Uremia Medication
- Author: A Brent Alper Jr, MD, MPH; Chief Editor: Vecihi Batuman, MD, FACP, FASN more...
Medication Summary
Usually, medications used for uremia are indicated to treat associated metabolic and electrolyte abnormalities, such as anemia, hyperkalemia, hypocalcemia, hyperparathyroidism, and iron deficiency. Medication selection and dosage depend on the patient's clinical state, which may change with the acute clinical setting. Dialysis is the primary treatment for uremia, but medications can effectively treat some of the associated symptoms and clinical abnormalities (eg, anemia, hypocalcemia).
Colony-stimulating factors
Class Summary
Increase reticulocyte count, hematocrit value, and hemoglobin levels.
Epoetin alfa (Epogen, Procrit)
Purified glycoprotein produced from mammalian cells modified with gene coding for human EPO. Biological activity mimics human urinary EPO, which stimulates division and differentiation of committed erythroid progenitor cells and induces release of reticulocytes from bone marrow into the blood stream. Indicated for treatment of anemia associated with CRF or renal insufficiency.
Calcium supplements
Class Summary
Used to correct hypocalcemia and improve symptoms associated with renal osteodystrophy. Also may be used to bind phosphate in patients with hyperphosphatemia.
Calcium carbonate (Caltrate, Os-Cal 500, Alka-Mints, Tums)
Indicated for treatment of hyperphosphatemia secondary to CRF. Effectively normalizes phosphate concentrations in dialysis patients. Combines with dietary phosphate to form insoluble calcium phosphate, which is excreted in feces. Marketed in a variety of dosage forms and is relatively inexpensive.
Calcium acetate (PhosLo, Calphron)
Indicated for treatment of hyperphosphatemia secondary to CRF. Effectively normalizes phosphate concentrations in dialysis patients. Combines with dietary phosphate to form insoluble calcium phosphate, which is excreted in feces.
Vitamins
Class Summary
Essential for normal metabolism of proteins, carbohydrates, and fats and normal DNA synthesis. Used in the treatment of hyperparathyroidism, vitamin D deficiency, and renal osteodystrophy.
Paricalcitol (Zemplar)
For treatment of secondary hyperparathyroidism in ESRD. Reduces PTH levels, stimulates calcium and phosphorous absorption, and stimulates bone mineralization.
Calcitriol (Rocaltrol)
Two known sites of action are intestine and bone. Other evidence indicates that it also acts on kidneys and parathyroid gland. Vitamin D-3 must be converted to calcitriol in liver and kidneys before it is fully active on its target tissues. Some evidence suggests that uremic patients have vitamin D–resistant state because of a failure of their kidney to metabolically activate vitamin D-3 to calcitriol, which increases calcium levels by promoting absorption of calcium in intestines and retention in kidneys.
Iron salts
Class Summary
Used to correct iron deficiency symptoms.
Ferrous sulfate (Feosol)
A nutritionally essential inorganic substance necessary for hemoglobin formation and oxidative processes of living tissue. Effectively treats iron deficiency anemia.
Antidotes
Class Summary
Used to reduce serum potassium levels.
Sodium polystyrene sulfonate (Kayexalate)
Exchanges sodium for potassium, binds it in the gut (primarily in the large intestine), and decreases total body potassium. PO onset of action ranges from 2-12 h and is longer when PR.
Antidiabetic agents
Class Summary
Stimulate cellular uptake of potassium.
Insulin (Humulin R, Novolin R)
Stimulates cellular uptake of potassium within 20-30 min. Administer glucose along with insulin to prevent hypoglycemia. Monitor blood sugar levels frequently.
Phosphate binders
Class Summary
Used to bind phosphate when calcium carbonate or acetate cannot be used because of a high serum calcium level.
Sevelamer (Renagel)
Cationic polymer that binds intestinal phosphate, which is excreted in the feces. Not absorbed and does not contain calcium or aluminum ions. Binding of bile salts may also occur, which may result in lowered low-density lipoprotein cholesterol levels.
Lanthanum carbonate (Fosrenol)
Noncalcium, nonaluminum phosphate binder indicated for reduction of high phosphorus levels in patients with end-stage renal disease. Directly binds dietary phosphorus in upper GI tract, thereby inhibiting phosphorus absorption.
Piorry PA, l'Heritier D. Traite des Alterations du Sang. Paris, France: Bury & JB Bailliere; 1840.
Carrero JJ, Witasp A, Stenvinkel P, et al. Visfatin is increased in chronic kidney disease patients with poor appetite and correlates negatively with fasting serum amino acids and triglyceride levels. Nephrol Dial Transplant. Mar 2010;25(3):901-6. [Medline].
Almoznino-Sarafian D, Shteinshnaider M, Tzur I, et al. Anemia in diabetic patients at an internal medicine ward: Clinical correlates and prognostic significance. Eur J Intern Med. Apr 2010;21(2):91-96. [Medline].
Teng M, Wolf M, Lowrie E, Ofsthun N, Lazarus JM, Thadhani R. Survival of patients undergoing hemodialysis with paricalcitol or calcitriol therapy. N Engl J Med. Jul 31 2003;349(5):446-56. [Medline].
Sprague SM, Llach F, Amdahl M, Taccetta C, Batlle D. Paricalcitol versus calcitriol in the treatment of secondary hyperparathyroidism. Kidney Int. Apr 2003;63(4):1483-90. [Medline].
