Medications and Your Kidney Health

CEAC 0792 September 2018

*This document was designed to support patients of the former RQHR.

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Table of Contents

Introduction 2

Booklet Summary 2

Taking Your Medications Properly 3

Generic vs Brand Name of Medications 4

Things You Should Do 4

Things You Should Know About Your Medications 4

High Blood Pressure 4

How to Take Your Blood Pressure 6

Heart Health 6

Protein in the Urine 7

Anemia 7

Bone Health 11

Diabetes 12

Potassium 14

Multivitamins 14

Herbal and Natural Products 15

Itch 15

Headache and Pain 15

Constipation 16

Stomach Problems 16

Cough and Cold Preparations 17

Medication Dose Adjustments 17

Withholding Medications When You Are Sick 17

CKD Clinic 18

Contact Information 18

Home Blood Pressure Log 19

List of Medications 20

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Introduction

This booklet will help you better understand your medications for ongoing or chronic kidney disease (also called CKD). CKD includes the time before dialysis and could also mean time on dialysis.

Dialysis is a treatment for kidney failure that removes wastes and water from the blood.

There are different kinds of dialysis such as peritoneal dialysis and hemodialysis.

You may also hear the term “renal replacement therapy” which includes dialysis treatment.

Your kidney health team is here to help. Members of this team could include:

a nephrologist (kidney doctor)

renal pharmacists (pharmacists that are specially trained to work with medications used in kidney disease)

nurses

dietitians

social workers. To help you with your kidney health, you may be on different kinds of medications. This booklet reviews some of these medications to help you to understand why you are on them and how to take them. By taking your medications properly and regularly, the goals are to:

slow down harm to your kidneys (kidney protection)

delay or prevent the need for dialysis

reduce the risk of having a heart attack or stroke (heart protection)

reduce the risk of anemia

improve bone health

reduce any unwanted effects of medications.

Note: Some goals may be different if you are on dialysis or renal replacement therapy already. If you have any questions about your kidney medications, talk to your nephrologist or renal pharmacist. If they are not available, talk to your kidney health team.

Booklet Summary

This booklet contains information to help you learn about some of the medications you may be taking for your kidney health. In addition, the booklet will explain the main thoughts and purpose of the medications for common conditions encountered in kidney disease. This booklet is lengthy, so it may be useful for you to just review each section that affects you. For example, if you are being treated for high blood pressure or anemia, go to those sections in the booklet.

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Taking Your Medications Properly

Even though you may not necessarily feel any different while taking your medications, it is important to continue to take your medications as prescribed. Your medications are carefully chosen with you to protect your kidneys and prevent further harm.

All medications may have unwanted or side effects that you may hear or read about. However, not everyone may experience those unwanted effects or these effects may go away in time as your body adjusts. If you are having problems with any of your medications, discuss them with your renal pharmacist or nephrologist.

Once in a while, there may be changes to your medications according to how you feel or based on your blood pressure or even blood work results. If so, these changes will be discussed with you.

You may be on some medications for a long time. If you have any questions about how long you need to be on a medication, discuss this with your renal pharmacist.

It is ideal that you try to fill your medications at the same pharmacy or drugstore and for your community pharmacist to know that you have kidney disease. This helps your pharmacist keep a complete and accurate list of your medications to look for drug interactions or any other problems.

When you get a new prescription and you do not know the pharmacist working that day, ask if the medication and dose are appropriate in kidney disease.

It is important to never run out of medication refills. A good idea is to contact your doctor when you get your last refill before the prescription ends, which will give your health care team time to organize.

If your doctor prefers the pharmacy to fax the request for refills to their office, ask your community pharmacist to do so.

For many people, the cost of medications may be a problem. There are programs to help if you cannot afford your medications. Ask your community pharmacist for more information on the assistance that is available. If finances continue to be a problem, talk to your kidney health team.

Some medications also may require extra steps to obtain special coverage with your government drug plan. Your pharmacist will inform you if there will be a delay in filling your prescription because of this.

