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By Robert Provenzano, M.D., F.A.C.P.

The relationship between a patient with chronic kidney disease (CKD) and a nephrologist focuses on many aspects of the person’s care. First and foremost is the identification of the cause of chronic kidney disease, and the development of a treatment plan. Second is the identification and management of the comorbid conditions associated with chronic kidney disease, such as diabetes and anemia. Not only does this include education about comorbidities, but education about using other products that can adversely affect a person’s health.

Nephrologists commonly advise their patients to not take anything over-the-counter without first checking with them. It is important to focus on medications, supplements and additives that may be problematic for people with kidney disease.

It is often a good idea for people to bring all medicines with them when visiting the nephrologist or any of their other doctors, including both prescription and non- prescription medicines. This will help prevent mistakes and misunderstandings that could potentially be dangerous to a patient’s health.

Areas of concern fall into four major categories:

• Prescription medications prescribed by non-nephrologists such as emergency room physicians, cardiologists or primary care physicians
• Non-prescription, over-the-counter medications and vitamins
• Food supplements and additives
• Cold/flu remedies

Prescription medications

Any time a patient is under the care of a physician who is not a kidney specialist, he or she should make sure the doctor is aware of their chronic kidney disease so that medications that may be harmful to the kidney will be avoided, or the dose adjusted. This will help prevent problems before they occur.  

Generally, you will want to notify your doctor that you have kidney disease, be wary of prescribed medications that fall into these two categories: antibiotics and non-steroidal anti-inflammatory. If you are prescribed medication in either of these categories and you are unsure of their impact on your kidneys, you should speak to your pharmacist or perform an Internet search. Helpful websites include and . Type into the search area your disease or name of your prescription and use the information you find to help generate questions for your next nephrologist visit.

Over-the-counter (OTC) medications

Over-the-counter (non-prescription) versions of non-steroidal anti-inflammatory drugs also are of concern. Examples include Advil^®, Motrin^® and Aleve^®. Please review the instructions on the package before purchasing, or avoid these medications if your doctor has previously indicated you should.

Aspirin also falls into this category. The use of aspirin once a day is not harmful to a person with kidney disease, and may in fact be helpful. But if you are taking buffered aspirin for a more serious disorder such as arthritis, and require multiple doses per day, consider that this treatment may be harmful to your kidneys and talk about it with your nephrologist first.  

Vitamins are included in the group of potentially harmful medications, specifically vitamin C. Vitamin C can increase the chance of having calcium kidney stones. People who have kidney stones or kidney damage from stones should avoid large doses of vitamin C.

Food supplements and food additives

Concern about food supplements or food additives typically focuses on younger people with chronic kidney disease. Young men who attempt to build muscle mass may take protein supplements which cause their kidneys to hyperfunction, leading to decrease in renal function. Other supplements to be aware of are the caffeine supplements that are found in food and drinks, as well as creatine.

Creatine is a worrisome additive that many people use to bulk up their muscles. It is metabolized into creatinine, a chemical waste product that functioning kidneys eliminate from the body. When you have kidney disease, creatinine builds up, and is used as a surrogate of renal function; the higher the creatinine, the worse the kidneys work.  

If you are instructed to avoid salt, be very careful. Salt substitutes are usually made of potassium chloride instead of sodium chloride. In your attempt to avoid sodium, you may be overdosing yourself with potassium, which can result in cardiac arrhythmia (irregular heartbeat) or even death. Talk to your doctor or dietitian about alternatives to salt and salt substitutes.

Cold and flu supplements

When the flu season hits, the use of treatments for cold and flu soars. These medications often include compounds that can intensify hypertension and salt retention. Should you require a product to treat cold and/or flu symptoms, it is strongly recommended that you take them as prescribed by your doctor and carefully read the package instructions.

In addition, people with kidney disease need to monitor their blood pressure — especially while on these types of medications. If your blood pressure increases, contact your nephrologist immediately.

Summary

These are just some broad guidelines for the use of prescription drugs and over-the-counter medications. When you have kidney disease, it is beneficial to be aware of how certain medicines can affect your body. Collaborating with your nephrologist and kidney health care team should keep you safe and protect your kidney function.

About Dr. Provenzano

Robert Provenzano, M.D., F.A.C.P., is Vice President of Medical Affairs at ºìÌÒÊÓƵ¸ßÇåappÏÂÔØ Inc. and Chief of Nephrology at St. John Hospital & Medical Center in Detroit.