Patients with kidney disease are usually on several medications, each addressing a different aspect of the disease. Understanding what each one does makes the regimen easier to manage and helps you ask better questions at appointments.
Medications that protect the kidneys
ACE inhibitors and ARBs
These first-line blood pressure medications also reduce protein loss in the urine and slow CKD progression. Common examples: lisinopril, ramipril, losartan, valsartan. They are particularly important in patients with diabetes or proteinuria. See the dedicated ACE inhibitors and ARBs page for details.
SGLT2 inhibitors
Originally developed for type 2 diabetes, these medications reduce kidney and heart events even in non-diabetic CKD. Common examples: dapagliflozin, empagliflozin. See the SGLT2 inhibitors page for more.
Medications that manage symptoms and complications
Diuretics
Loop diuretics (furosemide, torsemide, bumetanide) help manage fluid overload and high blood pressure in CKD. Thiazide diuretics may be added for additional blood pressure control.
Phosphate binders
In advanced CKD, the kidneys cannot remove enough phosphate, leading to bone and vascular complications. Phosphate binders, taken with meals, prevent absorption of dietary phosphate. See the phosphorus binders page.
Potassium binders
In advanced CKD, potassium can rise to dangerous levels. Newer potassium binders (patiromer, sodium zirconium cyclosilicate) are well-tolerated and allow patients to remain on protective medications like ACE inhibitors and ARBs.
Medications that replace hormonal functions
Erythropoietin-stimulating agents (ESAs)
The kidneys normally produce erythropoietin, which signals the bone marrow to make red blood cells. In CKD, low erythropoietin causes anemia. ESAs (epoetin alfa, darbepoetin alfa) restore red blood cell production. Iron supplementation is often given alongside.
Active vitamin D
The kidneys activate vitamin D into its usable form. CKD impairs this activation, contributing to bone disease. Calcitriol or analogs (paricalcitol) restore active vitamin D levels.
Considerations for any new medication
Many medications require dose adjustments for kidney function, and some are unsafe in CKD. Always tell every provider — including pharmacists, surgeons, and emergency room staff — that you have kidney disease before starting any new medication, supplement, or contrast dye for imaging.