If you need to be admitted into a hospital, take your medication bottles or an updated medication list with you. It is very important that the hospital staff know exactly what medications you take and how you are taking them. If the label instructions on your bottle(s) are different from how you take your pills, make sure you tell the health care worker. This will help your health care team to make well informed decisions.

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Generic vs Brand Name Medications

All medications may have more than one name.

The generic name is the chemical or medical name of a medication, which is always the same.

The brand name is the name the company gives the medication and may differ.

Examples:

Facial tissue (generic) vs Kleenex® (brand)

Acetaminophen (generic) vs Tylenol® (brand)

Things You Should Do

Let your doctor and renal pharmacist know of any changes in your medications.

Bring an updated list of medications or the medication bottles with you to all appointments. This should include non-prescription medicines such as vitamins, herbal supplements or traditional medicine.

Also bring information on any medication allergies and what happened when you took that medication.

Things You Should Know About Your Medications

the name and strength

how much medication to take, when, and how often

what it is for

how long until it works

what tests may need to be done to see if the medication is working

what to do if it does not work

what to do if you miss a dose

if it causes unwanted or side effects (what you should watch for and when you

should call the doctor).

High Blood Pressure

High blood pressure (also known as “hypertension”) may lead to CKD, or in some people, CKD may also lead to high blood pressure. Having high blood pressure for a long time may force your heart to work harder than normal and may lead to causing harm to your kidneys.

Other things that may happen with high blood pressure include a heart attack and stroke.

Even if you feel fine, it is important that you continue taking your medications. Lowering your high blood pressure can reduce your risk of these problems.

Ask your nephrologist or renal pharmacist what your personal blood pressure targets should be.

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You may need more than one medication to control your blood pressure. There are many different kinds of medications used to treat high blood pressure. Some of the families of medications used are listed below. Some unwanted effects may include light-headedness, dizziness, drowsiness, and tiredness, although not everyone experiences these side effects. Angiotensin Converting Enzyme Inhibitor (ACE-I)

Ends in “-pril”

o E.g. perindopril (Coversyl® and others), ramipril (Altace® and others)

Regular blood work helps us to watch your potassium levels, creatinine, and your kidneys.

If you develop a cough after taking this medication, discuss with your doctor or renal pharmacist.

Angiotensin Receptor Blocker (ARB)

Ends in “-sartan”

o E.g. telmisartan (Micardis® and others), candesartan (Atacand® and others), irbesartan

(Avapro® and others), valsartan (Diovan® and others)

Regular blood work helps us to watch your potassium levels, creatinine, and your kidneys.

Beta-blocker

Ends in “-ol”

o E.g. metoprolol (Lopressor® and others), atenolol (Tenormin® and others), labetalol

(Trandate® and others), bisoprolol Calcium channel blocker

E.g. amlodipine (Norvasc® and others), nifedipine (Adalat® and others), diltiazem (Tiazac®

and others), verapamil (Isoptin SR® and others)

Diuretic (“Water Pill”)

E.g. furosemide (Lasix® and others), chlorthalidone, hydrochlorothiazide, indapamide

(Lozide® and others), spironolactone (Aldactone® and others)

It is a good idea to check your blood pressure at home using an approved blood pressure monitor, as instructed by your kidney health care team. Talk to your doctor or pharmacist for advice on selection of a blood pressure monitor, if needed.

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How to Take Your Blood Pressure

1) Sit upright in a comfortable chair, with your back supported. Measure your blood

pressure after sitting quietly for at least 5 minutes.

2) Place feet flat on floor. DO NOT cross your legs.

3) Place the lower edge of the cuff 1 or 2 centimeters (1-2 finger widths) above the bend of the elbow.

4) The cuff should be snug, but not too tight; there should be enough room to slide your finger between the cuff and the arm.

5) The cuff should be positioned at heart level and the cuffed arm should rest on a firm

surface.

6) There should be no restrictive clothing on arms.

7) Take your blood pressure when your bowel and bladder are comfortable.

