According to the National Academy of Pharmacy in France, nearly three million people have chronic kidney disease and two thirds of these patients suffer from renal failure.
Chronic kidney failure: what are we talking about?
Chronic kidney failure is defined by a reduction in the kidney’s ability to filter the body’s blood. “We speak of renal failure when the glomerular filtration rate (DFG) is less than 60 ml/min/1.73m2specifies Professor Dominique Guerrot. More simply, this means that the kidneys are functioning less than 60% of normal.”
What are the symptoms of kidney failure?
Chronic kidney disease is often silent for several years. “Usually, it is diagnosed during a blood testconfirms the specialist. When the kidneys are really not working well, certain signs may appear such as shortness of breath, swelling of the legs (edema), high blood pressure, foamy or pink urine…”
What are the main risk factors?
In France, the main risk factor for kidney failure is diabetes. “Cardiovascular diseases such as myocardial infarction and hypertension when severe are also risk factors”, adds Professor Guerrot. Finally, people with hereditary kidney diseases such as polycystic kidney disease, autoimmune diseases (lupus) or those prone to febrile urinary infections or lithiasis are at greater risk of developing kidney failure.
How is it diagnosed?
The diagnosis is mainly based on biological tests of renal function – including the measurement of blood creatinine (serum creatinine) and the estimation of the glomerular filtration rate (GFR) – as well as a urine analysis.
What is the treatement ?
Treatment will first depend on the cause of the kidney failure. “For example, diabetes”, indicates the nephrologist. And to add: “In addition to correcting risk factors, specific treatments as well as the adoption of healthy and dietary rules – avoiding eating too much salt or consuming too much protein, practicing regular physical activity – help slow the progression of kidney disease. if we act in time.” Nephroprotective treatments such as ACE inhibitors, sartans or gliflozins may also be prescribed.
What medications are contraindicated in kidney failure?
There are two classes of medications requiring significant precautions in use or even being contraindicated in cases of advanced renal failure:
- so-called nephrotoxic drugs, that is to say toxic to the kidneys;
- medications at risk of overdose in cases of reduced renal function. A usual dosage may, in fact, be too high due to impaired drug elimination.
“In addition to these first two classes, there are drugs which protect the kidneys and are therefore not toxic, but which can vary kidney function and possibly worry patients during their blood tests, such as certain diuretics or anti-hypertensive drugs”explains the nephrologist.
Nephrotoxic drugs
Several medications can be toxic to the kidneys and therefore require a careful assessment of the relationship between the benefits and the risks involved:
- certain chemotherapies or immunotherapies;
- lithium prescribed for bipolar disorders;
- nonsteroidal anti-inflammatory drugs (NSAIDs) (ibuprofen, ketoprofen, etc.);
- proton pump inhibitors (PPI) (omeprazole, esomeprazole, etc.).
Medications at risk of overdose
“The main risk is overdoseinsists Professor Guerrot. When the kidneys function less well, the molecules will be eliminated less quickly.” It will therefore be necessary to adapt the dose or even stop urinary elimination medications such as:
- metformin prescribed for type 2 diabetes;
- certain anticoagulants;
- certain antibiotics;
- certain anti-hypertensives, notably spironolactone;
- certain chemotherapies.
The National Academy of Pharmacy recommends that prescribers indicate their estimated glomerular filtration rate on prescriptions for people suffering from kidney failure and advises patients to avoid self-medication without consulting their doctor or pharmacist. According to a study carried out on a cohort of people aged over 75 with chronic kidney disease (GFR estimated less than 20ml/min/1.73m2) nearly 77% of prescriptions were at renal risk and 11% were against -indicated. And Professor Guerrot concludes: “Patients with chronic kidney disease must absolutely be involved in their illness and report their kidney failure to any health professional so that the treatments prescribed are adapted to their situation.”