What are the best practices for maintaining kidney health?

Best Practices for Maintaining Kidney Health

To maintain optimal kidney health, adopt a plant-based diet with moderate protein intake (0.8 g/kg/day), limit sodium to less than 2 g/day, engage in at least 150 minutes of weekly physical activity, and avoid tobacco products. 1

Dietary Recommendations

Protein Management

• Maintain protein intake at 0.8 g/kg body weight/day for adults with or at risk of CKD 1, 2
• Avoid high protein intake (>1.3 g/kg/day) as it increases risk of kidney damage 1, 2
• Prioritize plant-based protein sources over animal-based proteins 2
• For those with advanced CKD (stages G3-G5), protein restriction may be beneficial under medical supervision 1

Sodium Restriction

• Limit sodium intake to <2 g/day (equivalent to <5 g of salt/day) 1
• Reducing salt intake helps lower blood pressure and reduces albuminuria 3
• Salt restriction has been shown to reduce the risk of renal composite outcomes by 28% 4
• High sodium intake can cause detrimental effects on glomerular hemodynamics and induce hyperfiltration 5

Overall Diet Composition

• Adopt a healthy, diverse diet with higher consumption of plant-based foods compared to animal-based foods 1
• Reduce consumption of ultraprocessed foods, refined carbohydrates, and sweetened beverages 1
• Increase intake of vegetables, fruits, whole grains, fiber, legumes, plant-based proteins, and unsaturated fats 1
• Consider consulting with a renal dietitian for personalized dietary guidance 1, 2

Physical Activity

• Engage in moderate-intensity physical activity for at least 150 minutes per week 1
• Adjust activity level to be compatible with cardiovascular health and physical tolerance 1
• Avoid sedentary behavior 1
• For those at higher risk of falls, adjust intensity (low, moderate, or vigorous) and type of exercise (aerobic vs. resistance) accordingly 1

Weight Management

• Achieve and maintain an optimal body mass index (BMI) 1
• For people with obesity and CKD, weight loss is recommended 1
• Weight management helps reduce hyperfiltration and kidney stress 6

Blood Pressure Control

• Target systolic blood pressure of <120 mm Hg when tolerated 1
• For those with diabetes and CKD, optimizing blood pressure control reduces risk of diabetic kidney disease progression 1
• Consider appropriate medications (ACE inhibitors, ARBs) when indicated, especially with albuminuria 1

Avoiding Harmful Substances

• Do not use tobacco products 1
• Smoking cessation programs should be offered where indicated 1

Special Considerations

For Diabetic Patients

• Optimize glucose control to reduce risk or slow progression of diabetic kidney disease 1
• Monitor urinary albumin and estimated glomerular filtration rate (eGFR) at least annually 1

For Older Adults

• Higher protein and calorie targets may be needed for those with frailty or sarcopenia 1, 2
• Adjust physical activity recommendations based on tolerance and fall risk 1

For Children

• Do not restrict protein intake in children with CKD due to growth impairment risk 1
• Encourage at least 60 minutes of daily physical activity 1

Monitoring Kidney Health

• Regular assessment of kidney function through eGFR and urinary albumin testing 1
• For those with diabetes: annual screening after 5 years with type 1 diabetes and from diagnosis with type 2 diabetes 1

Potential Pitfalls to Avoid

• Excessive protein restriction (<0.3 g/kg/day) without supplementation can increase mortality risk 2
• Dietary sodium restriction is not appropriate for patients with sodium-wasting nephropathy 1
• Low-protein diets should not be prescribed for metabolically unstable individuals 1
• Overly aggressive blood pressure targets may cause symptomatic hypotension in some patients 3

By implementing these evidence-based strategies, you can significantly reduce your risk of developing kidney disease or slow its progression if already present.