8) DO NOT take your blood pressure in the following situations, as your blood pressure readings could be affected:

When you have had caffeine (e.g. coffee, tea, caffeinated soft drinks), tobacco or alcohol within the last 30 minutes.

When you are eating, drinking or talking.

When you have just finished exercising.

When you are under stress or in pain. Note: Wrist blood pressure monitors are not preferred to measure blood pressure. If you use a wrist monitor, discuss with your doctor or kidney health team.

Heart Health

Heart health is also known as your “cardiovascular health”.

Cholesterol

People with kidney disease have an increased risk for a heart attack or stroke even if the cholesterol levels look okay.

Decreasing cholesterol may lower your risk of having a heart attack. Lifestyle changes like exercise and diet can improve your cholesterol, but you may need medication too.

A family of medications used to lower your cholesterol are called the “Statins” and end in “-statin.” Examples include atorvastatin, rosuvastatin, and pravastatin.

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The LDL cholesterol can be referred to as your “bad” cholesterol and can build up and clog your blood vessels.

Talk to your doctor, renal pharmacist or dietitian about your cholesterol. They will discuss what is best for you.

Acetylsalicylic acid (ASA, Aspirin®)

Not everyone with kidney disease needs to be taking ASA every day for heart health. Discuss with your doctor if you need to be taking ASA every day.

Protein in the Urine

A urine test called the “albumin:creatinine ratio” (ACR) is used to determine if there is protein (albumin) in your urine.

Protein in your urine may be a sign that the filters in your kidneys are not working as well as they should.

It is important that your blood pressure is well controlled and that you are on certain medications. These medications include the family called ACE Inhibitors or ARBs (which have been mentioned already) that can be used to control high blood pressure. They may also be used for other reasons.

If you are on these medications, it is important that your potassium and creatinine levels be monitored with your bloodwork.

Anemia

Anemia is a condition that occurs when your body is not making enough red blood cells. Red blood cells contain hemoglobin, which helps to carry oxygen throughout the body. If your hemoglobin or red blood cell count is low, the cells in your body are not getting enough oxygen which over time may affect your heart.

People with anemia may:

feel tired and/or weak

sleep more often

feel short of breath

feel cold

have a hard time concentrating

have less energy.

It is important that you do all the blood tests ordered at the times you were asked to do them. Your doctor and renal pharmacist will monitor your anemia. Common medications for treating anemia of kidney disease include EPO which is either erythropoietin (Eprex®) or darbepoetin (Aranesp®) and iron.

Not everyone needs to be on one or both of the medications.

You may need EPO if your body cannot make enough on its own or if you may have anemia due to low iron levels.

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Your kidney health team will carefully review and suggest what is best for you. If you have any questions about your EPO or iron, always feel free to ask your kidney health team.

There are other forms of anemia that we check for and sometimes you might need a vitamin B12 supplement.

EPO

EPO is a hormone made by the kidneys. It tells your bones to make more red blood cells when the body needs more oxygen.

If your kidneys are not working well enough, they may not be able to make enough EPO. The medications we use do the same job as the EPO made by the kidney.

The brand names of the EPO we use are called Eprex® or Aranesp®. EPO helps your body to make red blood cells to prevent blood transfusions. Once your hemoglobin levels get better, you may feel less tired and this will also help to protect your heart.

EPO is given under your skin as an injection, which can be from a few times a week to once a week or even longer, depending on how your body responds. Your health care team can teach you to do this on your own.

It is important that you take this medication exactly as directed and DO NOT change your instructions for taking EPO without talking to your nephrologist and renal pharmacist. It may take weeks or months to feel better after starting to take EPO.

DO NOT stop taking this medication on your own without talking to your kidney health team.

EPO is a very well-tolerated medication and side effects are uncommon. A few people may have a flu-like reaction with:

chills

shivering

sweating

muscle aches

bone pain.

These symptoms may appear 1-2 hours after an injection and usually go away within 12 hours. Tell your kidney health team if any of these problems continue or worsen.

