I have CKD. What lifestyle changes improve my condition?

Question

Hello doctor,

I am 60 and was recently diagnosed with stage 3 CKD. My eGFR is 56, and creatinine is 1.6. I have hypertension (controlled with amlodipine and losartan) and borderline diabetes (HbA1c 6.3%). I was advised to reduce protein intake and start SGLT2 inhibitors to slow progression. I am not sure how effective this drug is in people with mildly reduced kidney function.

However, I have a few concerns:

Should I avoid NSAIDs completely now?
Also, are there specific warning signs of worsening kidney function that I should watch for?
Can exercise or hydration improve kidney function, or is that a myth? Please advise on long-term lifestyle management.

Thank you in advance.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

With stage 3 chronic kidney disease (CKD) and an eGFR (estimated glomerular filtration rate) of 56, your kidney function is mildly to moderately reduced. The good news is that with the right management, you can slow down the progression quite a bit. Here’s how:

SGLT2 inhibitors (Sodium-Glucose Cotransporter-2 inhibitors), like Jardiance (Empagliflozin) or Farixga (Dapagliflozin), are a good option even at this stage. They help by:

Lowering pressure inside the kidney filters (called intraglomerular pressure).
Slowing down the drop in eGFR over time.
Reducing the risk of heart problems.
Providing kidney protection even in people with prediabetes or only mildly reduced kidney function.

They work even better when combined with Cozaar (losartan), a medication from the renin-angiotensin system blocker group, which you are already taking.

Yes, it is best to avoid NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) like Advil (Ibuprofen) and Voveran (diclofenac) because:

They reduce blood flow to the kidneys.
This can worsen kidney function, especially in people with CKD.If you need pain relief, Tylenol (Acetaminophen) is generally safer, but check with your doctor first.

You can watch out for these symptoms:

Swelling in your legs, ankles, or face.
Foamy urine (could mean protein loss).
Blood in urine.
Decreased urination or sudden changes in urine output.
Fatigue, nausea, or confusion. If you notice any of these, contact your doctor.

Hydration or exercise can help, but with balance. Drink water steadily throughout the day unless your doctor has restricted fluids. Too much water will not improve kidney function and can cause harm.

Gentle activities like walking, swimming, or cycling can help:
- Control blood pressure.
- Improve blood sugar levels.
- Support heart and kidney health.

Protein and diet

You do not need a high-protein diet. Moderation is key.

Aim for 0.6 to 0.8 grams of protein per kg of body weight per day.
Choose plant-based proteins or lean sources (like fish or eggs).
Consider seeing a renal dietitian to help plan your meals.

To keep your kidneys working well, I would suggest the following tips:

Keep blood pressure under 130/80 mmHg.
Maintain HbA1c (average blood sugar) below 6.5%, without episodes of low blood sugar.
Avoid nephrotoxic substances like NSAIDs and contrast dyes used in some scans.
Monitor kidney labs every three to six months.
Maintain a healthy weight, avoid smoking, and limit salt intake.

I hope this helps. Kindly revert so I can assist you further.