Renal Medications: 75 Years of Progress in Kidney Care

Over the past 75 years, advances in renal medications have transformed the management of kidney disease, improving survival and quality of life for patients with acute kidney injury (AKI), chronic kidney disease (CKD), and end-stage kidney disease (ESKD). The contributions of the multi-professional team—including renal pharmacists, nurses, and clinicians—have played a key role in these developments.

Pharmacist Charlotte Mallindine in clinic
Pharmacist Charlotte Mallindine in clinic

Erythropoietin (EPO): Transforming Anaemia Management

A major milestone in nephrology was the introduction of erythropoietin (EPO) in the UK in 1988, led by Professor Chris Winearls in Oxford, following the first publication on 10 HD patients in the UK in 1986. This transformed patients’ symptoms of anaemia and significantly reduced the reliance on blood transfusions, particularly within dialysis units and also reduced the associated risk of blood borne virus infections in patients with were transfusion dependent. This advancement led to the development of anaemia nurses and pharmacists working in this area leading the monitoring and prescribing.

Immunosuppressive Therapies: Advancing Kidney Transplantation

The success of kidney transplantation has been driven by innovations in immunosuppressive medications, including:

These medications have also transformed the management of renal autoimmune diseases. Specialist renal pharmacists have moved into clinics to effectively prescribe, monitor and deliver these medications as part of the renal team.

Breakthroughs in Rare Kidney Diseases & Targeted Therapies

In 2015 NICE approved the use of the complement inhibitor eculizumab for atypical haemolytic uraemic syndrome (aHUS). This showcased the effectiveness of highly specialised commissioning in delivering innovative therapies. The advancement in relation to treatments that modify the immune response continues with new “biological” therapies being introduced year on year.

ACE Inhibitors & ARBs: Slowing CKD Progression

Initially developed for hypertension, ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) became essential in reducing proteinuria and slowing CKD progression. For over 30 years, these medications have been the mainstay for treating proteinuric glomerular diseases.

The Renal Drug Handbook & Database: A Vital Resource

To ensure safe prescribing for patients with kidney impairment, the UK Renal Pharmacy Group (UK RPG) published the first Renal Drug Handbook in 1994. This resource has also evolved into the Renal Drug Database (2014). For many years this was written and updated tirelessly by Caroline Ashley and Aileen Dunleavy with assistance from other members of the UK RPG. This resource is used across many specialities in the UK but also worldwide. The UK Renal Pharmacy Group celebrated its 40th Anniversary in 2024.

The Renal Drug Handbook

Think Kidneys: Improving AKI Medication Safety

The Think Kidneys National AKI Programme placed a spotlight on safe prescribing for patients with AKI. Pharmacists, including Dr Sue Shaw, worked alongside clinical scientists, medical teams, specialist nurses and other professionals to develop prescribing systems and guidance which optimised medicines during AKI. The UKKA AKI Summit (2023) built on this work, leading to new recommendations on medication safety.

Recent Advances in Renal Pharmacology

In the last five years, groundbreaking therapies have emerged across the kidney care pathway, including:

  • SGLT2 inhibitors to slow progression of CKD and reduce poor cardiovascular outcomes. This has been a major advance and has also encouraged much greater collaboration between the kidney team and our colleagues working across the healthcare interface, in primary care, diabetes care and cardiology. Prescribing pharmacists are involved in running cardiorenal metabolic clinics to optimise medications both in primary and secondary care. UKKA has published clinical practice guidelines on SGLT-2 therapy.
  • Hypoxia-inducible factors (HIFs) such as roxadustat and vadadustat for anaemia, building on the Nobel Prize-winning work of Professor Peter Radcliffe (2001). The UKKA have clinical practice guidelines for anaemia of CKD.
  • Avacopan, a complement inhibitor, improving outcomes in vasculitis.
  • Targeted release budesonide, the first licensed therapy for IgA nephropathy.
  • COVID-19 therapeutics, including vaccines and antiviral pathways, protecting immunocompromised kidney patients.
Recent advancedments in renal medicine

The Future of Renal Pharmacology

With rapid advancements in pharmacogenomics, personalised medicine is shaping the future of nephrology. Genetic testing is now guiding treatment decisions for conditions like:

  • FSGS & CKD (APOL1 gene risk variants)
  • Membranous nephropathy (anti-PLA2R antibodies & rituximab response)
  • Complement disorders (eculizumab & genetic mutations)

After years of limited progress, glomerulonephritis treatments are entering a new era, with multiple novel therapies expected to be licensed within the next five years.

The Role of Specialist Renal Pharmacists

Specialist renal pharmacists will remain at the forefront of these developments, ensuring effective prescribing, monitoring, and delivery of new treatments—ultimately improving outcomes for people living with kidney disease.