Hyperbaric Oxygen Therapy for Chronic Kidney Disease
Hyperbaric oxygen therapy (HBOT) is not currently recommended for the treatment of chronic kidney disease, as there are no established clinical guidelines supporting its use for this indication, and the evidence base consists only of preliminary animal studies and small human trials without sufficient quality to change practice. 1
Current Guideline-Based Management of CKD
The established treatment approach for CKD focuses on blood pressure control and renin-angiotensin system inhibition, not HBOT:
Target systolic blood pressure <120 mmHg using standardized measurement techniques for all patients with CKD to reduce cardiovascular mortality and morbidity 2
Start ACEI or ARB therapy for patients with CKD and severely increased albuminuria (A3 category) without diabetes (strong recommendation) 2
Start ACEI or ARB therapy for patients with CKD and moderately to severely increased albuminuria (A2-A3 categories) with diabetes (strong recommendation) 2
These evidence-based interventions directly reduce kidney failure risk, cardiovascular events, and mortality—the outcomes that matter most. 2
Why HBOT Is Not Recommended for CKD
Absence of Clinical Guidelines
- No clinical studies or guidelines support HBOT use specifically for chronic kidney disease or diabetic nephropathy 1
- Current HBOT recommendations are limited to specific conditions: neuro-ischemic diabetic foot ulcers where standard care has failed, necrotizing soft tissue infections, and carbon monoxide poisoning 2, 1
Limited and Low-Quality Evidence
The available evidence for HBOT in kidney disease consists of:
One small human trial (2020) showing improved estimated GFR and reduced urinary albumin in 20 patients with stage 3-4 diabetic kidney disease, but this single study is insufficient to establish clinical efficacy 3
Preliminary metabolomic data from patients receiving HBOT for diabetic foot ulcers suggesting reduced biomarkers of renal injury, but without correlation to actual kidney function outcomes 4
Animal studies only demonstrating reduced kidney stress biomarkers in diabetic mice, which cannot be extrapolated to clinical practice 5, 6
Significant Practical Barriers
- High costs without established cost-effectiveness for this indication 2, 1
- Limited availability requiring specialized equipment and facilities 1
- Time-intensive treatment requiring weeks of daily sessions, limiting accessibility 2
- Potential side effects that must be weighed against unproven benefits 2
Common Pitfalls to Avoid
Do not delay proven therapies (ACEI/ARB, blood pressure control) while pursuing unproven interventions like HBOT for CKD. 2
Do not transfer patients to distant HBOT facilities for CKD treatment, as this diverts resources from evidence-based care and the intervention lacks supporting guidelines. 1
Recognize that HBOT benefits in diabetic foot ulcers do not automatically translate to kidney disease, despite shared microvascular pathology—the evidence threshold for clinical recommendation has not been met. 2, 4
When HBOT May Be Appropriate in Diabetic Patients
If a patient with CKD also has a neuro-ischemic or ischemic diabetic foot ulcer that has failed standard care, then HBOT should be considered as adjunctive therapy where resources already exist (conditional recommendation, low-quality evidence). 2 This represents the only guideline-supported use of HBOT in the diabetic population with potential kidney involvement.