The basics

Slowing the progression of kidney disease

Part of the series “All about CKD” 

How can I slow the progression of chronic kidney disease (CKD)?

There are many ways to help delay or prevent kidney failure, especially when chronic kidney disease (CKD) is diagnosed in the earlier mild to moderate stages of CKD. Because chronic kidney disease usually occurs gradually over time, finding out you have kidney disease in the early stages provides an opportunity to slow the progression of CKD.

Blood pressure control

Study after study has confirmed that good blood pressure control can help slow the rate of kidney disease. This is especially true in people who have diabetes and protein in the urine (proteinuria). In addition to helping prevent kidney failure, keeping blood pressure under control also helps prevent heart disease and stroke.

According to National Kidney Foundation (NKF) guidelines, you should strive to keep your blood pressure at or below 130/85 if you have kidney disease. If you have diabetes and/or proteinuria too, their suggested target blood pressure is 125/75.

• Keep your blood pressure at 130/85 or lower if you have kidney problems but not diabetes.
• Keep your blood pressure at 125/75 or lower if you have diabetes and/or protein in your urine.

Lifestyle changes such as losing weight, exercising, meditating, eating less salt and drinking less alcohol can help lower your blood pressure. Smoking is a risk factor for faster progression of kidney disease, so stopping smoking can also help slow progression.

Blood pressure medicine

Two types of blood pressure medicines slow the action of angiotensin, a substance that may contribute to kidney disease progression. Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are the two types of high blood pressure medicines. The generic names of some common ACE inhibitors are captopril, enalapril, and lisinopril. Some common ARBs are losartan, candesartan, and valsartan.

If you are diagnosed with high blood pressure, your doctor will prescribe blood pressure medicine for you to take as directed to control blood pressure and help slow the rate of kidney disease. If you have diabetes and have normal blood pressure, your doctor may still prescribe blood pressure medicine because studies have shown that angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) can help slow rate of kidney disease in people with diabetes, even if they do not have high blood pressure.

Other types of blood pressure drugs such as a diuretic (water pill) or a calcium-channel blocker may be added, as needed.

Ask your doctor what you can do to keep your blood pressure at a healthy level.

Blood glucose control

If you have diabetes, strict controls of your blood glucose levels can help slow the progression of kidney disease.

• Keep your hemoglobin A1c, which measures blood glucose control over the last two to three months, to less than 6.5%.
• To reach this level of strict glycemic control, you will need to monitor your blood glucose closely to avoid hypoglycemia.

You may need to use frequent insulin injections or an insulin pump. Talk to your doctor about your diabetes treatment options.

Diet and lifestyle

Ongoing research continues on dietary changes and drugs that may help to slow the progression of kidney disease. Examples include:

• Fish oil for IgA nephropathy
• Pirfenidone (an anti-fibrotic drug) in the treatment of focal segmental glomerulosclerosis (FSGS)
• Dietary intake of antioxidant or anti-inflammatory vitamins and foods

Some studies have shown that limiting protein and phosphorus in the diet can help slow kidney disease progression. Talk to a renal dietitian about your CKD non-dialysis diet and recommendations to prevent kidney failure.

Repairing kidney damage

In some cases, the kidney disease itself can be treated. If you have an obstruction that blocks your urine flow, surgery may help. If you have an infection, antibiotics may clear it up.

If your kidney damage is due to the effects of prescription or non-prescription medicines, your doctor may be able to suggest a different drug that is less harmful to your kidneys. If you have kidney disease and are prescribed antibiotics talk to your doctor about the effect it may have on your kidneys. Painkillers (even over-the-counter medicines) can cause damage your kidneys. Talk to your doctor about all medicines you take. Sometimes diagnostic lab tests are ordered with contrast dye. It may be necessary for you to have the test, but first find out if there are alternative methods as contrast dye can be harmful to kidneys.

Some diseases, such as IgA nephropathy, glomerulonephritis, and lupus can cause kidney damage when your immune system overreacts and inflammation occurs. It is sometimes possible to slow the disease process by controlling the immune system with steroids and/or other medicines.

Talk with your doctor to find out what you can do to help to slow the progress of your kidney disease.

Related articles

• What's your blood pressure?
• How diet can affect your blood pressure
• Are you in control of your diabetes?
• Stages of chronic kidney disease (CKD)