Medication-induced Micronutrient Deficiencies in Early-stage Chronic Kidney Disease

Chronic Kidney Disease (CKD) is a growing global health burden, with early-stage patients often managed through long-term pharmacotherapy. However, prolonged use of common medications may unintentionally disrupt micronutrient balance, compounding the metabolic and cardiovascular risks already present in CKD.

This narrative review aims to explore the associations between frequently prescribed medications and the development of micronutrient deficiencies in early-stage, non-dialysis CKD patients, highlighting underlying mechanisms, clinical implications, and potential management strategies.

Relevant literature published between 2020 and 2025 was identified through structured searches of PubMed, MEDLINE, and the Cochrane Library. Eligible studies included randomized controlled trials, observational cohorts, and prior reviews evaluating the effects of medications on micronutrient status in CKD stages 1-3. Evidence was narratively synthesized according to medication class, nutrient affected, and reported clinical outcomes.

Approximately 30-35 key studies were included. Phosphate binders, diuretics, antihypertensives, proton pump inhibitors, and immunosuppressants were most commonly associated with disruptions in vitamin D, iron, vitamin B12, calcium, and magnesium metabolism. These imbalances may contribute to anemia, mineral bone disorder, cardiovascular complications, and immune dysfunction in early CKD.

These findings suggest that medication-induced micronutrient disturbances may act as modifiable contributors to anemia, mineral-bone disorder, cardiovascular risk, and immune dysfunction in early-stage CKD. Routine nutritional monitoring alongside pharmacotherapy may therefore represent an important preventive strategy.

Medication-induced micronutrient deficiencies represent a clinically relevant yet underrecognized challenge in CKD management. The findings of this review are hypothesisgenerating and underscore the need for systematic, longitudinal research to establish causal pathways and inform evidence-based supplementation guidelines. Integrating nutritional monitoring into pharmacologic care may improve outcomes in early-stage CKD.