Chronic Kidney Disease (CKD) Treatment: Medication, Lifestyle Changes, and More

If the disease progresses to the point of kidney failure, there are only two treatment options: dialysis or a kidney transplant. There is currently no cure for CKD, and any loss of kidney function is irreversible.

If you have CKD, talk to your healthcare professional before starting a treatment or combining treatments, and discuss what’s best for you.

A number of prescription drugs can help manage CKD, including ones that treat diabetes and high blood pressure, two health conditions that are closely linked to this disease.

Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors

• canagliflozin (Invokana)
• dapagliflozin (Farxiga)
• empagliflozin (Jardiance)

Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists

• tirzepatide (Mounjaro, Zepbound)
• dulglutide (Trulicity)
• extendatide (Bydureon)
• liraglutide (Victoza)

Renin-Angiotensin System Inhibitors (RASi)

• lisinopril (Prinivil, Zestril)
• perindopril (Aceon)
• ramipril (Altace)

• losartan (Cozaar)
• olmesartan (Benicar)
• valsartan (Diovan)

Statins

• atorvastatin (Lipitor)
• rosuvastatin (Crestor)
• simvastatin (Zocor)

Diuretics

Some of the diuretic drugs that can be used in CKD are:

• bumetanide (Bumex)
• chlorthalidone
• furosemide (Lasix)
• hydrochlorothiazide
• metolazone

If your kidney disease progresses to kidney failure (end-stage kidney disease), your kidneys will no longer be able to work well enough to keep you alive. As a result, you will need a more serious intervention.

• Hemodialysis This is the most common type. Hemodialysis can be done at home or in a dialysis center. It uses a machine that removes blood from a surgically created connection in your arm, filters it through an artificial kidney known as a dialyzer, and returns the cleaned blood to your body. Alternatively, a catheter may be placed in the upper chest. In-clinic visits are usually three days a week, while in-home dialysis may be daily.

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• Peritoneal Dialysis This type uses the lining of your abdomen to filter blood. There is no machine required, and it’s done every day at home. There is an initial surgery so that doctors can place the catheter for future fluid exchange.

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• Hemodiafiltration This type is similar to hemodialysis, but it adds an extra filtration process that removes more waste products from the blood. It’s not widely used in the United States, but it has a positive effect on mortality rates.

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Dialysis is a significant burden, and it can greatly impact your quality of life.

Dr. Vassalotti says that in-center dialysis can be especially hard for patients, since it can be time-consuming. Patients need to come in “usually three times a week, for three to five hours,” he says. Patients can feel drained after dialysis treatment, often have to be on multiple medications, and can also struggle with the restricted diet that is necessary with this treatment.

“A preemptive transplant is the first treatment for kidney failure,” says Vassalotti. He adds that a kidney from a live donor is the best way to obtain a healthy organ, and transplants are typically better for quality of life than dialysis.

Your diet can have a big impact on kidney health, and healthy changes can significantly slow the progression of this chronic disease.

“Most people with kidney disease should see a registered dietitian for medical nutrition therapy,” says Vassalotti. You should discuss these nutrients with your healthcare team.

• Protein Your body breaks protein down into waste that’s removed from the blood. Some people with CKD may be advised to avoid eating too much protein, since this can make kidney function worse.

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  Choosing plant-based sources of protein, like nuts, beans, and tofu, may also help slow CKD progression.

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• Potassium When the kidneys aren’t functioning properly, potassium levels can become high, leading to heart and muscle problems. High potassium is a risk in later stages of CKD, but even people who need to limit potassium should still eat plenty of fruits and vegetables for the other health benefits they offer.

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• Sodium Sodium is extremely common in processed and frozen foods, and keeping track of your salt intake can be beneficial for your kidney health. Limiting sodium might help with CKD progression and blood pressure.
• Phosphorous Phosphorus, an important mineral, can build up in the bloodstream of people with CKD and harm your blood vessels and bones.

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  Phosphorus is found in a wide variety of foods, including dairy products, salmon, meat, and poultry.

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  The risk of phosphorus getting too high is typically greater later on in CKD.

Many people with CKD, especially during its earlier stages, will not have to limit nutrients like potassium and phosphorus. Choosing a healthy diet with plenty of fruits, veggies, whole grains, and minimally processed ingredients is a great start. Vassalotti recommends thinking about your overall dietary pattern and following healthy guidelines such as the U.S. Department of Agriculture (USDA) MyPlate concept. “Such an approach is more optimistic and useful than the focus on avoidance of certain foods,” he says.

• Stay active. Physical activity may slow down worsening kidney function, although more research is needed.

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  Physical activity can also help decrease heart disease risk and improve sleep.

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• Maintain a healthy weight. Both obesity and being underweight can pose risks for those who have CKD. Carrying extra weight can make the kidneys work harder, and being underweight is associated with an increased risk of developing end-stage kidney disease.

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• Avoid excessive alcohol. Binge drinking may contribute to CKD progression.

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  The Centers for Disease Control and Prevention (CDC) recommends that people with CKD limit alcohol because of its impact on blood pressure.

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• Stop smoking. Smoking may speed the progression of CKD.

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   Quitting smoking can also help decrease risk of premature death from cardiovascular disease.

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Vassalotti says that diabetes, hypertension, heart disease, heart failure, and obesity are common conditions that often coexist with kidney disease. Treatment for those conditions can help control or slow the progression of your CKD.

• Manage blood pressure. Good blood pressure control lowers the risks of cardiovascular events and all-cause mortality.

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• Lower cholesterol levels. Lowering your cholesterol can decrease the risk of atherosclerotic cardiovascular disease in those with CKD.

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• Stay on top of diabetes. Because these two health conditions are so closely interconnected, it’s essential to manage both. High blood sugar can speed up the decline of kidney function.

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• Chronic kidney disease is a progressive condition, but it can be managed through treatment. There currently is no cure.
• Medications such as SGLT2 inhibitors, GLP-1 receptor agonists, renin–angiotensin system inhibitors, and statins can all help slow the progression of the disease.
• Dialysis and kidney transplants are the only treatment options for those who have more advanced CKD.
• Modify your diet, stay active, and quit smoking and drinking alcohol to give yourself a better quality of life with CKD.