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Slowing progression

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How can I slow the progression of Chronic Kidney Disease (CKD)?
There are many ways to help delay or prevent kidney failure, especially when CKD is diagnosed in the mild to moderate stages. These include:

Blood pressure control

  • Keep your blood pressure at 125/75 or lower if you have diabetes and/or protein in your urine.
  • Keep your blood pressure at 130/85 or lower if you have kidney problems but not diabetes.

    Two types of blood pressure medication slow the action of angiotensin, a substance that may contribute to kidney disease progression. Studies have shown that angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) can help slow progression of kidney disease in people with diabetes, even if they do not have high blood pressure. The generic names of some common ACE inhibitors are captopril, enalapril, and lisinopril. Some common ARBs are losartan, candesartan, and valsartan.

    Blood glucose control

    If you have diabetes, strict controls of your blood glucose levels can help slow the progression of kidney disease.

  • Keep your hemoglobin A1c, which measures blood glucose control over the last two to three months, to less than 6.5%.
  • To reach this level of strict glycemic control, you will need to monitor your blood glucose closely to avoid hypoglycemia.

    You may need to use frequent insulin injections or an insulin pump. Talk to your doctor about your diabetes treatment options.

    Repairing the damage
    In some cases, the kidney disease itself can be treated. If you have an obstruction that blocks your urine flow, surgery may help. If you have an infection, antibiotics may clear it up.

    If damage is due to the effects of prescription or non-prescription medications, your doctor may be able to suggest a different medication that is less harmful to your kidneys. If you have CKD and are prescribed antibiotics, talk to your doctor about the effect it may have on your kidneys. Painkillers (even over-the-counter medicines) can cause damage to your kidneys. Talk to your doctor about all medication you take. Sometimes diagnostic studies are ordered with contrast dye. It may be necessary for you to have the study, but first find out if there are alternative methods.

    Some diseases - such as IgA nephropathy, glomerulonephritis, and lupus can cause kidney damage when your immune system overreacts and inflammation occurs. It is sometimes possible to slow the disease process by controlling the immune system with steroids and/or other medications.

    Smoking is a risk factor for faster progression of kidney disease, so stopping smoking can also help slow progression. Avoiding too much protein and phosphorus in the diet may help, as well.

    Check with your doctor to find out whether any of these things might help to slow the progress of your kidney disease.

    Diet and drugs
    Ongoing research continues on dietary changes and drugs that may help to slow the progression of CKD. Examples include:

  • Fish oil for IgA nephropathy
  • Pirfenidone (an anti-fibrotic drug) in the treatment of focal segmental glomerulosclerosis (FSGS)
  • Dietary intake of antioxidant or anti-inflammatory vitamins and foods

    Check the medical updates section of this website, or subscribe to DaVita's Kidney eNews email newsletter to help stay up to date on research developments to slow the progression of your CKD.

    Blood pressure control
    Study after study has confirmed that good blood pressure control can help slow the rate of CKD. This is especially true in people who have diabetes and protein in the urine (proteinuria). Keeping blood pressure under control also helps prevent heart disease and stroke.

    According to National Kidney Foundation (NKF) guidelines, you should strive to keep your blood pressure at or below 130/85 if you have CKD. If you have diabetes and/or proteinuria too, their suggested target blood pressure is 125/75.

    Lifestyle changes such as losing weight, exercising, meditating, eating less salt, and drinking less alcohol can help lower your blood pressure.

    For most people with CKD, blood pressure drugs are also needed. The first blood pressure drug is likely to be an “angiotensin converting enzyme inhibitor” (ACE inhibitor), or an “angiotensin receptor blocker” (ARB) because these drugs have been proven to slow the rate of some types of kidney disease. Other types of blood pressure drugs such as a diuretic (water pill) or a calcium-channel blocker may be added as needed. Ask your doctor what you can do to keep your blood pressure at a healthy level.