AARP Smart Guide to Kidney Health

12. Audit your long-term medications 

Our kidneys excrete many medications. But if you take some medications for too long, or in combination with other prescribed drugs, it can lead to kidney damage. These include NSAIDS (non-steroidal anti-inflammatory drugs) such as diclofenac (prescription), ibuprofen (sold over the counter under brand names such as Advil or Motrin) and others. If you take a number of medications, talk to your doctor to make sure the dosages are appropriate and that all of them interact safely.

13. Chemotherapy considerations

Chemotherapy can also damage the kidneys. According to one study, the incidence of drug-induced kidney damage (called nephrotoxicity) in older people may be as high as 66 percent, and people over 65 are among the most susceptible to damage from medications.

14. How race, gender and ethnicity apply

African Americans, Hispanics, Native Americans and Asian Americans have a greater risk for CKD. Women also have a slightly higher rate of it than men. According to Deidra Crews, M.D., a nephrologist and professor of medicine at Johns Hopkins University who specializes in kidney health equity, a confluence of factors may account for higher rates of CKD among various ethnic groups, yet it doesn’t fully explain the disparities. Some African Americans have a genetic variant that puts them at higher risk of kidney disease. But studies also show that stress, low socioeconomic status and poor access to high-quality medical care may be contributing factors, says Crews.

KEEPING YOUR KIDNEYS HEALTHY

15. Manage your levels

It’s crucial to manage your blood sugar, blood pressure and cholesterol. A decline in kidney function goes along with aging, but kidney disease is not a foregone conclusion for everyone, so at any age it’s important to protect your kidneys and keep track of the factors that lead to CKD. An A1C test, also called a glycosylated hemoglobin test, is a simple blood test that measures your average levels of blood sugar over the prior three months to track prediabetes or diabetes. The CDC recommends that you ask your doctor how often you should have an A1C test based on your age and medical profile. If you have high blood pressure, you can keep an eye on it with an at-home blood pressure monitor in addition to blood-pressure-lowering drugs if needed. Aim for a pressure of 120/80. 

“Patients whose pressure is 120/80 without medications are a little better off,” says the NIDDK’s Abbott. “However you can get there, through lifestyle changes or medication, it’s much better than having high blood pressure.” A cholesterol test, also known as a lipid panel, measures the amount of cholesterol and fats in your blood. If your cholesterol is high, your doctor may prescribe a statin, which can bring it down to a healthy level. 

16. Get routine screenings after 60

The National Kidney Foundation recommends that everyone over 60 be screened for kidney disease. Two tests are typically used to diagnose it. The “estimated glomerular filtration rate” (eGFR) is a blood test that shows how well your kidneys are filtering waste from your blood by measuring creatinine levels. Creatinine is a waste product that comes from the digestion of dietary protein and the normal breakdown of muscle tissue that is used to calculate eGFR. 

Think of eGFR as a percentage of kidney function. A good eGFR score for someone 60 and older is above 60; the higher the number, the better your kidney function. Less than 60 is considered low. A urine test called uACR measures the amount of the protein called albumin in your urine compared to creatinine. Albumin passes into the urine when kidneys are damaged. The lower your uACR score, the better. If you are at risk for kidney disease, both the blood test for eGFR and the urine test for uACR should be checked by your clinician. Medicare covers kidney health testing if your doctor deems it necessary.

17. Be your own advocate 

It’s important to be your own advocate when it comes to kidney health, says Crews. Make sure your doctor tests you for kidney disease if you have diabetes, prediabetes, high blood pressure, family members with kidney disease or any other risk factors. If your numbers have dropped, ask your doctor, “‘How are my kidneys doing?’” says Crews. “Finding out what you can do to protect your kidneys is the question you should be asking your doctor.”

18. Watch your diet and weight 

Diet is one of the first lines of defense against kidney disease. Eat a low-salt, low-sugar diet to boost kidney health. Predictably, there’s a direct link between too much sugar and diabetes, so stay away from cookies and cakes. Keep an eye on your protein intake, too; diets that are particularly high in protein can be problematic, so ask your doctor about what guidelines to follow. If you have any conditions such as diabetes or high blood pressure, be sure to follow the dietary guidelines for those disorders, too. 

Think of it like this: A heart-healthy diet is also a kidney-friendly diet. Try to eat at home rather than going out a lot (no, Uber Eats and DoorDash don’t count as in-home meal prep) so you can monitor what goes into what you eat. Nephrologists generally recommend a Mediterranean-style or DASH diet for kidney health, both of which consist of lots of fruits and vegetables, lean proteins and whole grains. A ketogenic diet, which has become trendy for quick weight loss, calls for a diet of about 70 to 80 percent fat, which may be problematic for many people concerned about kidney health, says Kramer.