Another uncommon, but possible effect is an increase in your blood pressure. If you have a home blood pressure monitor, check your blood pressure carefully over the first 2-3 weeks of taking EPO. Let your kidney health team know if your blood pressure continues to stay higher than your normal.

Call your doctor immediately if you develop:

chest pain

fast heartbeat

swelling

vision problems

seizures

a skin rash

hives.

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EPO comes as pre-filled or ready-to-use syringes and should be stored in the refrigerator. A syringe may be left out of the refrigerator for one single period of up to 7 days.

Take your next dose from the refrigerator 30 minutes before using it. Place it in a clean, dry area to allow it to warm to room temperature.

If your EPO has been out of the refrigerator for greater than 7 days, please return it to your pharmacy for an exchange. DO NOT use the syringe.

DO NOT allow the EPO to freeze.

Iron

Iron is very important for making red blood cells. For EPO to work best, your body must have enough iron.

Iron supplements are given to increase the iron levels in your blood. It may be given as oral pills to swallow or mixed with an intravenous fluid that will drip through a needle into your vein. Your doctor and renal pharmacist will choose which type and how much is best for you.

Different types of iron oral pills that you may be given include:

ferrous gluconate (usually a green tablet)

ferrous sulfate (sulphate) (usually a red tablet)

ferrous fumarate (various colors). There are other kinds of iron available, but check with your renal pharmacist.

Some possible side effects of oral iron are:

constipation

diarrhea

upset stomach

black stools.

How to Take Your Oral Iron Pills

DO NOT take with calcium pills, dairy products, or antacids, as the iron may not work as well.

Take on an empty stomach if possible. If you need to take with food, a non-dairy snack like crackers is fine.

Take with a glass of water.

Take at bedtime when you may have an empty stomach, which helps the body to absorb the iron the most (some people take 2-3 pills at once at bedtime).

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Intravenous Iron

Iron can also be given by intravenous (IV) infusion through a needle in your vein. It is often used for people who are not able to take oral iron pills or when the pills are not providing your body with enough iron. This form of iron is usually given in a hospital or special clinic.

Sometimes, depending on the type of IV iron used, a test dose may be ordered when receiving the iron for the first time.

Different types of IV iron include iron sucrose (Venofer®), sodium ferric gluconate complex (Ferrlecit®), and iron dextran (Infufer®).

IV iron may be given as a “load” where you get a few doses more frequently at the beginning. Some people may require regular IV iron after that. Again, your kidney health team will tell you how much IV iron you need.

If you were taking oral iron pills before IV iron, stop taking the pills. Check with your nephrologist or renal pharmacist to see if you need to restart iron pills once you are no longer receiving IV iron.

Possible unwanted effects of IV iron may include:

flu-like symptoms or fever

muscle and joint pain

backache

dizziness

stomach upset or vomiting.

If any unwanted effects occur, they are usually mild. They may occur anywhere from 4-48 hours after receiving the dose, but often disappear after 2-4 days and can be easily treated with acetaminophen (also called Tylenol®).

Very rarely, some patients may experience serious reactions when receiving IV iron that may occur within the first 15 minutes of the dose, but can occur up to an hour after receiving the dose.

You must report to the nurse immediately if you feel:

short of breath

dizzy

chest pain

itchiness

back or stomach pain

wheezing (noisy breathing)

flushing

stomach upset or vomiting.

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Bone Health

Healthy bones need a balance of calcium, phosphorus, Vitamin D and parathyroid hormone (PTH) in your body. Your kidneys keep these in balance. Medications may be used to restore this if your kidneys are not working as well.

Phosphorus

Phosphorus comes from foods we eat. The kidneys keep our phosphorus levels normal by getting rid of extra phosphorus in the urine.

If the kidneys are not working as well, you may need to reduce the amount of phosphorus that you eat. Speaking with a dietitian can help you learn which foods are best to eat. Some foods that are high in phosphorus include milk, cola, and processed foods such as meat and cheese.

If your phosphorus levels are too high you may experience itchiness, restless legs, red eyes, crystals forming in your skin, and bone pain.

