I have stage 3 CKD. Can I still prevent function decline?

Question

Hello doctor,

I am 58, with stage 3 CKD, and my eGFR dropped from 58 to 48 over the past year. Urine protein is 750 mg/day, and blood pressure is around 132/78 on Lisinopril 10 mg daily.

I have already cut back on salt and avoided NSAIDs, but I am worried the decline might speed up. My creatinine is 1.6, and my potassium is normal. My concerns are -

My doctor mentioned possibly starting Dapagliflozin. Is that useful at this stage?
Would seeing a nephrologist more often help slow things down?
Also, can changes to protein intake or adding things like omega-3 make any real difference, or is the loss of kidney function mostly inevitable now?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

At stage 3 chronic kidney disease (CKD) with an eGFR (estimated glomerular filtration rate) of 48 and proteinuria around 750 mg/day, there is still a meaningful opportunity to slow progression.

Medications like ACE (angiotensin-converting enzyme) inhibitors (Lisinopril, which you are already taking) are important for controlling blood pressure and reducing proteinuria.

The SGLT2 (sodium-glucose co-transporter 2) inhibitor, such as Dapagliflozin, can provide additional kidney protection even in patients without diabetes by lowering intraglomerular pressure and reducing protein leakage.

Regular follow-up with a nephrologist is highly beneficial, as it allows for timely adjustments of medications, blood pressure targets, and laboratory tests to prevent complications.

Moderate protein restriction may help reduce kidney stress, particularly from animal sources, but extreme restriction is generally not recommended. Omega-3 fatty acids may offer modest cardiovascular benefits but have a limited effect on CKD progression.

With optimized medical therapy, blood pressure control, avoidance of nephrotoxins, and lifestyle modifications, further decline can often be slowed; however, some gradual loss of kidney function over time is expected.

Early planning and proactive management give the best chance to preserve kidney function for as long as possible.

I hope I have answered your question.

Let me know if I can assist you further.

Regards.