Medications for Chronic Kidney Disease (CKD)
ICD-10: N18
Key Takeaways
- CKD management focuses on slowing progression and reducing cardiovascular risk — the leading cause of death in CKD patients.
- ACE inhibitors and ARBs are first-line for CKD with proteinuria — they reduce progression to ESRD by 30–40% independent of blood pressure lowering.
- SGLT-2 inhibitors (dapagliflozin, empagliflozin) have revolutionized CKD treatment — the DAPA-CKD trial showed dapagliflozin reduced kidney failure by 44%.
- Finerenone (Kerendia) is a new non-steroidal MRA that reduces CKD progression and cardiovascular events in diabetic CKD.
- Strict blood pressure control (target <130/80 mmHg) and tight glycemic control (HbA1c <7%) are the most important modifiable risk factors for CKD progression.
Overview
Chronic Kidney Disease (CKD) means your kidneys are damaged and can't filter blood as well as they should. This condition is quite common, affecting about 1 in 7 adults in the U.S., and can affect anyone, though it's more common in older adults and those with other health problems. Over time, CKD can lead to serious health issues like heart disease, stroke, and kidney failure if not managed. It's a long-term condition that usually gets worse slowly.
Treatment Overview
Treating CKD focuses on slowing down kidney damage, managing symptoms, and preventing complications. This often involves important lifestyle changes like eating a healthy diet, exercising, and quitting smoking. Medications such as ACE inhibitors (like lisinopril, ramipril, enalapril) or ARBs (like azilsartan) are often first-line to protect the kidneys and control blood pressure. A kidney specialist (nephrologist) will be involved to guide treatment, especially as the disease progresses.
Common Symptoms
27
Total Medications
3
Drug Classes
✓
Generic Options
Drug Classes for Chronic Kidney Disease (CKD)
Pharmacist-reviewed overview of each medication class, how it works, and when it's used.
ACE Inhibitors / ARBs
RAAS Inhibitors
Mechanism of Action
Block the renin-angiotensin-aldosterone system, reducing intraglomerular pressure (by dilating the efferent arteriole) and decreasing proteinuria. Proteinuria is both a marker and mediator of CKD progression.
Common Examples
Clinical Notes
First-line for CKD with proteinuria (urine albumin-creatinine ratio >30 mg/g), regardless of blood pressure. Do not combine ACE inhibitor + ARB — dual RAAS blockade increases hyperkalemia and acute kidney injury risk without additional benefit.
Common Side Effects
- Hyperkalemia
- Acute kidney injury (especially with dehydration or NSAIDs)
- ACE inhibitor cough
- Angioedema (ACE inhibitors)
SGLT-2 Inhibitors
SGLT-2i
Mechanism of Action
Reduce intraglomerular pressure through tubuloglomerular feedback (by increasing sodium delivery to the macula densa), independent of glucose-lowering effects. Also reduce inflammation and fibrosis in the kidney.
Common Examples
Clinical Notes
Dapagliflozin is FDA-approved for CKD regardless of diabetes status (DAPA-CKD trial: 44% reduction in kidney failure). Empagliflozin is approved for CKD in patients with type 2 diabetes (EMPA-KIDNEY trial). Use with caution in eGFR <20 mL/min — reduced efficacy and increased DKA risk.
Common Side Effects
- Genital mycotic infections
- UTI
- Euglycemic DKA
- Volume depletion
Finerenone
Finerenone
Mechanism of Action
Non-steroidal selective mineralocorticoid receptor antagonist. Blocks aldosterone-mediated inflammation and fibrosis in the kidney and heart without the hormonal side effects of spironolactone.
Common Examples
Clinical Notes
FDA-approved for CKD associated with type 2 diabetes. The FIDELIO-DKD and FIGARO-DKD trials showed finerenone reduced kidney failure and cardiovascular events. Lower hyperkalemia risk than spironolactone. Requires monitoring of potassium.
Common Side Effects
- Hyperkalemia
- Hypotension
Phosphate Binders
Phosphate Binders
Mechanism of Action
Bind dietary phosphate in the GI tract, reducing phosphate absorption. In CKD, impaired phosphate excretion leads to hyperphosphatemia, which drives secondary hyperparathyroidism and renal osteodystrophy.
Common Examples
Clinical Notes
Used in CKD stages 3b–5 when phosphate is elevated. Calcium-based binders are inexpensive but can worsen vascular calcification with long-term use. Sevelamer is non-calcium-based and preferred in patients with vascular calcification or hypercalcemia.
Common Side Effects
- GI side effects (nausea, constipation)
- Hypercalcemia (calcium-based binders)
Erythropoiesis-Stimulating Agents
ESAs
Mechanism of Action
Synthetic erythropoietin that stimulates red blood cell production in the bone marrow, correcting anemia of CKD caused by reduced endogenous erythropoietin production.
