Medication Information Leaflet - Patients at risk of Kidney/Renal impairment/ failure

 Being aware of kidney function is important in order to maintain health. Many people live with mild and moderately low kidney function, which is often referred to by health professionals as early stage chronic kidney disease or stage 3 CKD.

People with mild and moderately low kidney function are at greater risk of developing kidney damage during periods of acute illness such as infections caused by flu or gastroenteritis. This is known as acute kidney injury or AKI. AKI is common and affects over 20% of people who have an unplanned hospital admission. It is more common in the elderly and in people with multiple long term conditions. AKI is harmful and is associated with an increased risk of end stage renal failure requiring dialysis or kidney transplantation as well as a greater risk of death both in the short and long term. AKI is costly and results in more frequent, longer and more intensive admissions to hospital. AKI is also preventable. Recommendations to achieve this include keeping hydrated during episodes of acute illness, such as flu.

It is also recommended that people taking certain drugs called ACE Inhibitors, diuretics or non-steroidal anti-inflammatory drugs (e.g. ibuprofen) should temporarily stop these medicines during episodes of acute illness.

When you are unwell with any of the following:

 1. Vomiting or diarrhoea (unless only minor)

 2. Fevers, sweats shaking

 Then STOP taking the medicines listed below. You can restart when you are well (after 24-48 hours of eating and drinking normally).

 If you are in any doubt, please contact your local pharmacist or the surgery.

 ACE Inhibitors: Medicine names ending in 'pril' eg lisinopril, perindopril, ramipril

 ARBs: Medicine names ending in 'sartan' eg losartan, candesartan, valsartan

 NSAIDs: Anti-inflammatory pain killers eg ibuprofen, diclofenac, naproxen

 Diuretics: Sometimes called 'water pills' eg furosemide, spironolactone, indapamide, bendroflumethiazide

 Metformin: A medicine for diabetes

 SGLT-2 inhibitors: These are medicines for diabetes, and include dapagliflozin, empagliflozin, canagliflozin

National Patient Safety Alert which has asked us to ensure that patients on repeat oral steroid doses have a Steroid Emergency Card to support early recognition & treatment of any potential adrenal crisis in adult.

The guidance suggests that GPs inform

• All patients with primary adrenal insufficiency, such as those with Addison’s disease, congenital adrenal hyperplasia, and hypothalamo-pituitary damage from tumours or surgery, who are steroid dependent.
• Patients who are prescribed repeat steroids from the practice, who take steroids for other medical conditions (the commonest reasons for GP patients would be rheumatology and chest patients with complex disease). These patients may develop secondary adrenal insufficiency and may be steroid dependent

For all patients these apply to –

Missing doses of steroids for patients with adrenal insufficiency can lead to adrenal crisis; a medical emergency which if left untreated can be fatal. Patients with adrenal insufficiency require higher doses of steroids if they become acutely ill or are subject to major body stressors, such as from trauma or surgery, to prevent an adrenal crisis.

The alert asks healthcare providers to ensure all eligible patients are issued with a Steroid Emergency Card.

Coloured versions are available for you to print & laminate from the Society for Endocrinology website