Medications

There are a group of medications called phosphate binders. They soak up the phosphorus in your gut. These medications could include:

calcium carbonate (Tums® and others)

calcium acetate

aluminum hydroxide

sevelamer (Renagel®)

lanthanum (Fosrenol®).

Controlling your phosphorus levels can help avoid health problems such as heart attacks, hardening of the arteries, joint pain and bone problems.

Calcium

The correct amount of calcium in your body is very important. Some medications may make your calcium level go too high. However, if we suggest you take calcium supplements, we will carefully watch your calcium levels.

If your calcium level is too high, you may experience:

headache

weakness

tiredness

confusion

thirst

dry mouth or metallic taste

muscle or bone pain. Tell your doctor, nurse or pharmacist if you have any of these symptoms.

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Parathyroid Hormone (PTH)

The parathyroid gland makes too much parathyroid hormone (PTH) when phosphorus levels are too high, which causes less calcium in your bones.

The amount of PTH the body should have depends on your stage of kidney disease. Discuss your PTH number with your kidney health team.

Medications

Vitamin D and special vitamin D medications may be used to help bring down your PTH levels. These medications include vitamin D, calcitriol (Rocaltrol®), and alfacalcidol (One-Alpha®).

These medications help your body absorb calcium. They may help to prevent the calcium loss from your bones. It can sometimes be difficult to manage calcium, phosphorus, and PTH levels, so your medications may be adjusted often.

Diabetes

One of the major causes of kidney disease is diabetes. Improving control of your blood sugars has many benefits and may help to prevent:

eye problems

heart disease

stroke

nerve problems

further kidney damage.

Talk to your kidney health team about what your personal blood sugar targets should be. A blood test called the hemoglobin A1C (a measure of your average blood sugars over the past 3 months) may be included in your blood test.

Follow the treatment recommended by your doctor, diabetes educator or other member of your kidney health team. If you notice that your blood sugar levels are usually high, you may need a review.

Medications will be chosen with you based on your kidney disease. It may include taking pills and/or giving insulin by needle under your skin (subcutaneously). Based on your blood sugar levels, your doctor and/or diabetes educator will work with you.

It can be challenging to keep your blood sugar (also called blood glucose) levels within a healthy range. It is important to know and understand the symptoms of too low or too high blood sugar levels.

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Low Blood Sugar (hypoglycemia) When the amount of sugar in your blood drops below your target range, it is called low blood sugar or hypoglycemia. Your doctor or diabetes educator will discuss your personal blood sugar targets with you.

Low blood sugar can happen quickly, so it is important to treat it right away. If your blood sugar drops very low, you may need help from another person.

Signs that your blood sugars are too low may include feeling:

shaky,

light-headed

nauseated

nervous

irritable

anxious

confused

unable to concentrate

hungry

a fast heart rate

sweaty

headachy

weak

drowsy

numbness or tingling in your tongue or lips.

Very low blood glucose can make you:

confused and disoriented

lose consciousness

have a seizure.

Be aware that you may not feel symptoms of low blood sugar at all. This is why testing your blood sugars is important.

Ask your doctor, diabetes educator, or member of your kidney health team about the plan to treat low blood sugar levels.

High Blood Sugar (hyperglycemia)

Signs that your blood sugar is too high may include:

being thirsty

urinating more often than usual, especially during the night

feeling tired.

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Potassium

Potassium builds up when your kidneys cannot get rid of it. High potassium levels can be very dangerous and could cause your heart to stop. To keep a safe level of potassium in your blood, it helps to eat the right diet. A dietitian can give you information about this. Foods with lots of potassium include:

bananas

oranges

potatoes

spinach

tomatoes

prunes and juices

honeydew

cantaloupe

salt substitutes.

Medications

Your doctor may give you medication to lower potassium in your blood. This medication is called sodium polystyrene sulfonate (Kayexalate®, Solystat®), and comes as a powder or oral suspension (liquid).

Powder: Mix the powder with 1/3 – 1/2 cup plain water, Crystal Light® powder, diet 7-Up® or diet Sprite®.

