Managing kidney disease effectively comes down to controlling the conditions that damage your kidneys, making specific dietary changes, avoiding certain medications, staying active, and keeping up with regular monitoring. Most kidney disease progresses slowly, which means the steps you take now can preserve your remaining kidney function for years or even decades. What you need to do depends partly on how much function you’ve lost, measured by a blood test called eGFR.
Understanding Your Stage
Kidney disease is classified into five stages based on your estimated glomerular filtration rate, or eGFR, which measures how well your kidneys filter waste from your blood. The stages break down like this:
- Stage 1: eGFR above 90, but other signs of kidney damage are present (such as protein in urine)
- Stage 2: eGFR of 60 to 89, with signs of kidney damage
- Stage 3a: eGFR of 45 to 59
- Stage 3b: eGFR of 30 to 44
- Stage 4: eGFR of 15 to 29
- Stage 5: eGFR below 15, meaning the kidneys have lost almost all of their function
In stages 1 and 2, you may feel completely normal. The kidney damage shows up only in lab work, usually as protein leaking into your urine. This is actually good news: catching it early gives you the most room to slow things down. By stages 3 and 4, symptoms like fatigue, swelling, and changes in urination become more common, and dietary restrictions get tighter. Stage 5 typically requires dialysis or a transplant.
Get Blood Pressure Under Control
High blood pressure is both a cause and a consequence of kidney disease. It damages the tiny blood vessels inside your kidneys, and as those vessels deteriorate, blood pressure climbs further. Breaking this cycle is the single most impactful thing you can do. Current guidelines from KDIGO, the international kidney disease organization, recommend a systolic blood pressure target below 120 mmHg for adults with kidney disease. That target applies across age groups, including older adults.
Many people with kidney disease are prescribed a class of blood pressure medications that also protect the kidneys directly. These drugs work by reducing the pressure inside the kidney’s filtering units, which slows the leakage of protein into the urine. Your doctor will monitor your kidney labs after starting or adjusting these medications, since a small, expected dip in eGFR (up to 25%) is considered a sign the drug is working, not a reason to stop it. Potassium levels also need watching, since these medications can cause potassium to rise.
Adjust Your Diet
Dietary changes are one of the most hands-on parts of managing kidney disease, and the specifics shift as your kidney function changes. A renal dietitian can tailor recommendations to your stage, but a few principles apply broadly.
Sodium
General dietary guidelines recommend no more than 2,300 milligrams of sodium per day, roughly one teaspoon of table salt. Many people with kidney disease need to go lower than that. Reducing sodium helps control blood pressure and limits fluid retention. The biggest sources are restaurant meals, processed foods, canned soups, and deli meats. Cooking at home with fresh ingredients gives you far more control.
Protein
Protein creates waste products that your kidneys have to filter, so eating too much can accelerate damage. In earlier stages of kidney disease, a moderate reduction in protein intake can ease the workload on your kidneys. The right amount varies by person, which is why working with a dietitian matters here. If you eventually need dialysis, the equation flips: dialysis removes protein from the blood, so you’ll need to eat more of it.
Potassium
Healthy kidneys keep potassium in a tight range. As kidney function declines, potassium can build up to levels that affect your heart rhythm. Not everyone with kidney disease needs to restrict potassium, though. Your blood work will tell you whether your levels are running high. If they are, you may need to limit high-potassium foods like bananas, potatoes, tomatoes, and oranges, or adjust portion sizes rather than eliminating those foods entirely.
Medications That Can Harm Your Kidneys
Some common over-the-counter and prescription drugs are harder on the kidneys than most people realize. Knowing which ones to avoid, or use cautiously, is essential.
NSAIDs like ibuprofen (Advil, Motrin) and naproxen (Aleve) reduce blood flow to the kidneys. Occasional use might be acceptable for some people with early-stage disease, but regular or high-dose use can raise blood pressure and cause further kidney damage. Aspirin at doses above 325 mg per day carries similar risks. Acetaminophen (Tylenol) is generally considered safer for pain relief, but you should confirm the right approach with your care team.
Several other medication categories need dose adjustments as kidney function drops. Blood thinners like warfarin, apixaban, and rivaroxaban are cleared through the kidneys, so standard doses can build up and increase bleeding risk. Common heartburn medications like famotidine (Pepcid) and cimetidine (Tagamet) also accumulate when kidneys can’t clear them efficiently. If you have diabetes, some medications, particularly metformin, may need to be reduced or stopped once your eGFR falls below 30. Keep a current medication list and make sure every prescriber knows your kidney status, including dentists and urgent care providers.
Newer Treatments That Slow Progression
A class of medications originally developed for diabetes has proven to be a game-changer for kidney disease. These drugs, called SGLT2 inhibitors, slow the progression of kidney disease, reduce the risk of acute kidney injury, lower the chance of cardiovascular death, and decrease hospitalizations for heart failure. They work whether or not you have diabetes, and they’ve shown benefits across a wide range of eGFR levels. If you haven’t discussed these medications with your doctor, it’s worth bringing them up, especially if your kidney disease is progressing.
Stay Physically Active
Exercise benefits people at every stage of kidney disease, including those on dialysis and those who’ve had a transplant. The National Kidney Foundation recommends planning some form of physical activity on most days of the week. This doesn’t have to mean intense workouts. Walking, gardening, cycling, and swimming all count as aerobic exercise that strengthens your heart and helps control blood pressure and blood sugar.
Adding weight-bearing exercises with resistance bands or light weights helps maintain bone density and muscle mass, both of which tend to decline with kidney disease. If you’ve been sedentary, start slowly and build up gradually. Even 10 to 15 minutes a day is a meaningful starting point. The key is consistency over intensity.
Keep Up With Monitoring
Kidney disease is largely silent in its early stages. You can lose a significant amount of kidney function before feeling any symptoms, which makes regular lab work your main early warning system. Two tests matter most: your eGFR (from a blood draw) and your urine albumin-to-creatinine ratio, or uACR, which measures how much protein is leaking into your urine.
If you have risk factors for kidney disease, including diabetes, high blood pressure, heart disease, a family history of kidney problems, obesity, smoking, or being over 60, you should have a uACR test at least once a year. Once you’ve been diagnosed, your doctor may check it two to four times per year depending on your stage and how quickly things are changing. A single abnormal result doesn’t necessarily mean trouble; the test often needs to be repeated within three to six months to confirm accuracy. Tracking trends over time matters more than any single number.
Your eGFR will also be monitored regularly. Small fluctuations are normal, but a steady downward trend signals that your treatment plan may need adjusting. Keeping all your appointments and following up on lab orders is one of the simplest and most effective things you can do to stay ahead of this disease.