Can stage 3 CKD with diabetes be stopped from progressing?

Question

Hello doctor,

I am a 57-year-old with type 2 diabetes for 15 years. Recently, my nephrologist told me I am in stage 3 CKD. My creatinine has slowly risen to 2.0 mg/dL, and my eGFR is around 38. I feel very fatigued, and my ankles often swell. I have cut salt, trying to reduce protein, but confused about what diet is truly safe. Will dialysis be unavoidable one day, or can I stop it from progressing? Also, are there new kidney-protective drugs beyond ACE inhibitors?

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

You have chronic kidney disease stage 3, with eGFR (estimated glomerular filtration rate) around 38. This means your kidneys are moderately reduced but still functioning. Many people remain in stage 3 for years with proper care. Your fatigue can be due to anemia, toxin buildup, or diabetes itself. Ankle swelling happens because the kidneys cannot remove salt and water efficiently. This can often be controlled with diet and proper medicines.

Dialysis is not inevitable for everyone. Progression can be slowed significantly if blood sugar and blood pressure are tightly controlled. Many patients never reach dialysis if managed properly.
Strict diabetes control is very important. A good HbA1c (glycated hemoglobin) target (usually around 7 % or individualized) reduces further kidney damage. Avoid sudden sugar fluctuations.
Blood pressure control is important. ACE (angiotensin-converting enzyme inhibitors) and ARB (angiotensin II receptor blockers) drugs not only help in reducing BP but also protect the kidneys. Normal BP levels include anything lower than 130/80mmHg.
There are some new drugs for kidney protection. Drugs like empagliflozin and other sodium-glucose co-transporter 2 inhibitors have proven to be effective in protecting kidneys from diabetes-associated CKD (chronic kidney disease).
Finerenone is another option that causes less kidney injury and cardiovascular risk in diabetic CKD patients.
The diet needs to be a balanced one and not an exaggerated one. Protein consumption needs to be moderate and not zero at all. Salt intake needs to be restricted severely. Processed food and pickles need to be avoided.
Avoid painkillers like NSAIDs (nonsteroidal anti-inflammatory drugs), as they worsen kidney function. Stay hydrated, but do not overdrink.

Regular monitoring of creatinine, potassium, urine protein, and hemoglobin every three to four months is important. With modern medicines and tight control, progression can be slowed significantly. Many patients maintain stable function for long periods. If you share your HbA1c and urine protein level, I can guide more specifically.

I hope this information helps you.

Revert in case of queries.

Regards.