What can I do to improve my kidney function and overall kidney health, especially if I have a history of kidney disease, diabetes, hypertension, or am over 60 years old?

Improving Kidney Function and Overall Kidney Health

If you have diabetes, hypertension, cardiovascular disease, or are over 60 years old, you should be screened for chronic kidney disease with both estimated glomerular filtration rate (eGFR) and urine albumin testing, then focus on blood pressure control (target ≤130/80 mmHg), use of ACE inhibitors or ARBs especially if you have albuminuria, SGLT2 inhibitors if you have diabetes, dietary sodium restriction, regular exercise, and avoidance of nephrotoxic medications like NSAIDs. 1

Screening and Early Detection

Who should be screened:

• All persons with diabetes or hypertension should undergo testing for chronic kidney disease 1
• Those over 60 years of age, with family history of kidney disease, or belonging to racial/ethnic minorities at higher risk 1
• Individuals with cardiovascular disease, obesity, or smoking history 1

What tests to obtain:

• Estimated GFR calculated from serum creatinine using the MDRD or Cockcroft-Gault equations 1
• Urine albumin-to-creatinine ratio (UACR) on a random urine sample 1
• Both tests are necessary—eGFR alone misses kidney damage with preserved filtration 1

Important caveat: A single abnormal test is insufficient for diagnosis. CKD requires abnormalities persisting for at least 3 months, so repeat testing is essential 1, 2

Blood Pressure Management

Target blood pressure:

• For CKD patients with albuminuria ≥30 mg/24 hours: maintain BP ≤130/80 mmHg 1
• For CKD patients without significant albuminuria: maintain BP ≤140/90 mmHg 1

Medication selection:

• ACE inhibitors or ARBs are first-line agents, particularly when albuminuria is present, as they reduce proteinuria and slow CKD progression 1
• Monitor for hyperkalemia and acute kidney function changes when initiating these medications 3
• Check serum creatinine and potassium within 1-2 weeks after starting ACE inhibitors/ARBs 3

Critical warning: In patients with bilateral renal artery stenosis, ACE inhibitors can cause acute kidney failure and should be used with extreme caution 3

Diabetes Management (if applicable)

Glycemic control:

• Target HbA1c should be individualized but generally <7% to reduce microvascular complications 1
• In patients with advanced CKD and substantial comorbidity, less intensive targets may be appropriate 1

Specific glucose-lowering medications with kidney benefits:

• SGLT2 inhibitors (empagliflozin, canagliflozin) reduce albuminuria progression by 27-39% and slow GFR decline through mechanisms independent of glycemic control 1
• GLP-1 receptor agonists (liraglutide, semaglutide) reduce risk of new or worsening nephropathy by 22-36% 1
• These medications provide cardiovascular and kidney protection beyond glucose lowering 1

Lifestyle Modifications

Dietary sodium restriction:

• Low-salt diet reduces blood pressure and albuminuria in patients with CKD 1
• Target sodium intake <2 grams per day (approximately 5 grams of salt) 1

Exercise:

• Regular aerobic exercise improves blood pressure control in CKD patients 1
• Both aerobic and resistance training show benefits 1

Protein intake:

• Moderate protein restriction may slow CKD progression, though evidence is mixed 1
• Avoid very high protein diets 1

Medication Safety

Avoid nephrotoxic agents:

• NSAIDs (ibuprofen, naproxen) can worsen kidney function and should be avoided 2, 4
• Certain antibiotics and contrast dyes require dose adjustment or avoidance 2

Dose adjustment:

• Many medications require dose reduction based on eGFR, including certain antibiotics, oral hypoglycemic agents, and other drugs 2, 4

Cardiovascular Risk Reduction

Statin therapy:

• Most patients with CKD should receive statins for cardiovascular risk reduction 2, 4
• CKD is an independent risk factor for cardiovascular disease 1

Monitoring for Complications

Regular assessment for:

• Anemia (common in CKD) 1, 5
• Bone and mineral disorders including hyperphosphatemia, vitamin D deficiency, and secondary hyperparathyroidism 2
• Hyperkalemia, especially when on ACE inhibitors/ARBs 3
• Metabolic acidosis 2

When to Refer to Nephrology

Refer when:

• eGFR <30 mL/min/1.73 m² (Stage 4 CKD) 1
• Albuminuria ≥300 mg per 24 hours 2
• Rapid decline in eGFR 2
• Uncertainty about CKD etiology 1
• Difficult management issues including resistant hypertension, anemia, or electrolyte disturbances 1

Critical point: Late referral to nephrology (shortly before dialysis) is associated with increased mortality after dialysis initiation 1

Age-Specific Considerations

For patients over 60:

• An eGFR of 60-89 mL/min/1.73 m² may represent normal age-related decline rather than disease 6
• Serial eGFR measurements over time are more informative than single values for risk stratification 6
• Start antihypertensive therapy gradually with close monitoring for orthostatic hypotension and electrolyte disorders 1, 3
• Elderly patients have doubled drug levels and AUC, requiring careful dose selection starting at the low end of the dosing range 3