Slowing Chronic Kidney Disease Progression
by David Dunaief
Apr 27, 2021 | 4030 views | 0 0 comments | 460 460 recommendations | email to a friend | print
Dr. David Dunaief is located in Downtown Brooklyn and focuses on the integration of medicine, nutrition, fitness and stress management.
Dr. David Dunaief is located in Downtown Brooklyn and focuses on the integration of medicine, nutrition, fitness and stress management.
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On the heels of our recent article about kidney health, let’s look more closely at strategies for reducing chronic kidney disease (CKD). Those at highest risk for CKD include patients with diabetes, high blood pressure and those with first-degree relatives who have advanced disease.

CKD is tricky because, similar to high blood pressure and high cholesterol, it tends to be asymptomatic, at least initially. Only in the advanced stages do symptoms become distinct, though there can be vague symptoms in moderate stages such as fatigue, malaise and loss of appetite.

What are the CKD stages?

CKD is classified into five stages based on the estimated glomerular filtration rate (eGFR), a way to determine kidney function. Stages 1 and 2 are the early stages, while stages 3a and 3b are the moderate stages, and stages 4 and 5 are the advanced stages. Stage 5 is end-stage renal disease, or kidney failure.

Who should be screened?

According to the U.S. Preventive Services Task Force and the American College of Physicians, those who are at highest risk should be screened including, as I mentioned above, patients with diabetes or hypertension.

In an interview on Medscape.com, “Proteinuria: A Cheaper and Better Cholesterol?” two high-ranking nephrologists suggest that first-degree relatives to advanced CKD patients should also be screened and that those with vague symptoms of fatigue, malaise and/or decreased appetite may also be potential screening candidates.

This broadens the asymptomatic population that may benefit from screening.

Slowing CKD progression

Fortunately, there are several options available, ranging from preventing CKD with specific exercise to slowing the progression with lifestyle changes and medications.

How much exercise?

Here we go again, preaching the benefits of exercise. But what if you don’t really like exercise? Good news! Results of a study with 6,363 participants show that walking reduces the risk of death and the need for dialysis significantly.

The results of walking followed a dose-response curve. In other words, those who walked more often saw greater results. So, participants who walked one-to-two times per week had a significant 17 percent reduction in death and a 19 percent reduction in kidney replacement therapy, while those who walked at least seven times per week experienced a more impressive 59 percent reduction in death and a 44 percent reduction in the risk of dialysis.

How much protein should you consume?

When it comes to CKD, more protein is not necessarily better, and may even be harmful. In a meta-analysis of 10 randomized controlled trials from Cochrane database studies, results showed that the risk of death or treatment with dialysis or kidney transplant was reduced by 32 percent in those who consumed less protein compared to unrestricted protein.

Sodium: How much is too much?

Good news! In a study, results showed that a modest sodium reduction in our diet may be sufficient to help prevent proteinuria (protein in the urine). Here, less than 2000 mg was shown to be beneficial, something all of us can achieve.

Medications have a place

We routinely give two classes of anti-hypertensives, ACE inhibitors or ARBs, to patients who have diabetes to protect their kidneys. What about patients who do not have diabetes? Results of a study show that these medications reduced the risk of death significantly in patients with moderate CKD. Most of the patients were considered hypertensive.

However, there was a high discontinuation rate among those taking the medication. If you exclude discontinuations, the results are robust with a 63 percent reduction.

You don’t have to rely on drug therapies. Lowering sodium modestly, walking frequently, and lowering your protein consumption may all be viable options, with or without medication.

Screening for CKD should occur in high-risk patients and possibly be on the radar for those with vague symptoms of lethargy as well as aches and pains. Of course, this is a discussion to have with your physician.
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