If you have trouble swallowing this medication due to taste, speak with your renal pharmacist or a member of your kidney health team.

Multivitamins

Some people may need vitamins because:

Your diet may have changed since you developed kidney disease.

You may be on dialysis, which can remove vitamins B and C.

You may need Vitamin B12 for a specific form of anemia.

Your doctor or renal pharmacist will suggest a multivitamin that is made for people with kidney disease if you need it. Some examples are Replavite® or Stressplex®. These vitamins contain the right amounts of B vitamins (including folic acid) and vitamin C. Avoid other vitamins unless directed by your doctor or renal pharmacist, because your kidneys may not be able to get rid of the extra vitamins and minerals in them.

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Herbal and Natural Products

There are many herbal and natural products available and we may not know how they affect your kidneys.

We DO NOT recommend the use of any herbal products unless you have discussed them with your nephrologist or renal pharmacist. Check with your nephrologist or renal pharmacist before taking any herbal or natural products.

Itch

Itchiness may be a problem for some people with kidney disease. There are many causes of itchiness. Some examples are:

Dry skin o If you have dry skin, try using a humidifier or a moisturizing lotion.

High phosphorus levels o Check with a dietitian to see if you are eating too much phosphorus.

Medications

If your itch is not controlled, sometimes medications called “antihistamines” may be used to help. However, DO NOT take these medications unless they are recommended by your nephrologist or renal pharmacist. Your kidneys may not be able to get rid of certain antihistamines and a build-up of the medication in the body may cause unwanted effects. For this reason, the dose of the medication may need to be adjusted by your renal pharmacist.

Examples of antihistamines are:

diphenhydramine (e.g. Benadryl® and others)

chlorpheniramine (e.g. Chlor-triplon® and others)

loratadine (e.g. Claritin® and others)

desloratadine (e.g. Aerius® and others)

cetirizine (e.g. Reactine® and others).

Headache and Pain

If you have a headache or pain, acetaminophen (Tylenol®) may be a good option for you.

Kidney patients should NOT take anti-inflammatory medications without checking with your nephrologist or renal pharmacist. These may damage your kidneys or affect your body in a bad way. Examples include: ibuprofen (Motrin®, Advil®) or naproxen (Aleve®).

Sometimes anti-inflammatory medications can be found in combination with other medications. Ask your pharmacist if your medication contains an anti-inflammatory.

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Constipation

There are many reasons you may be constipated, such as:

You may be fluid restricted (need to drink less water or fluid).

You are eating less fibre to keep phosphorus and potassium at a safe level.

You may not be exercising as much.

You may be taking medications which can cause constipation. Speak with your doctor or renal pharmacist if you are having problems with constipation. If you have to use a laxative before a test, ask your doctor or renal pharmacist if it is safe to use with kidney disease.

People who are on peritoneal dialysis have to be very careful to avoid constipation.

Your kidney health team will recommend laxatives for your use if needed.

Stomach Problems

You may experience upset stomach or other stomach problems such as heartburn or feelings of fullness.

If you have problems with your stomach:

Avoid foods that can cause heartburn. These foods increase the acid in your stomach. Some examples are spicy foods and foods or drinks that contain caffeine.

Try eating smaller meals more often rather than larger meals only once or twice a day.

Sit up for at least 1 hour after eating. This stops acid from coming up from your stomach.

Medications

Medications called antacids may help. Most antacids may not be the best choice for people with kidney disease because they may contain magnesium and aluminum. Your kidneys cannot get rid of extra magnesium or aluminum, so they can build up and cause problems.

It is best to avoid antacids that you buy from the drug store unless directed by your nephrologist or renal pharmacist.

There are many different types of medications that lower stomach acid. These are different from antacids. Non-prescription examples of antacid medications include calcium carbonate (Tums® and others), ranitidine (Zantac® and others), famotidine (Pepcid® and others), and omeprazole (Losec® and others).

Talk to your nephrologist or renal pharmacist if you need something regularly; they will tell you if these medications are right for you.

