helps lower high phosphorus levels in the blood that weaken your bones.
  • Calcium and vitamin D supplements: Kidney disease often causes calcium and vitamin D deficiencies or excesses. Supplements help restore balance and promote bone health. [2]

Secondary Hyperparathyroidism and CKD

Anatomy of parathyroid glands

Secondary hyperparathyroidism is when the parathyroid glands overproduce the parathyroid hormone (PTH). This excessive PTH in the bloodstream can lead to complications such as: [2]

  • Bone disease
  • Accumulation of calcium in vital organs like the heart and blood vessels [2]

Due to impaired kidney function, individuals with CKD face a higher risk of developing hyperparathyroidism. The kidneys are responsible for maintaining calcium and vitamin D balance. When this equilibrium is disrupted, the parathyroid gland responds by producing more PTH. [2]

Fortunately, there are treatment options available for those diagnosed with hyperparathyroidism. 

  • Calcimimetics: These medications tell your parathyroid glands to reduce the amount of PTH they produce.
  • Calcium or vitamin D: These can help restore the balance of calcium and vitamin D levels in the body, signaling the parathyroid glands to lower PTH secretion. [2]


While CKD cannot be cured, it can often be well-controlled through attentive self-care and medical management. With commitment to your treatment regimen, open communication with your providers, and lifestyle adjustments to support your kidneys, you can slow the progression of CKD and maintain a good quality of life. 

To learn more about CKD, visit our dedicated chronic kidney disease blog.

The content in this article is intended for informational purposes only. This website does not provide medical advice. In all circumstances, you should always seek the advice of your physician and/or other qualified health professionals(s) for drug, medical condition, or treatment advice. The content provided on this website is not a substitute for professional medical advice, diagnosis, or treatment.