Medication Management for People with Kidney Disease

By Tricia Patterson, BSN, RN

Hello AAKP members. My name is Tricia Patterson, BSN, RN. I had the pleasure of attending  the AAKP National Patient Meeting in Washington, DC in September and met many of you and heard some great lectures. I am a nephrology nurse and a member of the American Nephrology Nurses Association (ANNA). In recognition of “Talk about Your Medication Month”, I’m partnering with AAKP to blog about the importance of medication management. Since I donated a kidney three years ago, I am also a person with CKD who needs to carefully manage my labs and medications.

Please skip down to read the section for each type of kidney patient - CKD, dialysis or transplant:

Medication Management for People with CKD (Chronic Kidney Disease)

 

We all know that the kidneys are responsible for clearing toxins and fluids in the urine. But many people do not understand that the kidneys are also responsible for keeping the body in chemical balance. This is called homeostasis. For example, acid and base, potassium, calcium, and sodium are balanced by the kidneys. The kidneys have a hormone that helps with the blood levels for anemia.  In addition, the kidneys have a hormonal system for blood pressure control. When the kidneys are working well, they keep all of these things in balance every day, every hour, every minute. When the kidneys are not working well, the nephrologist (kidney doctor) works to manage homeostasis (your body’s chemical balance) by doing frequent lab checks to determine the right dose of all the medicines you need to get the values to the proper level and feel your best.

 

As people with CKD, we have a crucial role in keeping our bodies in balance. We should make sure that we schedule regular visits with our doctor(s) and make sure that the labs are drawn a few days before the visit to get the most accurate and timely results. It is important to fill new prescriptions right away and update your medication list, which should always be tucked inside your wallet. Many patients even find it convenient to store this information on their smart device or an app.  We all see multiple doctors, and each one should have an accurate updated list of your current medication, dosage and frequency. Over the counter medications (OTC) should be included on this list and should also be approved by your nephrologist before use.

 

For blood pressure management, it is helpful to your doctor if you keep a record of blood pressures every day so that the doctor can see trends and how you are responding to your BP meds. Record the morning BP 30 to 60 minutes after taking the BP medications, and take another reading before bed. Blood pressure that is too low is dangerous too, so call the doctor if you see pressures below 110/70.

 

For high phosphorus there are several medications called “binders” that are to be taken with the first bite of food at each meal to bind the excess phosphorus from the foods we eat that your body will not be able to get rid of, due to your kidney disease. The phosphorus is then excreted in the stool. Some of these pills should be kept in a small pill bottle that travels with you everywhere so you don’t forget to take it with your meals.

 

For high potassium (also known as hyperkalemia) there are medications that are mixed with water and should be taken every day as a maintenance medication. Lab results that show potassium at normal level means that the medicine is working, it does not mean it is time to stop taking the potassium binder. The level would creep back up. Your doctor will stop the medication only if your levels drop below normal.

 

For anemia some people with CKD will need to take a synthetic version of a kidney hormone that signals the bone marrow to make new red blood cells. This medicine is given as a small injection under the skin once every two weeks. Frequent lab draws are required to keep the dose at the correct level. 

 

 

Medication Management for People with ESRD (End Stage Renal Disease) on Dialysis

We all know that the kidneys are responsible for clearing toxins and fluids in the urine. But many people do not understand that the kidneys are responsible for keeping the body in chemical balance. This is called homeostasis. For example, acid and base, potassium, calcium, and sodium are balanced by the kidneys. The kidneys have a hormone that helps with the blood levels for anemia.  In addition, the kidneys have a hormonal system for blood pressure control. When the kidneys are working well, they keep all of these things in balance every day, every hour, every minute. When the kidneys are not working well, the nephrologist (your kidney doctor) works to manage homeostasis (your body’s chemical balance) by doing frequent lab checks to determine the right dose of all the medicines needed to get the values to the proper level and feel your best.

As people with ESRD, you have a crucial role in keeping your bodies in balance. Dialysis will remove some fluids, but it is less stressful to your body when less fluid is removed during dialysis. That is why the staff at dialysis is frequently reminding you to limit fluid intake and sodium in foods. In the same way, managing your blood pressure with medications is better than the high and low peaks of pre and post dialysis blood pressures.  The nephrologist reviews the labs that are drawn at dialysis monthly and  will tweak your medications based on these results. It is important to fill new prescriptions right away and update your medication list, which should always be tucked inside your wallet. We all see multiple doctors, and each one should have an accurate updated list. Over the counter medications (OTC) should be included on the list and should also be approved by your nephrologist before use.

