Lifestyle Modifications and Nutritional and Therapeutic Interventions in Delaying the Progression of Chronic Kidney Disease: A Review

Abstract

Chronic kidney disease (CKD) is a debilitating progressive illness that affects more than 10% of the world's population. In this literature review, we discussed the roles of nutritional interventions, lifestyle modifications, hypertension (HTN) and diabetes mellitus (DM) control, and medications in delaying the progression of CKD. Walking, weight loss, low-protein diet (LPD), adherence to the alternate Mediterranean (aMed) diet, and Alternative Healthy Eating Index (AHEI)-2010 slow the progression of CKD. However, smoking and binge alcohol drinking increase the risk of CKD progression. In addition, hyperglycemia, altered lipid metabolism, low-grade inflammation, over-activation of the renin-angiotensin-aldosterone system (RAAS), and overhydration (OH) increase diabetic CKD progression. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend blood pressure (BP) control of <140/90 mmHg in patients without albuminuria and <130/80 mmHg in patients with albuminuria to prevent CKD progression. Medical therapies aim to target epigenetic alterations, fibrosis, and inflammation. Currently, RAAS blockade, sodium-glucose cotransporter-2 (SGLT2) inhibitors, pentoxifylline, and finerenone are approved for managing CKD. In addition, according to the completed Study of Diabetic Nephropathy with Atrasentan (SONAR), atrasentan, an endothelin receptor antagonist (ERA), decreased the risk of renal events in diabetic CKD patients. However, ongoing trials are studying the role of other agents in slowing the progression of CKD.

Maintained Renal Function by Blood Pressure Control in Patient with Diabetic Kidney Disease (DKD)

“…The current case study concerned a 74-year-old male who has been treated for type 2 diabetes (T2D), hypertension, dyslipidemia, and diabetic nephropathy stage G3b. These diseases have shown mutual influences and relationships in the light of arteriosclerosis [14]. He has been able to control adequate levels of blood glucose, blood pressure, and renal function for years in relation to T2D, hypertension, creatinine (Cre), and estimated glomerular filtration rate (eGFR).…”

“…He has been able to control adequate levels of blood glucose, blood pressure, and renal function for years in relation to T2D, hypertension, creatinine (Cre), and estimated glomerular filtration rate (eGFR). This article will describe some perspectives concerning i) glucose control, ii) blood pressure control, and iii) an adequate diet for diabetic kidney disease (DKD) [14].…”

Renal-Protective Roles of Lipoic Acid in Kidney Disease

“…Nonetheless, the nephroprotective role of ALA has not been comprehensively evaluated in this animal model, which should be investigated in the future. Additionally, the protective effects of ALA on each of the five stages of chronic kidney disease [ 156 , 157 , 158 ] should also be studied in this animal model of CKD.…”

Role of Gut Microbiota, Immune Imbalance, and Allostatic Load in the Occurrence and Development of Diabetic Kidney Disease

“…LA is a typical polyunsaturated fatty acid (PUFA) in plant-derived oils, mainly derived from vegetable oils and nuts in the diet [ 163 ]. A diet high in linoleic acid is typical of the Mediterranean diet, and previous studies have suggested that in patients with DKD, adopting the Mediterranean diet could potentially present a lifestyle approach that effectively postpones kidney deterioration [ 164 , 165 ]. A study conducted on 366 patients as part of a clinical trial revealed that an enhanced intake of polyunsaturated fatty acids had a notable association with a decreased preponderance of DKD [ 166 ].…”