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Diabetic Medications Used in CKD

Diabetes

  • Diabetes Mellitus is the most common cause of CKD. 

  • 30-40% of Type 2 Diabetics and 20-30% of Type 1 Diabetics will devlop CKD. 

  • Your primary care provider should be monitoring you for increased levels of urine albumin, which is one of the first signs of CKD.

  • Good Blood Sugar control helps reduce your risk of CKD and if you have CKD can slow worsening ing kidney function 

  • Talk to your provider about whether any of these agents might be appropriate for your diabetes and kidneys

Click on the           for more information about any of these drugs

 

Insulin

  • Type 1 Diabetes - primary treatment

  • Type 2 DM - when blood sugar is not controlled on other medications

Metformin

  • Helps the insulin your body makes, work better, decreases blood sugar

  • Recommended initial treatment for Type 2 Diabetes

  • Can be started if your GFR is greater than 45 ml/min (see what is the creatinine and GFR). 

  • If your GFR is 30-45 ml/min it should only be started with careful monitoring by your doctor. 

  • Not recommended if your GFR is less than 30 ml/min because it can cause a problem called lactic acidosis. 

Sodium Glucose cotransporter-2 inhibitors (SGLT2i)

  • Include dapagliflozin (Farxiga)       and empagliflozin (Jardiance)       and canagliflozin (Invokana)

  • Increases sugar loss in urine

  • Can slows progression of CKD

  • Reduces risk of heart failure and cardiovascular problems

  • Dapagliflozin can be used at all stages of CKD

Glucagon-like peptide-1 receptor agonists (GLP1ra)

  • Include semaglutide (Ozempic, Rybelsus)       and dulaglutide (Trulicity)

  • Improve blood sugar control and control appetite and can lead to weight loss

  • Can slow progression of CKD

  • Can be beneficial for your heart

  • These drugs can be used at all stages of CKD

Mineralocorticoid Receptor Antagonists (MRA)

  • Mild diuretics that help retain potassium

  • Can slow progression of CKD.

  • Used also in treating high blood pressure and congestive heart failure

  • Can slow progression of CKD

  • Include Spironolactone, Eplerenone and Finerenone

  • Not recommended if your GFR is less than 25 ml/min

  • More information about MRAs can be found here

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Blood Pressure Meds

Blood Pressure Medications Used in CKD

  • Hypertension is the second most common cause of CKD in the United States. 

  • 20% of people with hypertension will devlop CKD. 

  • If you have hypertension your primary care provider should check you for increased levels of urine albumin every 1-2 years.  This is one of the first signs of CKD.

  • Good blood pressure control helps reduce your risk of CKD and if you have CKD can slow worsening ing kidney function 

  • The goal for your blood pressure should be less than 140/90, and ideally less than 130/90. 

​THIS LIST IS NOT MEANT TO INCLUDE ALL BLOOD PRESSURE MEDICATIONS

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Angiotensin Converting Enzyme Inhibitor (ACEi) and Angiotension Receptor Blockers (ARB)

  • These medications have been shown to slow progression of CKD, especially in those with Diabetes.  They also are beneficial in heart failure.

  • Include Lisinopril, Benazapril, Losartan, Valsartan, Irbesartan       .

  • More information and a list of ACEi and ARBs can be found here

Calcium Channel Blockers (CaCB)

  • These medications may also help slow progression of CKD through blood pressure control.

  • Include Amlodipine, Nifedipine, Diltiazem.

  • More information and a list of CaCB can be found here    

Thiazide and Loop diuretics

  • Thiazides are used primarily for blood pressure control though they may sometimes be added to a loop diuretic to help with swelling.

  • Thiazides include Hydrochlorthiazide, and Chlorthalidone. 

  • More information and a list of thiazide diuretics can be found here      

  • Loop diuretics are primarily used to control fluid build up which can improve blood pressure control

  • Include Furosemide (Lasix), Bumetanide (Bumex), Torsemide (Demadex), and ethacrynic acid.