Schlieper G, Aretz A, Verberckmoes SC, et al. Ultrastructural Analysis of Vascular Calcifications in Uremia. J Am Soc Nephrol. Mar 4 2010;[Medline].
El-Agroudy AE, El-Baz A. Soluble Fas: a useful marker of inflammation and cardiovascular diseases in uremic patients. Clin Exp Nephrol. Jan 26 2010;[Medline].
Muscaritoli M, Molfino A, Bollea MR, et al. Malnutrition and wasting in renal disease. Curr Opin Clin Nutr Metab Care. Jul 2009;12(4):378-83. [Medline].
Fakhouri F, Roumenina L, Provot F, et al. Pregnancy-Associated Hemolytic Uremic Syndrome Revisited in the Era of Complement Gene Mutations. J Am Soc Nephrol. Mar 4 2010;[Medline].
Chuang YW, Shu KH, Yu TM, et al. Hypokalaemia: an independent risk factor of Enterobacteriaceae peritonitis in CAPD patients. Nephrol Dial Transplant. May 2009;24(5):1603-8. [Medline].
Seyffart G, Schulz T, Stiller S. Use of two calcium concentrations in hemodialysis--report of a 20-year clinical experience. Clin Nephrol. Mar 2009;71(3):296-305. [Medline].
[Best Evidence] Singh AK, Szczech L, Tang KL, Barnhart H, Sapp S, Wolfson M, et al. Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med. Nov 16 2006;355(20):2085-98. [Medline].
Drüeke TB, Locatelli F, Clyne N, Eckardt KU, Macdougall IC, Tsakiris D, et al. Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med. Nov 16 2006;355(20):2071-84. [Medline].
Fouque D, Laville M. Low protein diets for chronic kidney disease in non diabetic adults. Cochrane Database Syst Rev. Jul 8 2009;CD001892. [Medline].
Baigent C, Burbury K, Wheeler D. Premature cardiovascular disease in chronic renal failure. Lancet. Jul 8 2000;356(9224):147-52. [Medline].
Bolton WK, Kliger AS. Chronic renal insufficiency: current understandings and their implications. Am J Kidney Dis. Dec 2000;36(6 Suppl 3):S4-12. [Medline].
Fort J. Chronic renal failure: a cardiovascular risk factor. Kidney International. 2005;99:S25-29.
IV. NKF-K/DOQI Clinical Practice Guidelines for Anemia of Chronic Kidney Disease: update 2000. Am J Kidney Dis. Jan 2001;37(1 Suppl 1):S182-238. [Medline].
K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. Feb 2002;39(2 Suppl 1):S1-266. [Medline].
Kausz AT, Obrador GT, Arora P, Ruthazer R, Levey AS, Pereira BJ. Late initiation of dialysis among women and ethnic minorities in the United States. J Am Soc Nephrol. Dec 2000;11(12):2351-7. [Medline].
Levey AS, Adler S, Caggiula AW, England BK, Greene T, Hunsicker LG, et al. Effects of dietary protein restriction on the progression of advanced renal disease in the Modification of Diet in Renal Disease Study. Am J Kidney Dis. May 1996;27(5):652-63. [Medline].
Lim VS, Kopple JD. Protein metabolism in patients with chronic renal failure: role of uremia and dialysis. Kidney Int. Jul 2000;58(1):1-10. [Medline].
May RC, Mitch WE. Pathophysiology of uremia. In: Brenner BM, ed. Brenner & Rector's The Kidney. Vol 2. 5th ed. Philadelphia, Pa: WB Saunders; 1996:2148-69.
Noris M, Remuzzi G. Uremic bleeding: closing the circle after 30 years of controversies?. Blood. Oct 15 1999;94(8):2569-74. [Medline].
Palmer BF. Sexual dysfunction in uremia. J Am Soc Nephrol. Jun 1999;10(6):1381-8. [Medline].
Roubicek C, Brunet P, Huiart L, et al. Timing of nephrology referral: influence on mortality and morbidity. Am J Kidney Dis. Jul 2000;36(1):35-41. [Medline].
US Renal Data System. Excerpts from the USRDS 2000 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. Am J Kidney Dis. 2000;36 (Suppl 2):S1-S239.
US Renal Data System. USRDS 1999 Annual Data Report. Bethesda, Md: National Institutes of Health; 1999:[Full Text].
Vanholder R. The Uremic Syndrome. In: Greenberg A, ed. Primer on Kidney Disease. 2nd ed. San Diego, Calif: Academic Press; 1998:403-7.
Vanholder R, De Smet R. Pathophysiologic effects of uremic retention solutes. J Am Soc Nephrol. Aug 1999;10(8):1815-23. [Medline].
Vanholder R, De Smet R, Lameire N. Protein-bound uremic solutes: the forgotten toxins. Kidney Int Suppl. Feb 2001;78:S266-70. [Medline].
Walker R. General management of end stage renal disease. BMJ. Nov 29 1997;315(7120):1429-32. [Medline].
Xu X, Fang W, Ling H, et al. Diffusion-weighted MR imaging of kidneys in patients with chronic kidney disease: initial study. Eur Radiol. Sep 30 2009;[Medline].
Yavuz A, Tetta C, Ersoy FF, D'intini V, Ratanarat R, De Cal M, et al. Uremic toxins: a new focus on an old subject. Semin Dial. May-Jun 2005;18(3):203-11. [Medline].
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