For blood pressure management, it is helpful to your doctor if you keep a record of blood pressures every day so that he can see trends and how you are responding to the BP meds. Record the morning BP 30 to 60 minutes after taking the BP medications, and take another reading before bed. Blood pressure that is too low is dangerous too, so call the doctor if you see pressures below 110/70.

For high phosphorus there are several medications called “binders” that are to be taken with the first bite of food at each meal to bind the phosphorus from the foods we eat. The phosphorus is then excreted in the stool. Some of these pills should be kept in a small pill bottle that travels with you everywhere.  When phosphorus levels get too high in the blood, the phosphorus binds with calcium in the blood to form little “pebbles” of a material that is hard like your teeth. These phosphorus-calcium pebbles lodge in every little fork in the blood stream. The pebbles can build up and cause a blockage in crucial places like the heart muscle. Phosphorus binders work to prevent that buildup, but the medicine is not able to remove the old plaque buildup. I tell my patients that taking your binders every day is serious. Serious as a heart attack.

For high potassium there are medications that are mixed with water and should be taken every day as a maintenance medication. Lab results that show potassium in normal level means that the medicine is working, it does not mean it is time to stop taking the potassium binder. The level would creep back up. The doctor will stop the medication only if your levels drop below normal.

 

Medication Management for People with Kidney Transplants

We all know that the kidneys are responsible for clearing toxins and fluids in the urine. But many people do not understand that the kidneys are responsible for keeping the body in chemical balance. This is called homeostasis. For example, acid and base, potassium, calcium, and sodium are balanced by the kidneys. The kidneys have a hormone that helps with the blood levels for anemia.  In addition, the kidneys have a hormonal system for blood pressure control. When the kidneys are working well, they keep all of these things in balance every day, every hour, every minute. When the kidneys are not working well, the nephrologist (kidney doctor)works to manage homeostasis(your body’s chemical balance) by doing frequent lab checks to determine the right dose of all the medicines needed to get the values to the proper level and feel your best.

As people with CKD, we have a crucial role in keeping our bodies in homeostasis. We should make sure that we schedule regular visits with the nephrologist and make sure that the labs are drawn a few days before the visit. It is important to fill new prescriptions right away and update your medication list, which should always be tucked inside your wallet.

For post-transplant medications, it is required to have frequent lab tests to monitor the medication levels in your blood. Levels that are too low cause a risk of organ rejection, and levels that are too high are a risk of poisoning. Be sure to have your labs drawn on the dates ordered. You should have access to your lab results online and be educated on what levels are normal for you.  

For blood pressure management, it is helpful to your doctor if you keep a record of blood pressures every day so that the doctor can see trends and how you are responding to the BP meds. Record the morning BP 30 to 60 minutes after taking the BP medications, and take another reading before bed. Blood pressure that is too low is dangerous too, so call the doctor if you see pressures below 110/70.

For high phosphorus there are several medications called “binders” that are to be taken with the first bite of food at each meal to bind the phosphorus from the foods we eat. The phosphorus is then excreted in the stool. Some of these pills should be kept in a small pill bottle that travels with you everywhere. When phosphorus levels get too high in the blood, the phosphorus binds with calcium in the blood to form little “pebbles” of a material that is hard like your teeth. These phosphorus-calcium pebbles lodge in every little fork in the blood stream. The pebbles can build up and cause a blockage in crucial places like the heart muscle. Phosphorus binders work to prevent that buildup, but the medicine is not able to remove the old plaque buildup. I tell my patients that taking your binders every day is serious. Serious as a heart attack.

For anemia some people with CKD will need to take a synthetic version of a kidney hormone that signals the bone marrow to make new red blood cells. This medicine is given as a small injection under the skin once every two weeks. Frequent lab draws are required to keep the dose at the correct level. 

I hope these few tips were helpful. Stay healthy! 

 

 

 

 

 

Tricia Patterson, BSN, RN is a CKD Nephrology Nurse, Annapolis Nephrology Associates, Annapolis Maryland.  She spent seven years as Peritoneal Dialysis Nurse.  She is a Home Therapies Specialty Practice Network Lead for American Nephrology Nurses Association (ANNA).  She has published two articles in Nephrology Nursing Journal and was a presenter at national ANNA conference in 2018, 2019.