Side effects due to reduced kidney function
Your kidney function is important, especially if you take medication on a daily basis. After all, all medicines you take are removed from the body by the liver and kidneys. Over the course of your life, your kidney function deteriorates. Significant side effects from your medications and even hospitalization can result.
If you take medication every day, you may not realize how important your kidneys are. But these organs – together with your liver – break down medicines, after which you pee out the remnants. However, as you get older, kidney function slowly declines. One is a bit faster than the other. Certain conditions cause kidney function to deteriorate even faster, such as high blood pressure or diabetes. If the kidney function falls below a critical limit, some medicines are removed from the body with a delay. Such a substance can then build up in your body, increasing the risk of side effects. The risk of worsening kidney damage also increases. Of all avoidable hospital admissions, 10 percent are the result of non-adjustment of drug use in the case of impaired renal function. In the elderly this is even 30 percent. The number of preventable drug-related hospitalizations has increased from 39,000 in 2008 to 49,000 in 2013.
Symptoms of kidney damage
Your kidney function starts to deteriorate from the age of 40. You don’t notice it at first. Only when the kidneys have failed for about 70 percent do you get complaints. And even then, the symptoms are often vague: fatigue, itching, nausea and loss of appetite. They belong to kidney damage, but also to other disorders. Serious kidney damage is therefore usually detected relatively late. One in ten people has chronic kidney damage. About 17,000 Dutch people have kidney failure, for which they (have) received kidney function replacement treatment: dialysis or transplantation.
In severe kidney damage, the kidneys no longer remove excess fluid. This leads to (severe) shortness of breath because fluid often also ends up in the lungs. The body poisons itself further and further, causing other serious complaints over time, such as cardiovascular complaints. Ultimately, patients may be dependent on a donor kidney or on dialysis.
Worsening of kidney damage
So when your kidneys don’t work properly, certain drugs build up in the body. This increases the risk of side effects and (worsening) kidney damage. The list of medicines that disappear less well from the body in the event of kidney damage is long. Sometimes lowering the dose is the solution. Other times, the doctor will switch your medications. This depends on the degree of kidney damage and the medicine you are taking.
Risk recipe
Your kidney function will be determined in the hospital lab. Physicians are obliged to report a reduced kidney function to the pharmacy. And if you know your kidney function value as a patient, you can of course always pass this on to the pharmacist yourself. At the pharmacy, the computer system gives a signal as soon as someone from a risk category comes with a risky prescription. When the pharmacy is aware of your kidney function, every prescription you receive is checked to see if it is safe. Is the kidney function unknown and you should start a medicine as soon as possible, a antibiotic treatment for example, the pharmacy employee may test the kidney function himself. The pharmacy employee has followed a special training for this.
NSAIDs and kidney damage
What the pharmacy has no insight into are the medicines that you buy at a supermarket or drugstore without a prescription. The so-called NSAIDs in particular can be dangerous for people with impaired kidney function. Examples include ibuprofen, naproxen, and diclofenac. If you have kidney damage, always consult your pharmacy whether the standard dosage of such agents is suitable for you. Incidentally, NSAIDs can also cause chronic kidney damage with long-term use. Furthermore, it is important to be careful with these agents in case of stomach flu and/or severe diarrhoea. If the body dries out, NSAIDs can lead to acute kidney damage.
At an increased risk of kidney damage:
- Have your kidney function assessed at least once a year.
- Be careful with certain painkillers (NSAIDs): they can cause kidney damage.
- Give permission to exchange your kidney function value between the doctor and pharmacist; this way they can monitor the kidney safety of your medication.
