The truth about kidney medications: are you spending money on pills you might not need?

For many people with chronic kidney disease (CKD), understanding why they are taking certain medications is crucial -- not just for their health but also for their wallets. In the Philippines, where many individuals work tirelessly to meet basic needs like food and shelter, spending hard-earned money on treatments that might not offer real benefits can be a significant burden.

But what if some of the medications you are prescribed aren’t actually necessary? Knowing which medications truly help your kidneys and which ones might be unnecessary empowers you to make better decisions about your health and finances.

Sometimes, patients feel that leaving the doctor’s office without a prescription means they didn’t get their money’s worth. It’s a common perception that a consultation should result in medication, leading doctors to feel pressured to prescribe something to meet these expectations.

However, a good doctor doesn’t need to prescribe medication at every visit. It’s important to understand that the best care doesn’t always come in the form of a pill. Often, the most effective care comes from focusing on lifestyle changes -- things like eating the right foods, controlling blood pressure and managing blood sugar levels. These adjustments can make a bigger difference than adding more pills to your routine.

Take sodium bicarbonate, for example -- a common medication prescribed for CKD. It’s a simple compound, similar to baking soda, used to help balance acid levels in your blood when your kidneys aren’t functioning well. While it can be beneficial for some patients with high acid levels (a condition known as metabolic acidosis), not everyone with CKD needs it. If your blood acid levels are normal, taking sodium bicarbonate could cause unwanted side effects like swelling or high blood pressure due to increased sodium intake. Even though this medication is inexpensive, if you don’t need it, you’re wasting money -- and potentially risking your health. It’s worth discussing with your doctor whether this medication is necessary based on your specific condition.

Supplements

Now, let’s discuss ketoanalogues, which are specialized supplements designed to reduce the likelihood of protein malnutrition in patients following a very low-protein diet (VLPD). A VLPD significantly restricts protein intake -- usually to about 0.3-0.4 grams of protein per kilogram of body weight per day -- to lessen the workload on the kidneys and potentially slow the progression of CKD. For example, if you weigh around 60 kg (about 132 pounds), you’re limited to 18-24 grams of protein per day -- that’s roughly equivalent to a small, palm-sized piece of chicken or fish for the entire day.

But it’s not just meat and fish that contain protein. Common foods like rice, bread and vegetables also contribute to your daily protein intake. For instance, a cup of cooked rice contains about four grams of protein, and a cup of cooked vegetables adds another two grams. If you eat three meals a day with rice and vegetables, you’re already adding significant amounts of protein without even considering any meat or fish. This makes it incredibly easy to exceed your daily protein limit, even when you’re trying to be careful.

Because such a restrictive diet can lead to protein malnutrition, ketoanalogues are intended to provide essential amino acids without adding extra nitrogen waste products that burden the kidneys. However, ketoanalogues only work effectively if you’re strictly adhering to the VLPD and taking the correct dosage, usually around 9-12 tablets a day. Taking just one to three tablets daily, or not following the VLPD closely, renders the treatment ineffective. It’s like trying to cook rice for a family of five with only a few drops of water -- it just doesn’t work. Without the right dose and strict diet adherence, the medication won’t help much, and you’re likely wasting your money. It’s important to have an honest conversation with your doctor about whether this treatment is suitable for you and whether you can realistically follow such a strict diet.

Medication

Now, let’s address AST-120, a medication that has been on the market for over 30 years but remains controversial. First approved in Japan in 1991, AST-120 is designed to bind toxins in your gut before they enter your bloodstream and harm your kidneys. The concept is appealing -- it suggests delaying the need for dialysis by reducing toxin levels. However, despite decades of use, AST-120 hasn’t become a standard treatment in most countries, and for good reason.

Clinical studies have shown inconsistent and often disappointing results regarding AST-120’s effectiveness in slowing CKD progression. Large-scale trials, such as the Evaluating Prevention of Progression In Chronic Kidney Disease (EPPIC) studies, failed to provide clear evidence that it offers significant benefits to patients. In fact, the drug is not approved by regulatory agencies like the US Food and Drug Administration (FDA) or the European Medicines Agency (EMA), which indicates a lack of su fficient proof of its efficacy and safety.

So why is AST-120 still being prescribed? Some believe it’s due to lingering hope based on early, limited studies or because it’s become routine practice in certain places. However, continuing to spend money on a medication with unproven benefits may not be in your best interest. It’s crucial to have an open and honest discussion with your doctor about whether AST-120 is truly necessary for your treatment plan. Are you investing in a medication that promises much but delivers little?

Some people have also heard about renal probiotics, which claim to improve kidney health by altering gut bacteria and reducing toxin production. While the idea sounds promising, the scientific evidence behind renal probiotics is limited and inconclusive. They’re not considered a standard part of CKD treatment because we don’t have enough proof that they work. Until more research is done, you might be better off saving your money for treatments that are proven to benefit your kidneys.

Now consider the financial impact. Medications like AST-120 and unnecessary ketoanalogues can be expensive. For families already struggling to make ends meet, these costs add up quickly. Are we sacrificing essential needs like food and shelter for treatments that might not provide meaningful health improvements? Your hard-earned money should go toward treatments that truly benefit your health, not on medications with questionable effectiveness.

Ask your doctor

If you ever feel unsure about why you’re taking a certain medication, don’t hesitate to ask your doctor important questions. Why is this medication necessary? What evidence supports its use? Are there more effective or affordable alternatives? Remember, if a drug has been around for a long time but still isn’t a standard part of CKD treatment globally, there might be a good reason -- it may not be necessary or effective for everyone. By asking the right questions and focusing on proven treatments, you can ensure that your care is both effective and affordable.

Ultimately, understanding your treatment plan empowers you to make informed decisions about your health. Don’t be afraid to discuss your concerns with your doctor. Together, you can focus on treatments that offer real benefits, ensuring that you’re investing your time and money in the most effective way possible.