How can I slow kidney disease?

What the science says now

What matters most?

The NIDDK calls controlling blood pressure the most important step you can take to treat kidney disease. For most people the goal is less than 140/90 mm Hg, but your provider sets your own goal. (NIDDK)
Official guidance for people with kidney disease.

What else is on the list?

The NIDDK also lists meeting your blood glucose goal if you have diabetes, tracking your kidney tests, taking medicines as prescribed, working with a dietitian, being active, aiming for a healthy weight, getting enough sleep, stopping smoking and coping with stress. (NIDDK)
Official guidance for people with kidney disease.

Do blood sugar, weight and urine protein matter?

In primary care records of adults with type 2 diabetes in South London, higher HbA1c (the three-month blood sugar average), higher BMI and higher systolic blood pressure were each linked to advanced kidney disease. So was protein in the urine, found with a urine test called ACR. (Chronic kidney disease and type 2 diabetes: a urine test and three numbers to know · BMJ Public Health)
In people; observational.

Can a glucose sensor help?

Adults with diabetes who used insulin and started a real-time continuous glucose monitor lost kidney function more slowly over 3 years than similar adults who did not. This was a records study, so it shows a link, not proof. (A glucose sensor may help protect your kidneys when you live with diabetes · Endocrinology)
In people; observational.

Are there new treatments for specific kidney diseases?

For IgA nephropathy, yes. In a two-year trial of 428 adults, kidney disease got worse in 11 people on weekly atacicept (5.1%) and in 38 on placebo (17.8%). (A weekly shot nearly stopped kidney decline in IgA nephropathy · New England Journal of Medicine)
In people; trials.

In another trial of 510 adults, sibeprenlimab every four weeks held eGFR level at +0.3 units per year, while it fell 4.2 units per year on placebo. (A shot every four weeks kept kidneys steady for two years in IgA nephropathy · New England Journal of Medicine)
In people; trials.

Do medicines matter?

The NIDDK says two types of blood pressure medicines, ACE inhibitors and ARBs, may slow kidney disease and delay kidney failure, even in people without high blood pressure. It also warns that NSAIDs, such as ibuprofen and naproxen, can damage kidneys, especially with kidney disease, diabetes and high blood pressure. (NIDDK)
Official guidance for people with kidney disease.

What we don’t know yet

Our sources do not show any single step that cures or reverses kidney disease. The sensor and urine studies are observational, so they cannot prove cause. In the sensor study, urine protein was about the same in both groups. The IgA nephropathy trials were paid for by the drug makers and lasted two years, so long-term results are still to come. They also do not tell us which treatment fits you.

When to talk to your doctor

Ask for your eGFR (a blood test of kidney filtering) and a urine albumin test. At each visit, ask how they compare with the last results. Ask about your blood pressure goal and about every medicine you take, including over-the-counter ones and supplements. Do not start, stop or change a medicine on your own. If you have IgA nephropathy, ask about newer treatments and trials.

Talk about it at dinner

Kidneys are the body’s filters. Pour water through a coffee filter together and ask: what does the filter catch, and what passes through? Then ask each person for one small habit that looks after the body, like a walk after dinner.