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Cough and Cold Preparations

Patients with kidney disease should be careful when choosing cold medications for their symptoms. Ask your pharmacist for help and ensure you tell them you have kidney disease.

If you also have heart disease and/or high blood pressure, let your pharmacist know.

If you are not getting better after 3-4 days, you may want to visit your family doctor. Medications

There are many non-prescription cough and cold products out there and it is important to be mindful of products with multiple ingredients, as some of those ingredients can be harmful to your kidneys.

Always be sure to check the medication label and ask your pharmacist or doctor which medications are safe for you to take and how much to take.

Oral decongestants like “pseudoephedrine” or “phenylephrine” may raise your blood pressure. Make sure you check for this ingredient when picking out cold medications.

Medication Dose Adjustments

Your kidneys play a role in the way that medications pass through your body. If your kidneys are not working well, those medications may build up in your body and cause unwanted effects. You may need less of some medications if you have kidney disease.

Some examples include:

colchicine

valacyclovir and acyclovir

antibiotics (i.e. sulfamethoxazole-trimethoprim or Septra® or Bactrim®, ciprofloxacin or Cipro®)

apixaban (Eliquis®), rivaroxaban (Xarelto®), or dabigatran (Pradaxa®)

antihistamines (i.e. loratadine (Claritin®), desloratadine (Aerius®), or cetirizine (Reactine®).

Before changing any of your medications, always discuss first with your nephrologist, renal pharmacist, and kidney health team to ensure that your medications can be safely taken with your kidney disease.

Withholding Medications When You Are Sick

If you have a bad flu or other illness which causes you to vomit or have diarrhea and you cannot eat or drink normally, your body may become dry or dehydrated.

Dehydration can affect your kidney function and blood pressure.

If you are vomiting, have diarrhea, or feel very sick, try to drink fluids. It is best to drink caffeine-free fluids.

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If you are sick and cannot drink your normal amount of fluids or eat your meals, you may have to stop taking some medications until you are feeling better and able to drink fluids again, or this may harm your kidneys. Discuss this with your nephrologist, renal pharmacist, or kidney health team.

CKD Clinic

You may be referred to a CKD Clinic by your nephrologist. The CKD Clinic may have a team that includes the nurse, renal pharmacist, dietitian and social worker.

At the CKD Clinic, there are different classes for groups of people with kidney disease. Some classes include CKD Intro Group Ed and Renal Replacement Therapy. Other clinics may have other group education classes like Peritoneal Dialysis Education.

You may have individual appointments with the team on a one-to-one basis. The first appointment is usually longer and includes learning about different parts of kidney disease. For example, the nurse may review your kidney disease, the renal pharmacist will review your specific medications, or the dietitian will chat with you about food choices.

The social worker may want to discuss advance care planning which is also called a living will or advance directives and has information about support group or resources if you would like someone to talk to about kidney disease.

Further follow up appointments help to ensure we are keeping a watchful eye on your kidney health. You may be asked to do regular bloodwork for the clinic to keep an eye on your kidney health.

Results are carefully reviewed by the team with the guidance of your nephrologist.

If you have any other questions, be sure to ask your kidney health team.

Contact Information

Nephrologist: __________________________________

Phone Number: ________________________________

Family Doctor: _________________________________

Phone Number: ________________________________

CKD Clinic address: _____________________________

Phone Number: ________________________________

Pharmacy: _____________________________________________

Phone Number: _________________________________________

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Home Blood Pressure Log

Speak to your doctor or health care team about the following:

1. Blood Pressure Target: __________________

2. How often do I need to test my blood pressure? ________________

Date

AM PM

Notes (Swelling, weight, etc.)

Blood Pressure

Pulse/ Heart Rate

Blood Pressure

Pulse/ Heart Rate

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List of Medications

Medication Name Dose

(How much you take) What do you take this medication for? Start Date Stop Date

Please update this list regularly and bring it to any medical appointments/hospital admissions.

CEAC 0792 September 2018

*This document was designed to support patients of the former RQHR.