7.5. Drugs used in Chronic Kidney Disease
7.5.1. Mineralocorticoid Receptor Antagonists
7.5.2. Sodium-glucose co-transporter 2 (SGLT2) inhibitors
Restrictions:
Chronic Kidney Disease:
Restricted to initiation by clinicians, either in primary or secondary care, experienced in the treatment of chronic kidney disease (CKD) for use in patients having individually optimised standard care (including angiotensin converting enzyme inhibitors or angiotensin II receptor blockers, unless these are contraindicated or not tolerated), and either, at the start of treatment:
- an estimated glomerular filtration rate (eGFR) of 20 mL/min/1.73m2 up to 45 mL/min/1.73m2, or
- an eGFR of 45 mL/min/1.73m2 up to 90 mL/min/1.73m2 and either:
- A urine albumin-to-creatinine ratio (uACR) of 22.6 mg/mmol or more, or
- Type 2 Diabetes Mellitus (T2DM).
For use in chronic heart failure, see section 2.5.6
Restrictions:
Chronic Kidney Disease:
Restricted to initiation by clinicians, either in primary or secondary care, experienced in the treatment of chronic kidney disease (CKD) for use in patients having individually optimised standard care (including angiotensin converting enzyme inhibitors or angiotensin II receptor blockers, unless these are contraindicated or not tolerated), and either, at the start of treatment:
- an estimated glomerular filtration rate (eGFR) of 20 mL/min/1.73m2 up to 45 mL/min/1.73m2, or
- an eGFR of 45 mL/min/1.73m2 up to 90 mL/min/1.73m2 and either:
- A urine albumin-to-creatinine ratio (uACR) of 22.6 mg/mmol or more, or
- Type 2 Diabetes Mellitus (T2DM).
For use in chronic heart failure, see section 2.5.6
7.5.3. Cation exchange compound
Restrictions:
Restricted to specialist initiation in patients with hyperkalaemia (serum potassium >6.0mmol/L) with chronic kidney disease (CKD) stage 3b to 5 and/or heart failure who would otherwise need to downtitrate or discontinue their renin-angiotensin-aldosterone system inhibitor (RAASi) therapy to maintain a clinically acceptable serum potassium level.
Prescribing Notes:
Please refer to section 9.2.1.1 for treatment of acute, life-threatening hyperkalaemia.
Restrictions:
Restricted to specialist initiation in patients with hyperkalaemia (serum potassium >6.0mmol/L) with chronic kidney disease (CKD) stage 3b to 5 and/or heart failure who would otherwise need to down-titrate or discontinue their renin-angiotensin-aldosterone system inhibitor (RAASi) therapy to maintain a clinically acceptable serum potassium level.
Prescribing Notes:
Please refer to section 9.2.1.1 for treatment of acute, life-threatening hyperkalaemia.
7.5.4. Selective kappa opioid receptor agonist
Restrictions:
Treatment of moderate-to-severe pruritus associated with chronic kidney disease in adult patients on haemodialysis. Restricted to in-centre haemodialysis use only, in patients with an inadequate response to best supportive care for reducing itch.
7.5.5. Treatment of Primary Immunoglobulin A Nephropathy
Restrictions:
Restricted to specialist use in adults with primary immunoglobulin A nephropathy (IgAN) with a urine protein excretion ≥1.0 g/day (or urine protein-to-creatinine ratio ≥0.8 g/g*).
*equivalent to ≥90 mg/mmol
Restrictions:
Restricted to specialist use in adults with primary immunoglobulin A nephropathy (IgAN) with a urine protein excretion ≥1.0 g/day (or urine protein-to-creatinine ratio ≥0.75 g/g*).
*equivalent to ≥85 mg/mmol
Further restricted to patients whose condition has not responded adequately to current standard of care that is; maximally tolerated angiotensin converting enzyme inhibitor or angiotensin receptor blocker and sodium-glucose cotransporter-2 inhibitor, as appropriate. Patients should stop sparsentan at week 24 if no response to treatment.