Common Examples
Clinical Notes
Used for CKD-associated anemia when hemoglobin <10 g/dL. Target hemoglobin 10–11.5 g/dL — higher targets increase cardiovascular risk. Always correct iron deficiency before or with ESA therapy.
Common Side Effects
- Hypertension
- Thrombosis
- Increased cardiovascular events at high hemoglobin targets
All Medications
FDA-approved and commonly used medications for Chronic Kidney Disease (CKD) in our database.
Medications
Lisinopril
(Prinivil)Lisinopril (Prinivil, Zestril) is one of the most widely prescribed medications in the United States and the most commonly used ACE inhibitor. It lowers blood pressure by relaxing blood vessels, reduces hospitalizations and death in heart failure, and improves survival after a heart attack. It is also used to slow kidney disease progression in people with diabetes. Generic lisinopril is available for as little as $4–$15 per month, making it one of the most cost-effective cardiovascular medications available.
Generic Available
Trandolapril
(Mavik)Trandolapril is a medication used to treat high blood pressure (hypertension) and to improve outcomes for certain patients after a heart attack. It works by relaxing blood vessels so the heart does not have to work as hard to pump blood.
Ramipril
(Ramipril)Ramipril is a medication in a class called ACE inhibitors, primarily used to treat high blood pressure. By helping to relax your blood vessels, it lowers blood pressure and can also reduce the risk of heart attack, stroke, and help manage heart failure after a heart attack.
Captopril
(Captopril)Captopril is a medication belonging to a class of drugs called ACE inhibitors, primarily used to treat high blood pressure (hypertension). It works by helping to relax blood vessels, which allows blood to flow more easily and lowers blood pressure.
Enalapril Maleate
(Enalapril Maleate)Enalapril maleate is a medication called an ACE inhibitor, primarily used to treat high blood pressure and heart failure. It works by relaxing blood vessels, which helps lower blood pressure and makes it easier for your heart to pump blood. This can improve symptoms and overall heart function.
Benazepril Hydrochloride
(Benazepril Hydrochloride)Benazepril is a medication in a class called ACE inhibitors, primarily used to treat high blood pressure. It works by relaxing blood vessels, which helps lower blood pressure and reduces the risk of serious heart problems like strokes and heart attacks.
Quinapril
(Quinapril)Quinapril is a medication used to treat high blood pressure. It works by relaxing blood vessels, which helps to lower blood pressure and reduce the risk of serious heart problems like strokes and heart attacks.
Quinapril Hydrochloride
(Quinapril)Quinapril (Quinapril Hydrochloride) is a medication used to treat high blood pressure. It belongs to a group of drugs called ACE inhibitors, which work by relaxing blood vessels, allowing blood to flow more easily and lowering the pressure on artery walls. By reducing high blood pressure, Quinapril helps decrease the risk of serious heart problems like strokes and heart attacks.
Fosinopril
(Monopril)Fosinopril (Monopril) is an ACE inhibitor used to treat high blood pressure (hypertension) and heart failure. It works by blocking angiotensin-converting enzyme, relaxing blood vessels and reducing the workload on the heart.
Generic Available
Perindopril Erbumine
(Perindopril Erbumine)Perindopril Erbumine is an ACE inhibitor medication used to treat high blood pressure (hypertension) and to reduce the risk of heart attack or death in people with stable coronary artery disease. It works by relaxing blood vessels, which helps lower blood pressure and makes it easier for the heart to pump blood.
Moexipril Hydrochloride
(Moexipril Hydrochloride)Moexipril Hydrochloride is a medication used to treat high blood pressure (hypertension). It belongs to a group of drugs called ACE inhibitors, which work by relaxing blood vessels to help lower blood pressure and improve blood flow. This helps reduce the risk of heart problems and strokes.
Empagliflozin
(Jardiance)Empagliflozin (Jardiance) is a medication that helps your kidneys remove extra sugar from your body through urine. It is prescribed to treat type 2 diabetes by lowering blood sugar, and also helps reduce the risk of heart-related problems and hospitalizations in adults with heart failure or chronic kidney disease.
Bexagliflozin
(Bexagliflozin)Bexagliflozin is a medication used alongside diet and exercise to help adults with type 2 diabetes manage their blood sugar levels. It works by helping your kidneys remove more sugar from your body through your urine. This helps lower high blood sugar.
Sotagliflozin
(Inpefa)INPEFA is a medication used to help adults with heart failure, or those with type 2 diabetes and kidney disease, reduce their risk of serious heart problems. It works by helping your body remove excess sugar and salt, which can ease the strain on your heart and kidneys. This helps prevent cardiovascular death, hospital stays for heart failure, and urgent heart-related doctor visits.
