Chronic kidney disease

Persistent reduction of kidney function lasting more than three months or the presence of kidney damage markers. Classified by GFR stages G1–G5 and albuminuria categories.

ICD-10 N185 drugs

Also known as: CKD, Chronic renal failure, CRF

Drugs used for this condition

ADapagliflozinFirst line · Sodium-glucose cotransporter-2 (SGLT2) inhibitorFoundation therapy in chronic kidney disease in adults per KDIGO 2024 to slow eGFR decline regardless of diabetes. DAPA-CKD (2020) reduced CKD progression, dialysis, transplant, or death by 39%. Minimum starting eGFR 25 mL/min. Dose 10 mg once daily.
AEmpagliflozinFirst line · Sodium-glucose co-transporter 2 inhibitors (SGLT2i)Per KDIGO 2024, SGLT2 inhibitors are recommended in CKD with eGFR ≥ 20 mL/min/1.73 m², with or without albuminuria. EMPA-KIDNEY (6,609 patients) showed a 28 % reduction in CKD progression or cardiovascular death. Benefit is similar with or without diabetes. Combined with maximally tolerated ACEi/ARB therapy.
AEnalaprilFirst line · Angiotensin-converting enzyme inhibitors (ACEi)ACE inhibitors slow progression of chronic kidney disease in patients with albuminuria, particularly in diabetic nephropathy. Target blood pressure depends on albuminuria level. Check creatinine and potassium 1–2 weeks after initiation and each dose increase; a rise of up to 30 % in creatinine is acceptable. Discontinue for larger rises or persistent hyperkalemia.
ALosartanFirst line · Angiotensin II receptor blockers (sartans)Losartan slows progression of diabetic nephropathy in type 2 diabetes. The RENAAL trial showed a 25 % reduction in doubling of creatinine and a 28 % reduction in end-stage renal disease. Monitor creatinine and potassium 1–2 weeks after initiation.

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

DAzilsartan medoxomilNot recommended · Angiotensin II receptor blockerAzilsartan is sometimes offered for kidney protection in chronic kidney disease, borrowing the reputation of the class. Renal outcomes were tested in randomised trials for losartan and irbesartan in diabetic nephropathy, where reduced proteinuria and slower loss of filtration held up. Azilsartan has no such trial, the AEMPS Edarbi label carries no renal indication, and experience in severe renal impairment is limited. At the same time the molecule raises potassium and can lower filtration in the first weeks, and reduced kidney function makes both effects stronger. When a sartan is needed for the kidneys specifically, the class holds drugs with direct data. If azilsartan was prescribed as a kidney protector, consider seeking a second opinion.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit