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Patient Education
Chapter 12 – Page 1
KEEP Notebook
Medication
Information and
Glossary
Objectives:
1. Understand guidelines
for taking medication
and why it is critical
for patients with
kidney disease to
follow doctor’s orders
about taking
medications.
2. Refer to terms related
to kidney disease and
dialysis, defined in the
glossary (see page 4),
Some medications damage the kidneys. Many
medications are excreted by the kidneys. When kidney
function decreases, dosage of medications may need
to be changed. There are two key reasons to follow
what your doctor tells you about taking your
medications:
1. Most medications have side effects in addition to the
desired effects.
2. Some medications have undesireable effects when
taken with other medications.
Be sure to take the right dosage of your medication at
the right time. Follow all instructions for taking
medications. Do not take medications without your
doctor’s approval.
This chapter describes medications most often
prescribed for people with kidney disease.
as needed.
American Nephrology
Nurses’ Association
Greater Puget Sound Chapter
Chapter 12 – Page 2
KEEP Notebook
Phosphate Binders
Renagel (sevelamer), Phos-Lo (calcium acetate), Tums (calcium
carbonate), aluminum hydroxide (Alu-cap, Alu-tab, Amphojel,
Dialume), aluminium carbonate (Basaljel)
These drugs are used by people on dialysis to treat high phosphorous
levels in the blood. They prevent the absorption of phosphorus into the
blood and soft tissue, by binding it in your intestines. It then passes
from your body in the stool. These “binders” help prevent bone disease
by maintaining the proper calcium-phosphorus balance. When these
medications are used as phosphate binders, they should be taken when
you eat to be effective.
Erythropoietin (EPO)
Procrit, Aranesp
This is a hormone normally made in the kidney that stimulates bone
marrow to produce red blood cells. It is a shot that can be given
intravenously (by IV) or injected under the skin.
Iron Supplements
Ferrous sulfate (Feosol, Fer-In-Sol, Fero-Gadument), Ferrous
gluconate (Fergon), Ferrous fumerate (Femiron, Feostat, Fumerin,
Ircon), Tabron (iron/vitamin supplement), or Chromagen Forte
Supplement iron pills that provide the building blocks for the body to
make new blood.
Injectable Iron Supplement
Iron gluconate (Ferrlecit), iron sucrose (Venofer)
Used to replace iron in people who cannot take oral forms or in people
in which the oral form is not effective when rapid replacement is
needed.
Anticoagulants (prevents blood clotting)
Warfarin (Coumadin), Heparin, Lovenox
Used to decrease the clotting of blood. Often called a blood thinner. An
anticoagulant is used during hemodialysis to prevent the blood from
clotting in the blood access, blood lines, and dialyzer. Heparin is also
placed in dialysis catheters to prevent clotting while the catheter is not
in use.
Chapter 12 – Page 3
KEEP Notebook
Antihypertensive Drugs (blood pressure medications)
Antihypertensive drugs are drugs or agents that reduce or control high
blood pressure. There are groups that act on different parts of the body
to decrease blood pressure including:
ACE inhibitors: lotensin, lisinopril, captopril, monopril, zestril,
Vasotec, ramapril
Beta Blockers: Metopolol, Atenolol, Propranolol, Coreg
Diuretics: Hydrochlorothiazide, Spironolactone
ARBs: Avapro, Cozaar, Diovan, Atacand, Micardis
Calcium Channel Blockers: Plendil, Norvasc, Adalat, Cardizem
Drugs Used to Control Calcium Balance
Oscal: This medication is made from oyster shells, and contains
250 mg of calcium and 125 units of vitamin D per tablet.
Tums: A calcium replacement.
25-Dihydroxycholecalciferol or Calcitriol (Rocaltrol)
Zemplar
An active form of vitamin D3. For the control of hyperparathyroidism
in ESRD patients. Used in the management of calcium problems in
chronic dialysis patients.
Hypnotics (relaxants and sleeping pills)
Diazepam (Valium), Lorazepam (Ativan)
Used to relieve nervousness or tension, to relax muscles or relieve
muscle spasms, and to induce sleep. Take only as prescribed.
Laxatives and Stool Softeners
Psyllium mucilloid (Metamucil): Bulk-forming laxative.
Docusate sodium (Colace): Stool softener.
Dulcolax (Bisacodyl): Laxative.
Miralax: Gentle laxative.
Chapter 12 – Page 4
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Immunosuppressives (suppress the immune system)
Deltasone (Prednisone), cycophosphamide (Cytoxan), cyclosporine
(Sandimmune, Neoral), azathioprine (Imuran), OKT 3, ATG, FK 506
(Tacrolimus), MMF (Mycophenolate or cellcept), Sirolimus
(Rapimmune)
Used to prevent or reduce rejection of transplanted organs.
Vitamins
Nephrocaps, Nephrovits, or Diatx
The B and C vitamins are water soluble. During dialysis, these watersoluble vitamins are removed, so they are replaced by taking oral
supplements. Check with your doctor before taking any vitamins.