Empagliflozin, Linagliptin, Metformin Hydrochloride
(Trijardy XR)Trijardy XR is a combination medicine used by adults with type 2 diabetes, along with diet and exercise, to help lower blood sugar levels. It combines three different medications that work in various ways to help your body manage sugar. For some adults with type 2 diabetes and existing heart disease, it can also help reduce the risk of heart-related death.
Empagliflozin, Metformin Hydrochloride
(Synjardy XR)Synjardy XR is a combination medicine that helps adults and children (10 years and older) with type 2 diabetes manage their blood sugar. It works by helping your body remove excess sugar through your urine and by reducing the amount of sugar your liver makes and your body absorbs. For adults with type 2 diabetes and established heart disease, it also helps reduce the risk of cardiovascular death.
Dapagliflozin
(Dapagliflozin)Dapagliflozin (brand name: DAPAGLIFLOZIN) is a medication that helps your kidneys remove excess sugar from your body. It is used to treat type 2 diabetes, heart failure, and chronic kidney disease by improving blood sugar control and protecting your heart and kidneys.
Canagliflozin
(Invokana)Invokana (canagliflozin) is a medication for adults and children aged 10 and older with type 2 diabetes. It helps lower blood sugar by causing the kidneys to remove more sugar from the body through urine. For adults with type 2 diabetes and existing heart or kidney disease, Invokana also helps reduce the risk of serious heart problems, hospitalization for heart failure, and progression of kidney disease.
Ertugliflozin
(Steglatro)STEGLATRO (ertugliflozin) is a medication called an SGLT2 inhibitor, used to help adults with type 2 diabetes manage their blood sugar levels. It works by helping your kidneys remove more sugar from your body through your urine, which lowers your overall blood sugar. This medication is used along with diet and exercise.
Losartan Potassium
(Cozaar)Losartan potassium (Cozaar) is an angiotensin II receptor blocker (ARB) used to treat high blood pressure, protect the kidneys in type 2 diabetes, and reduce the risk of stroke in patients with hypertension and left ventricular hypertrophy. Unlike ACE inhibitors, losartan does not cause a dry cough and carries a significantly lower risk of angioedema. It is also the only ARB with a clinically meaningful uricosuric (uric acid-lowering) effect, making it a preferred choice in patients with hypertension and gout.
Valsartan
(Valsartan)VALSARTAN (brand name: Valsartan) is a ARBs. 1 INDICATIONS & USAGE Valsartan is an angiotensin II receptor blocker (ARB) indicated for: Hypertension in adults and children six years and older, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial…
Irbesartan
(Irbesartan)IRBESARTAN (brand name: Irbesartan) is a ARBs. 1 INDICATIONS & USAGE Irbesartan tablet is an angiotensin II receptor blocker (ARB) indicated for: • Treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions. ( 1.1 ) •…
Olmesartan Medoxomil
(olmesartan medoxomil)Olmesartan Medoxomil is a medication used to treat high blood pressure (hypertension) in adults and children aged six and older. It works by relaxing blood vessels, which helps to lower blood pressure and reduce the risk of serious heart problems like strokes and heart attacks.
Telmisartan
(Telmisartan)Telmisartan (brand name: Telmisartan) is a medication known as an angiotensin II receptor blocker (ARB). It is primarily used to treat high blood pressure, helping to relax blood vessels so blood can flow more easily. By lowering blood pressure, Telmisartan helps reduce the risk of serious heart problems like strokes and heart attacks.
Candesartan Cilexetil
(Candesartan Cilexetil)Candesartan Cilexetil is a medication known as an angiotensin receptor blocker (ARB) that helps relax blood vessels. It is primarily used to treat high blood pressure in adults and children, which helps reduce the risk of heart attacks and strokes. This medication also helps manage heart failure by improving symptoms and reducing hospitalizations.
Candesartan
(Candesartan)Candesartan is a medication belonging to a class called angiotensin receptor blockers (ARBs). It is primarily used to treat high blood pressure in adults and children, and also to manage heart failure in adults. This medicine works by helping to relax your blood vessels, which lowers blood pressure and reduces the strain on your heart.
Azilsartan Kamedoxomil
(Edarbi)Edarbi (azilsartan kamedoxomil) is a prescription medication used to treat high blood pressure in adults. It works by blocking certain natural substances that tighten blood vessels, allowing them to relax and widen, which helps to lower blood pressure and reduce the risk of serious heart problems like strokes and heart attacks.
How to Choose the Right Medication
Clinical decision factors used by prescribers when selecting a treatment.
