Medications to treat chronic kidney disease

Chronic kidney disease (CKD) is a long-term condition in which the kidneys become damaged or lose some of their ability to filter waste and excess fluid from the blood. In this article, a consultant nephrologist discusses medicinal approaches to the treatment of CKD.

CKD is usually identified through blood tests measuring kidney function (eGFR) and urine tests looking for albumin or protein. CKD is common, particularly among people with diabetes, high blood pressure or cardiovascular disease, and its severity can range from mild kidney impairment to kidney failure.

One of the important features of CKD is that it can progress gradually. However, early diagnosis and appropriate treatment can significantly slow progression and reduce the risk of cardiovascular complications.

What are the symptoms of chronic kidney disease?

In its early stages, CKD often causes no noticeable symptoms at all. This is why routine blood and urine tests are particularly important for people at increased risk.

As kidney function declines, some people may develop tiredness, reduced appetite, nausea, ankle or leg swelling, changes in how often they pass urine, itching, muscle cramps or breathlessness. These symptoms are not specific to CKD, however, and may have many other causes. A person should therefore speak with their GP or healthcare team rather than assuming that symptoms are due to their kidneys.

What causes chronic kidney disease?

There are several possible causes. Diabetes and high blood pressure are among the most common, while other causes include inherited kidney conditions, recurrent kidney infections, inflammation of the kidney, urinary tract obstruction and certain medications or long-term exposures.

Sometimes CKD develops following an earlier episode of kidney injury. In other cases, the underlying cause is never completely identified. Understanding the cause remains important because it can influence both treatment and the risk of progression.

The main pillars of treatment

The modern approach to CKD is not based on one medication. Instead, treatment combines blood pressure control, kidney-protective medicines, management of diabetes and cardiovascular risk, healthy lifestyle measures and regular monitoring.

For many patients with protein or albumin in the urine, an angiotensin receptor blocker (ARB) may be an important part of treatment. ARBs lower blood pressure and reduce pressure within the kidney's filtering units, helping to reduce albumin loss in the urine and protect kidney function. Kidney function and potassium levels are normally checked after starting or changing the dose.

SGLT2 inhibitors have also become an important pillar of kidney protection. Although originally developed as medicines for type 2 diabetes, drugs in this class have demonstrated kidney and cardiovascular benefits in selected people with CKD, including some patients without diabetes. They can reduce the risk of CKD progression and are now an established part of modern CKD management.

For people with type 2 diabetes and CKD, GLP-1 receptor agonists such as semaglutide may have an additional role. They improve blood glucose control and can support weight loss and cardiovascular risk reduction. Evidence has also strengthened for kidney benefits, including data showing reduced kidney-related outcomes with semaglutide in people with type 2 diabetes and CKD. Current guidance supports long-acting GLP-1 receptor agonists when individualised glucose targets have not been achieved despite appropriate treatment, including an SGLT2 inhibitor where suitable

Lifestyle, monitoring and long-term care

Medication works best alongside practical measures. Stopping smoking, maintaining a healthy weight, taking regular physical activity, moderating salt intake and following an appropriate diet can all form part of CKD care. Cholesterol and cardiovascular risk should also be addressed, because people with CKD have an increased risk of heart attack and stroke.

Regular monitoring allows treatment to be adjusted as kidney function, blood pressure, urine albumin and other blood results change. Not every medication is suitable for every patient, and doses may need to change as kidney function declines.

The overall aim is straightforward: preserve kidney function for as long as possible while protecting the heart and maintaining quality of life. With earlier diagnosis and an increasingly effective range of treatments, many people with CKD can remain well for many years.