Glossary
anemia – A condition where you have a low number of red blood cells
in your body. It can make you tired and cold.
artery – Blood vessels that carry blood from the heart to the tissues.
artificial kidney (dialyzer) – A semipermeable membrane that
removes waste from the blood and restores chemical balance in the
body. Used with hemodialysis.
blood access – The site used during hemodialysis to remove and return
your blood from the machine. Surgery is needed to prepare the site.
blood pressure – The pressure within the arteries. It reaches its peak
when the heart beats and drops to its lowest level between beats.
bruit – A murmur or buzzing sound that can be heard at the fistula or
graft site.
cadaveric transplant – A transplant that uses a kidney donated by a
person who has recently died.
continuous ambulatory peritoneal dialysis (CAPD) – The most
common type of peritoneal dialysis. With CAPD, the blood is always
being cleaned. The procedure uses a system of bags and tubing. No
machine is required.
continuous cycling peritoneal dialysis (CCPD) – A form of
peritoneal dialysis that uses a cycling machine. The machine
automatically performs the exchanges while the person sleeps and
usually involves 3 to 5 exchanges per night.
chronic renal failure (CRF) – The stage of kidney failure that requires
dialysis or kidney transplant to maintain life and health.
Chapter 12 – Page 5
KEEP Notebook
daily short dialysis – A term used to describe frequent hemodialysis. It
is usually 5 to 7 treatments per week, each lasting 2 to 3 hours.
deciliter – A measure of volume equal to one-tenth of a liter.
dialysate (bath) – The solution used in dialysis to remove metabolic
waste products from the blood.
dialysis – The process of maintaining the chemical balance of the blood
when the kidneys have failed (cleansing the blood).
dialysis access – Any device used to connect a person to dialysis. This
includes peritoneal catheters, fistulas, artificial vessels, and
hemodialysis catheters.
dialyzer – A part of the hemodialysis machine that removes wastes and
extra fluid from the blood, also called the artificial kidney.
dry weight (tissue weight) – A range of normal weight when no
excess fluid is present. Your dry weight changes when your “tissue”
body weight changes.
edema – An abnormal accumulation of fluid in body tissues. You can
check yourself for edema or swelling on your ankles, hands, face or
eyelids.
erythropoietin – A hormone made mainly by the kidneys that instructs
your bone marrow to make red blood cells.
fistula – A patient’s own vein, that is changed by joining an artery
(which has high blood flow), to a vein (which has lower blood flow),
causing the vein to enlarge and the vein walls to become strengthened
for hemodialysis access.
fluoroscopy – An X-ray procedure that makes it possible to see
internal organs in motion.
graft – An artificial vessel implanted under the skin and joined to the
vascular system for access.
hematocrit – The percentage of volume of blood that is red blood
cells.
hypertension – High blood pressure.
hypotension – Low blood pressure.
interventional radiologist – A clinician who uses fluoroscopy to
perform procedures such as inserting and removing catheters and
dilating or stenting vessels and fistulas/grafts.
Chapter 12 – Page 6
KEEP Notebook
kidney disease programs (KDPs) – State-funded programs that assist
CKD patients with expenses related to their treatment. KDPs serve as
payors of last resort.
kilogram – A measure of weight. One kilogram equals 2.2 pounds.
liter – A measure of volume. One liter equals 1.06 quarts.
living related donation – A person who is willing to donate a kidney,
and is related to the person needing it.
living unrelated donation – A person who is willing to donate a
kidney, but isn’t related to the person needing it.
milli (m) – A prefix used in the metric system meaning one-thousandth.
milligram (mg) – A measure of weight equal to one-thousandth of
a gram.
milliliter (ml) - A measure of volume. One milliliter equals onethousandth of a liter.
nephrologist – A doctor who treats patients with kidney problems and
hypertension.
peritoneum – The smooth sac which lines the cavity of the abdomen.
peritoneal catheter – A soft tube, about one-quarter inch in diameter
and 13 to 15 inches long, which is inserted into the peritoneal cavity
through the skin of the abdomen, providing a small opening through
which dialysate can be placed.
peritoneal membrane – A sac, resembling cellophane with holes,
which serves as the lining of the abdominal cavity and holds organs in
place within the peritoneal cavity.
peritonitis – An inflammation or infection of the peritoneal membrane.
Peritonitis is treated with antibiotics that are included in a special type
of peritoneal fluid.
phosphorus (phosphate) binder – A medication taken with food that
binds with phosphorus so the phosphorus doesn’t get into the blood.
Bound phosphorous goes out of the body in the stool.
protein – A nutrient used by the body to replace old or damaged
tissues and to build new tissues such as muscle and blood.
residual renal function – The degree of kidney function remaining in
patients with chronic kidney disease.
serum – The fluid portion of the blood remaining after clot formation.
Chapter 12 – Page 7
KEEP Notebook
shunt – Another name for fistula or graft blood access.
stent – A tube made of metal or plastic that can be inserted into a
vessel to keep it open.
thrill – A vibrating feeling found in a fistula or graft where the arterial
blood enters the vein.
transplantation – Surgically placing a kidney (or other organ) from a
donor to a recipient.
ultrafiltration – The process of removing water from the blood by
exerting pressure on the blood in the dialyzer during hemodialysis, and
by using higher glucose concentrations in PD.
uremia – The accumulation of waste products in the blood that the
kidney normally filters into the urine.
vascular – Refers to the blood vessels and blood carrying system of the
body.
vascular catheter – A synthetic tube or catheter inserted through the
skin into a vessel to access the blood supply for hemodialysis.
vein (venous) – Blood vessels that carry blood from the body tissues
to the heart.
waste products (metabolic end-products) – Chemicals produced by
normal body functions that are not needed by the body.
Chapter 12 – Page 8
KEEP Notebook
Notes
Questions?
Your questions are important. Call your doctor or
health care provider if you
have questions or concerns.
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American Nephrology
Nurses’ Association
Greater Puget Sound Chapter
© University of Washington Medical Center
07/2004