19. Limit your salt intake 

Restricting salt is one of the most important dietary rules for kidney health. Because 70 percent of the sodium we consume comes from packaged and prepared foods, shop for items labeled “reduced sodium” or “low sodium.” While the American Heart Association recommends a daily sodium intake of between 1,500 and 2,300 milligrams, it depends on whether you have kidney issues and other health factors, such as high blood pressure. The National Kidney Foundation recommends no more than 2,000 mg a day for people with kidney disease, but be sure to talk to your doctor about the best sodium levels for your individual medical profile.

20. Stay hydrated

Staying properly hydrated will help flush out your kidneys. The Urology Care Foundation recommends 48 to 64 ounces of water daily to help kidneys work well and to prevent kidney stones. Getting enough fluids each day may not be easy. If you’re a person who doesn’t get particularly thirsty or forgets to drink water during the day, create a routine, such as one glass of water every time you brush your teeth or sit down to eat. Take advantage of technology and set your smartphone to go off for a “hydration reminder” every two hours. And track your water intake on your phone. You can also eat more hydrating foods.

21. Work out weekly 

Aim for 150 minutes of exercise a week. Physical activity is an important part of keeping your kidneys healthy. Do some kind of cardio and aerobic exercise — bicycling, walking, swimming — for 150 minutes a week. The more, the better, even if it is only walking. Exercise improves blood pressure and blood sugar levels, lowers cholesterol and helps you keep a healthy weight. Vassalotti also recommends resistance training, even if you only use three-pound weights. Gym machines and resistance bands can also be helpful. 

“You don’t have to try to be Jack LaLanne, but it’s important to maintain muscle health,” he says. As we age, we tend to lose muscle strength and mass, making these exercises even more important. Strength and balance also help to prevent falls in seniors. Check with your doctor or physical therapist to decide the type of exercise that is right for you.

22. Look at medication interactions 

A number of over-the-counter (OTC) and prescription medications, and some antibiotics, can harm the kidneys. Remember, every drug you swallow passes through your kidneys. Most people over 60 take several medications for health conditions, but some may not interact well with each other, and chronic use or high doses of NSAIDs can negatively affect kidney health. “Avoid chronic use, or take the lowest dose,” advises NIDDK’s Abbott.

23. Be cautious about supplements 

We live in an age where the “wellness” industry is flourishing, and the internet is awash in products that make all sorts of claims about health and longevity. But many of these have not undergone rigorous testing in humans and can be dangerous to your kidneys. Learn which supplements are harmful and which are safe. At any stage of kidney disease, the American Kidney Fund recommends you avoid: astragalus, cat’s claw, goldenrod, java tea leaf, and parsley root, among others.

24. Avoid alcohol and tobacco 

Alcohol affects the kidneys by raising blood pressure. According to the National Kidney Foundation, tobacco smoking can impact medications used to control high blood pressure, which in turn worsens kidney health and also slows blood flow to the kidneys.

25. Get good, refreshing sleep 

Good sleep is important for kidney health. Most people need about seven hours a night. If you have trouble sleeping, consider a sleep routine wherein you set a schedule for when you wind down and go to bed every night. Avoid TV and other electronics before bedtime — unplug. If you have consistently poor sleep, or loud snoring, talk to your doctor about the possibility of sleep apnea or other sleep disorders, which manifest as poor sleep. Sleep apnea is more common among people living with kidney diseases.

LIVING WITH KIDNEY DISEASE

26. If you’re diagnosed with CKD

Let a CKD diagnosis be a wake-up call. Some people tend to ignore or even go into denial about having chronic kidney disease, especially because it is often asymptomatic and they may feel fine. Others are terrified and assume they will have to go on dialysis, which isn’t the case, says Kattah of Mayo Clinic. One of the first things to do if your doctor tells you have CKD is to be proactive. Get on top of and manage any other health problems such as diabetes, high blood pressure and anemia (a shortage of red blood cells), which is often a complication because your kidneys aren’t filtering blood the way they should. 

As daunting as a CKD diagnosis may seem, ask questions and bring your partner or loved ones into conversations so you can all work together to manage your kidney disease. You may only have to make dietary and other lifestyle changes, or you may have to take new medications to slow down progression if you’ve reached a later stage.

“There are treatment options that fit with your goals and values,” says nephrologist Jamie Green, who is chair of medical affairs for the American Kidney Fund. “Patients with kidney disease can thrive, still work and do all things they enjoy doing: travel, exercise. It’s a matter of having treatments fit your lifestyle.”

