Top 6 Ways to Prevent Further Decline in Kidney Function

Chronic kidney disease (CKD) progression can often be slowed with the right lifestyle changes. If you’re looking to prevent further decline in kidney function, here are 6 key strategies to focus on.

1. Control Blood Sugar Levels

Why It Matters:

High blood sugar damages the small blood vessels in the kidneys, reducing their ability to filter waste properly. Diabetes is the leading cause of kidney disease, so keeping glucose levels under control is essential.

What You Can Do:

• Monitor your blood sugar levels regularly. • General rule of thumb (if you have diabetes): fasting blood glucose should be <130, and <180 two hours after eating a meal. • Have your hemoglobin A1C checked at least every 6 months. Ideally your A1C will be <7%, however, discuss your specific target goal with your nephrologist.

• Follow a balanced diet with fiber, healthy fats, and lean protein to help stabilize blood sugar.

• Work with your registered dietitian/nutritionist to determine the right carbohydrate intake for you (typically no more than 40 grams per MEAL and no more than 15-20 grams per SNACK).

2. Manage Blood Pressure

Why It Matters:

High blood pressure puts excess strain on the kidneys, accelerating damage over time.

Think of it like this - pressure building up in an engine causing damage.

Imagine that the "engine" is your kidney, and the "pressure" represents the force of blood flowing through the delicate blood vessels within the kidney; when blood pressure is too high, it acts like excessive pressure in an engine, damaging the filtering units in the kidney over time, leading to impaired kidney function, much like a worn-out engine component due to constant strain. 

What You Can Do:

• Aim for a blood pressure target of less than 130/80 mmHg, as recommended for people with kidney disease.

• Reduce sodium intake by avoiding processed foods and restaurant meals (typically <2300 mg sodium per day...oh and FYI...1 teaspoon (tsp) of salt contains 2300 mg sodium!!)

• Exercise regularly, even gentle activities like walking or yoga. • Prioritize getting quality sleep (7-9 hours per night ideally).

• Be aware of your stress/anxiety/depression levels, and be intentional about incorporating the stress-reducing techniques that work for you more often (breathing techniques, massages, acupuncture, walking, meditating, etc.).

• Consider medications (such as ACE inhibitors or ARBs) if prescribed by your doctor.

3. Stay Hydrated (But Don’t Overdo It)

Why It Matters:

Adequate hydration helps flush toxins from the kidneys, but too much fluid can be harmful for people with CKD, especially those with fluid retention or heart issues (example: Congestive Heart Failure).

What You Can Do:

• Drink enough water to maintain a slightly yellow tinged urine, but follow your doctor’s advice if you are supposed to follow a fluid restriction.

• Be cautious with excessive caffeine or alcohol, as they can lead to dehydration.

4. Moderate Your Protein Intake

Why It Matters:

Protein metabolism produces waste that the kidneys must filter. Eating excessive protein—especially animal protein—can increase the kidneys’ workload and contribute to further decline.

Animal protein is considered acidic to the kidneys because it contains a higher proportion of sulfur-containing amino acids (the building blocks of proteins) like methionine and cysteine.

When these are metabolized, they produce sulfate, a non-metabolizable anion that contributes to the body's acid load—putting stress on the kidneys to neutralize and excrete this excess acid.

Plant proteins generally produce less acid during metabolism because they contain fewer sulfur-containing amino acids, and many plant-based foods also contain alkaline components that can help neutralize dietary acid. 

What You Can Do:

• Choose plant-based proteins (like beans, lentils, and tofu) more often.

• Eat moderate portions of lean animal protein (chicken, fish, eggs) as advised by your healthcare team.

• Work with your dietitian to determine your specific daily protein needs based on the stage of CKD and your lab work.

5. Avoid NSAIDs and Other Nephrotoxic Substances

Why It Matters:

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen/Advil, meloxicam, and naproxen/Aleve can reduce blood flow to the kidneys and worsen function over time.

Some supplements and other medications can also be harmful. Always have your pharmacist cross-check your medications and supplements to make sure you're not taking any harmful combinations.

What You Can Do:

• Use acetaminophen (Tylenol) instead of NSAIDs for pain relief if needed (unless otherwise directed by your doctor).

• Avoid herbal supplements unless approved by your healthcare provider—some can contain toxic compounds harmful to the kidneys.

• Be mindful of contrast dyes from medical imaging, as they can be hard on kidney function. Make sure all of your physicians are aware of your kidney functional status prior to having medical imaging with contrast completed.

6. Eat More Fiber to Support Your Gut and Kidney Health

Why It Matters:

A high-fiber diet supports a healthy gut microbiome, which plays a role in reducing kidney inflammation and managing toxin buildup. Aim to consume at least 20-25 grams of fiber per day.

What You Can Do:

• Eat more fruits, vegetables, whole grains, and legumes (as tolerated based on your CKD stage).

• Include prebiotic and probiotic foods (like yogurt, kefir, and fermented vegetables) to promote a healthy gut environment.

• Reduce ultra-processed foods, which can negatively impact gut and kidney health.

Final Thoughts

If you're dealing with kidney disease, make sure you're working on these 6 ways to prevent kidney decline — 1) managing blood sugar and 2) blood pressure, 3) staying hydrated, 4) adjusting protein intake, 5) avoiding nephrotoxic substances, and 6) supporting gut health with adequate fiber intake.

Making these changes with the guidance of your registered dietitian/nutritionist can help you protect your kidney function for the long term.

Your dietitian will personalize your specific nutrition plan based on your lab work, food preferences, height/weight/age, activity level, and any other health conditions that may be at play.

If you're ready to start improving your health, fill out a coaching application today to get started working with Jacksonville's top renal dietitian/nutritionist!

Emily R. Conyers, MS, RDN, LD/N

Registered Dietitian/Nutritionist Jacksonville, Florida