  • More information about Loop diuretics can be found here

Beta Blockers

  • These medications lower blood pressure by slowing your heart rate and intesity of your heart beat

  • They are used in blood pressure management as well as for managemetn of heart disease

  • Include Metoprolol succinate, carvedilol, and Labetolol

  • More information and a list of Beta Blockers can be found here

Alpha blockers and Central Alpha Agonists

  • These medications lower blood pressure by relaxing blood vessels 

  • Alpha blockers such as may be used in benign prostate hypertrophy (BPH)

  • Include doxazosin, prazosin, and clonidine

  • More information and a list of alpha blockers        and central alpha agonists

Vasodilators

  • These medications also lower blood pressure by relaxing blood vessels 

  • Includes hydralazine

 

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Anemia Meds

Medications used to treat Anemia in CKD

Anemia is common in CKD due to several factors. 

  • The kidneys produce a hormone, called erythropoeitin.  This hormone is responsible for signaling the body to make more red blood cells, which carry oxygen to our tissues.  In CKD the kidneys may not make as much of this hormone but it can be replaced with an injection of this hormone.

  • Iron deficiency or an inability to use Iron effieciently is another reason that patients with CKD can develop anemia.  Iron can be replaced either by Iron supplements taken by mouth or if the iron deficiency is severe, by intravenous Iron.

  • Sometimes patients with CKD and those on dialysis may have dietary restrictions that reduce their intake of B12 and folate.  These vitamins can be removed with dialysis resulting in deficiencies.  To replace these vitamins you may need to take a supplement. 

Acid Build up Meds

Medications to neutralize blood acid in CKD

The kidneys help maintain appropriate levels of acid in our bodies.  In CKD acid levels in the blood can increase causing what is called acidosis.  This acidosis can contribute to fatigue, muscle weakness, bone loss and possibly accelerate the loss of kidney function.  

  • Sodium Bicarbonate can be taken to help neutralize this acid build up. 

Bone Disease Meds

Medications to manage Bone disease in CKD

The kidneys play a role in regulating Calcium and Phosphorus in our body and in our bones. 

  • In CKD there are several changes that can lead to an increase in Phosphorus in our blood and cause loss of Calcium from bone, as well as calcification of arteries.

  • These changes can cause a hormonal imbalance called hyperparathyroidsim.  

  • Dietary restriction of high Phosphorus foods is an important part in managing these abnormalities

  • Medications that help reduce Phosphorous are commonly called Phosphorus binders

  • Medications for hyperparathyoidsim include Vitamin D and Calcimimetics

  • You can learn more about hyperparathyroidism in CKD here ​

Phosphorus binders

Bind phosphorous from our food so that it is not absorbed from the gut into our blood.

These medications need to be taken when you eat

Phosphorus binders include 

  • Calcium carbonate (TUMS)

  • Calcium Acetate (Phos-Lo)

  • Sevelamer Acetate (Renvela)

  • Lanthanum Carbonate (Fosrenol)

  • Sucroferric Oxyhydroxide (Velpharo)

  • Ferric Citrate (Auryxia)

Find more information about each of these binders​

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Vitamin D

Nutritional Vitamin D

  • In CKD these forms of Vitamin D may not work as well as they need the kidneys to activate, however, they remain the preferred intial Vitamin D treament for hyperparathyrodism from CKD

  • Can increase dietary absorption of Phosphorus. 

  • Cholecalciferol (Vitamin D3) and ergocalciferol (Vitamin D2)

Vitamin D 1,25

  • Fully activated Vitamin D.  The kidneys are not required to activate

  • Cacitriol (Rocaltrol) - an oral medication

  • Paricalcitol (Zemplar) and Doxercalciferol (Hectorol) - though these have oral forms they are usually given intravenously in dialysis 

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Calcimimetics

  • These medications directly suppress the parathyroid gland

  • Cinacalcet (Sensipar) - an oral medication

  • Etelcalcetide (Parsabiv) - usually given intravenously in dialysis 

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