27. Find a good nephrologist  

Someone who has an eGFR of 30 or less, uncontrolled blood pressure or a family history of kidney diseases should see a nephrologist who specializes in kidney disease, says Green. If kidney function appears to be declining faster than normal, a nephrologist can identify possible causes and come up with treatments to slow the process and preserve kidney function.

Your treatment for CKD will depend on the stage of kidney disease and any other medical conditions you have. People over 75 can live with a considerably decreased amount of kidney function and may need only dietary changes and monitoring. Although kidney damage can’t be repaired or reversed, it doesn’t have to get worse. Although a low eGFR may be more serious in a younger adult, many physicians see it as a normal part of the aging process in older people. In fact, some physicians believe that the guidelines for defining CKD in older adults should be revised.

28. Consider working with a registered dietitian 

Diet is an essential part of living with kidney disease. To sort through it all, it helps to see a registered dietitian who can provide an individualized menu of foods you can eat if you have stage 3 kidney disease or higher. If a caregiver does the cooking in your household, he or she may also benefit from working with a dietitian. It’s usually covered by Medicare. 

According to Kattah, “the biggest complaint for people on dialysis is diet. It can be very restrictive. They have to watch salt, potassium, water and protein intake. If they work with a dietitian, they can help find recipes they like and that taste good. They can figure out what they can eat instead of what they can’t eat.”

29. Get your stress under control

Make stress management a priority. The stress of struggling with kidney disease, especially dialysis, can affect your mental health. Relaxation techniques like meditation and yoga may help. A study published earlier this year in the journal Cureus found that meditation and yoga can improve the quality of life for people with advanced kidney disease, although more research is needed.

30. Embrace a plant-based diet 

Eat more plants to promote kidney health. If you have kidney disease but are not on dialysis, your doctor will probably recommend a lower-protein diet. Some studies suggest a plant-based diet, as opposed to a diet high in animal protein, may be beneficial. According to the National Kidney Foundation, the amount of protein you need depends on your body size, nutritional status and specific kidney problem. A dietitian can help you find the ideal amount of protein you should be consuming daily. If you are on dialysis, you may need more protein, because dialysis removes protein waste from the blood.

31. Limit your phosphorus intake

Phosphorus is usually found as a preservative in fast foods, prepared foods, canned and bottled drinks, and most processed foods. If you have kidney disease, your phosphorus intake is important. Too much can deplete your bones of calcium and weaken them. It can also lead to calcium deposits in your lungs, blood vessels and heart, which, over time, can lead to a heart attack or stroke. So when you go shopping, read food labels to avoid phosphorus, which usually appears as “PHOS.” Sometimes phosphorus is added to deli meats, fresh meat and poultry. If your market happens to employ a butcher, ask them about the use of phosphorus as a preservative.

32. Consider medication for kidney treatment 

Medications can help. Although there is no magic pill, there are medications that are highly effective in treating various stages of kidney disease to protect both kidney and heart health. The primary drugs target other conditions such as heart disease and diabetes and have been around for a long time: ACE (angiotensin converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) are generally prescribed first to older people with high blood pressure because they lower blood pressure and slow the progression of kidney disease. 

ACE inhibitors and ARBs lower blood pressure by widening your blood vessels. Diuretics (water pills) help your kidneys release extra salt and water through urine. Some newer drugs also are kidney- and heart-protective: Several years ago, the U.S. Food and Drug Administration approved finerenone (brand name Kerendia), a “non-steroidal mineralocorticoid receptor antagonist (nsMRA),” for diabetic kidney disease. A class of drugs known as SGLT2 (sodium-glucose cotransporter 2) inhibitors, the first of which was approved for use in 2015, helps keep the small filters in your kidneys (called glomeruli) healthy and lower your uACR ratio. 

If you’ve been watching TV, you’ve undoubtedly seen commercials for Farxiga (also known as dapagliflozin) and Jardiance (also known as empaglifozin), both of which are FDA-approved for chronic kidney disease; they slow the rate at which your kidneys filter blood. Invokanna (also known as canagliflozin) is a third SGLT2 inhibitor that is FDA-approved to treat chronic kidney disease. And now the GLP1-receptor agonists, weight-loss drugs like Wegovy and Ozempic that contain the ingredient semaglutide, are starting to be recognized as effective in treating kidney disease. In May, a study published in The New England Journal of Medicine found that people with type 2 diabetes who took Ozempic were 24 percent less likely to lose kidney function or need dialysis or transplant than those who did not take the drugs. The findings led to the FDA approving Ozempic for type 2 diabetes and kidney disease in 2025.

