My uncle has kidney disease. Should he restrict protein intake?

Question

Hi doctor,

My uncle is 59 and has CKD stage 3 with creatinine 2.1 and eGFR around 38. His urine test also showed trace proteinuria. He has been on Losartan and a low-salt diet, but his blood pressure still fluctuates between 140–150 systolic. Our concerns are:

Are newer drugs such as SGLT2 inhibitors recommended in his situation?
Are they safe for the kidneys at this stage?
How often should kidney function and electrolytes be monitored?
Should we restrict protein intake strictly, or is moderate protein acceptable for slowing further kidney damage?

He is very worried about needing dialysis soon.

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

With chronic kidney disease (CKD) stage 3, the main goal is to slow progression and preserve kidney function.

His current medications and low-salt diet are appropriate, but since his blood pressure fluctuates between 140 to 150 mmHg, it should be further optimized. Keeping it below 130/80 mmHg is crucial for kidney protection.

In recent years, SGLT2 (sodium-glucose cotransporter 2) inhibitors such as Dapagliflozin or Empagliflozin have shown strong evidence in slowing CKD progression and protecting heart health, even in non-diabetic patients.

These are generally safe when eGFR (estimated glomerular filtration rate) is above 30, though kidney function and electrolytes must be monitored, as a mild, temporary dip in eGFR may occur initially.

These drugs can safely be used with Losartan or other angiotensin II receptor blockers for added kidney protection.

For monitoring, kidney function and electrolytes should be checked every three to six months, or more often when starting new medications.

Regarding diet, complete protein restriction is not needed. A moderate protein intake (0.8 gram per kilogram per day) is ideal unless otherwise advised by a nephrologist or dietitian.

Avoiding excess salt, processed foods, and NSAIDs (nonsteroidal anti-inflammatory drugs), and maintaining good blood sugar control (if diabetic) are also key.

With careful management, medication adherence, and regular follow-up, many patients with stage 3 CKD live comfortably for years without dialysis. The focus should remain on consistent blood pressure control and kidney-friendly habits.

I hope this information helps. Please get back to us for any further queries.

Thank you.