- 1For all CKD patients with proteinuria: ACE inhibitor or ARB is first-line — start at low dose and titrate to maximum tolerated dose.
- 2For diabetic CKD: add an SGLT-2 inhibitor (dapagliflozin or empagliflozin) and finerenone to the ACE inhibitor/ARB — this combination provides additive nephroprotection.
- 3For non-diabetic CKD with proteinuria: dapagliflozin (Farxiga) is FDA-approved regardless of diabetes status.
- 4Blood pressure target: <130/80 mmHg for all CKD patients; <120/80 mmHg for those with proteinuria.
- 5Avoid NSAIDs in CKD — they reduce renal blood flow and accelerate progression.
- 6For CKD anemia (Hgb <10 g/dL): correct iron deficiency first; add ESA if Hgb remains <10 g/dL.
Monitoring & Follow-Up
- Check eGFR and urine albumin-creatinine ratio at least annually; every 3–6 months in CKD stages 3b–5.
- Monitor potassium closely when using ACE inhibitors, ARBs, SGLT-2 inhibitors, or finerenone — hyperkalemia is the main risk.
- Check hemoglobin every 3 months to monitor for CKD anemia.
- Monitor phosphate, calcium, PTH, and vitamin D levels in CKD stages 3b–5.
- Adjust medication doses for eGFR — many drugs require dose reduction or are contraindicated in advanced CKD.
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Frequently Asked Questions
What is Chronic Kidney Disease (CKD)?
Chronic Kidney Disease (CKD) is a long-term condition where your kidneys are damaged and can't clean your blood properly. This means waste and extra fluid build up in your body, which can cause many health problems over time. It's a progressive disease, meaning it usually gets worse slowly.
What causes CKD?
The most common causes of CKD are high blood pressure and diabetes. Other causes can include kidney infections, genetic diseases like polycystic kidney disease, long-term use of certain medicines, and blockages in the urinary tract. Sometimes, the exact cause is not known.
How is CKD diagnosed?
CKD is usually diagnosed with simple blood and urine tests. A blood test checks your GFR (glomerular filtration rate), which shows how well your kidneys are filtering. A urine test checks for protein in your urine, which can be a sign of kidney damage. Your doctor might also do imaging tests like an ultrasound.
What are the treatment options for CKD?
Treatment for CKD focuses on slowing down the damage and managing symptoms. This includes lifestyle changes like a healthy diet, exercise, and avoiding smoking. Medications like ACE inhibitors (e.g., lisinopril, ramipril) or ARBs (e.g., azilsartan) are often used to protect kidneys and control blood pressure. Other medicines may help with related problems like anemia or bone disease. In advanced stages, dialysis or a kidney transplant may be needed.
Can Chronic Kidney Disease be cured?
Currently, there is no cure for Chronic Kidney Disease. However, treatment can help slow down the progression of the disease, manage symptoms, and prevent serious complications. Early diagnosis and consistent management are key to maintaining kidney function for as long as possible and improving quality of life.
How can I manage CKD day-to-day?
Managing CKD daily involves following your doctor's advice closely. This includes taking your medicines as prescribed, eating a kidney-friendly diet (often low in salt, potassium, and phosphorus), staying active, and controlling blood pressure and blood sugar. Regular check-ups are important to monitor your kidney function and adjust your treatment plan as needed.
Can CKD be reversed?
CKD is generally not reversible — kidney damage from scarring and fibrosis is permanent. However, progression can be significantly slowed or halted with appropriate treatment. The goal is to preserve remaining kidney function and avoid reaching end-stage renal disease (ESRD), which requires dialysis or transplant. Some acute causes of kidney injury (obstruction, medication toxicity) can be reversed if caught early.
What foods should I avoid with CKD?
Dietary restrictions depend on CKD stage and lab values. Common recommendations include: limiting potassium (bananas, oranges, potatoes, tomatoes) if potassium is elevated; limiting phosphate (dairy, processed foods, dark colas) if phosphate is elevated; limiting sodium to <2,300 mg/day for blood pressure control; limiting protein to 0.6–0.8 g/kg/day in advanced CKD (stages 4–5) to reduce uremic toxin production. A renal dietitian can provide individualized guidance.
References & Clinical Sources
- 1.Heerspink HJL, et al. Dapagliflozin in patients with chronic kidney disease (DAPA-CKD). N Engl J Med. 2020;383(15):1436-1446.
- 2.Bakris GL, et al. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes (FIDELIO-DKD). N Engl J Med. 2020;383(23):2219-2229.
- 3.KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int. 2022;102(5S):S1-S127.
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The information on RxGuide is intended for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, pharmacist, or other qualified health provider with any questions you may have regarding a medical condition or medication. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.