33. Limit imaging that uses dyes

Sometimes dyes used in contrast imaging can impact kidney function by reducing blood flow to the kidneys. This can potentially cause “contrast-induced nephropathy (CIN),” particularly in individuals with pre-existing kidney disease with an eGFR less than 30 (and sometimes for those with eGFR 30-45). Although it is relatively rare, older people with a eGFR score of 45-60 should let their doctors  know before undergoing CT scans or angiograms. They may also have to drink additional fluids before and after contrast-imaging or be given intravenous fluids during the angiogram. “If you can get the imaging without contrast dyes, that would be better,” says the NIDDK’s Abbott. “But if you need it, be careful.”

​34. Be skeptical of vitamins

Let your doctor know the vitamins you take. If you have CKD, you should not take vitamins A, D, E and K unless your doctor prescribes them. You should also avoid a daily multivitamin. Large doses of vitamin C can cause a buildup of naturally occurring compounds called oxalates in the bones and soft tissues that should be avoided. Herbal remedies and over-the-counter nutritional supplements should also be avoided. They can interact with other medications or create side effects. Kidney injury can also occur from seemingly benign things like black licorice for “some people in some situations,” says Crews. “We have seen situations where people who did not know they had kidney disease were even taking too many TUMS and getting too much calcium carbonate, which is hard on the kidneys to clear.”

IF YOUR KIDNEYS FAIL

35. Consider whether dialysis is right for you

Dialysis is a medical process that cleans your blood when your kidneys can’t. Typically, people start dialysis when their kidney function is at 15 percent or less and they’re in kidney failure, according to the NIDDK. If medications don’t work, dialysis may be the only option. 

In dialysis, your blood is diverted to a machine that removes waste products and excess fluid. There are three kinds of dialysis. In-center hemodialysis is usually done at a dialysis center three or four times a week and administered by medical professionals. Home hemodialysis is done five to seven days a week in your home. With peritoneal dialysis, wastes are filtered inside your body through a catheter that has been surgically inserted in your abdomen, then released and disposed of. It can be done at home or even when you travel, but it requires you to handle the equipment. 

“It’s a big decision, a medical one and an existential one,” says Kattah of choosing the kind of dialysis that works for you. “I ask patients, ‘How do you want to live?’ Home dialysis allows more flexibility — and you don’t feel the burden of going back and forth to a dialysis center three times a week — but typically has to be done every night for 8 to 10 hours. Some patients like it. They can do it while they sleep and wake up and be done with dialysis.” Dialysis only does 10 to 15 percent of what normal, healthy kidneys can do.

36. Ask if you can avoid dialysis

You may avoid dialysis with medication. For some older people, particularly those with limited life expectancy or poor functional status, medical management — also called conservative management or supportive kidney care — may be a preferable alternative to dialysis. Medical management aims to support the whole person, helping them maintain quality of life through medications that slow the progression of kidney disease. A recent study published in the journal Annals of Internal Medicine found that over three years, frail older patients with kidney failure who started dialysis lived only an average of 77 days longer than those who never started it. Moreover, those patients spent less time at home; they were in a hospital, a nursing home or a rehab center for about 15 more days than those who never started dialysis. 

Shared decision-making is important. “Sometimes patients feel they never get a choice,” says Susan Wong, M.D., a nephrologist at the Department of Veterans Affairs in Seattle, and coauthor of the study. “It’s an ultimatum presented: Do dialysis or you die. We wanted to gather more information for patients and providers and debunk myths about dialysis being a panacea without costs.”

37. Talk about transplant options 

A kidney transplant can offer the best quality of life for eligible seniors. It consists of placing a healthy kidney from a living or deceased donor into a person whose kidneys no longer function properly. This replaces the function of the natural kidneys better than dialysis in general. According to estimates, about 20 percent of all transplant recipients are over 60. But according to the National Institute on Aging, kidney transplants in older patients are becoming more common. Research shows that healthy people in their 70s and 80s can have excellent outcomes, and age alone should not be an absolute contraindication against kidney transplantation.

38. Find the right support and resources 

Support and resources are available. Many support services can help you at any stage of kidney disease. Medications and medical care are generally covered by insurance, including Medicare and supplemental plans. There are also resources for financial assistance with dialysis and transplants.

The American Kidney Fund website has tips on healthy eating for those at different stages of kidney failure. It also offers advice on physical activity. The National Kidney Foundation has a list of support services for coping with CKD. Online communities offer a forum to communicate with others who may have kidney disease or are caring for a family members with CKD. From swapping kidney-friendly recipes to emotional support groups, a robust network of support and resources is there to help.