Chronic kidney disease (CKD) affects millions of people and often progresses gradually, increasing the risk of heart problems, bone loss, and kidney failure. To manage these complications and slow disease progression, patients are often prescribed medications for blood pressure, fluid control, and mineral balance. While these drugs are essential, they can cause side effects that you should understand and prepare for by speaking with your nephrologist. 

ACE Inhibitors and ARBs

ACE inhibitors (like lisinopril) and angiotensin receptor blockers (ARBs) (like losartan) are widely prescribed to lower blood pressure and reduce protein in the urine—two important steps in protecting kidney function.

They can also cause:

• High potassium levels (hyperkalemia), which may affect heart rhythm
• Cough, especially with ACE inhibitors
• Increased creatinine (often temporary), a sign of reduced kidney filtering
• Dizziness or low blood pressure, especially when standing up quickly
  

These medications are generally safe with regular lab monitoring. Potassium and creatinine levels should be checked routinely, especially in advanced CKD, when the risk for hyperkalemia is higher.

Diuretics: Controlling Swelling and Blood Pressure

Diuretics, such as loop diuretics (furosemide) and thiazide diuretics (hydrochlorothiazide), are used to reduce fluid buildup and control blood pressure in people with CKD.

Common side effects of diuretics include:

• Electrolyte imbalances, especially low potassium, sodium, or magnesium
• Dehydration and low blood pressure
• Gout attacks, more likely with thiazide diuretics
• Frequent urination
• Muscle cramps
• Fatigue
  

Electrolyte imbalances can be serious in CKD and need quick correction to prevent arrhythmias or neurological symptoms. Patients on diuretics long-term should get blood tests regularly to check these levels.

Phosphate Binders and Vitamin D

As CKD progresses, the kidneys can’t get rid of phosphate properly, which can lead to bone disease and cardiovascular complications. Doctors often prescribe:

• Phosphate binders (like sevelamer or calcium acetate), and
• Active vitamin D drugs (like calcitriol or paricalcitol)
  

These medications can cause side effects like:

• Constipation, especially from calcium-based binders
• High calcium levels (hypercalcemia), which may lead to hardening of blood vessels
• Nausea, headache, or fatigue from vitamin D analogues
  

Kidney Disease: Improving Global Outcomes (KDIGO), a global organization that develops evidence-based clinical practice guidelines for kidney disease, recommends customizing treatment to keep calcium and phosphate levels in a healthy range and to prevent adverse effects from over-treatment.

Takeaway

Medications for CKD are vital for managing the disease and avoiding complications, but they can also cause side effects that may further compromise your health and quality of life. The best way to stay safe is through regular lab tests, tracking symptoms, and working closely with your healthcare providers. Don’t stop or change your medications without first consulting your doctor.

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