Protecting Your Kidneys and Your Heart

Treatment will focus on:

• Preventing or slowing further declines in kidney function
• Managing your symptoms and any other risk factors, and
• Easing any added stress on the heart

Your care team will talk with you about medications you may need to take. Which ones will depend on your stage of kidney disease, if you are at an unhealthy weight, and if you have diabetes, heart disease, or other conditions. Be sure to talk about what matters most to you.

Coordinated care is important. This may include working with your primary care provider along with specialists in nephrology (kidneys), cardiology (heart and blood vessels), and endocrinology (diabetes), among others.

Lifestyle changes

• Make time to move more. Aim for at least 30 minutes of physical activity most days. Regular movement can help to naturally lower blood pressure and blood sugar and support overall heart and kidney health. Find an activity you like and keep moving throughout the day, especially if you sit a lot.
• Get to and maintain a healthy weight. Ask your care team what a healthy body mass index and waist circumference is for you. It may be helpful to pay attention to what you eat (number of calories in) and how active or inactive you are (how many calories you burn), which can affect your weight. Losing just 5-10% of your body weight can make a big difference.
• Manage other conditions that harm the kidneys and the heart 
  • Check your blood pressure regularly (for tips, read How to Take Your Blood Pressure at Home)
  • Keep an eye on your blood sugar and cholesterol levels too
  • Cut back on sodium (salt).  Too much sodium can raise blood pressure and cause the body to hold on to fluid. This can make the heart and kidneys work harder. Limit processed, prepared and packaged foods, which are often high in sodium.
    • 2,300 mg of sodium a day is the recommended limit for the general population, but 1,500 mg a day may be better for people with chronic kidney disease, heart failure and other types of heart disease – that’s about ¼ teaspoon
  • Add more fruits and vegetables to your meals and as options for a healthy grab-and-go snack.
  • Make water your go-to beverage of choice instead of sugary drinks. And be sure to limit alcohol.
  • Quit smoking or using tobacco products or don’t start. Ask about resources to help you quit.
  • Prioritize sleep and lowering stress. Poor sleep and ongoing stress can affect blood pressure, blood sugar and overall health.
  • Keep up with regular health visits and stay up to date on checks of your weight (body mass index and waist circumference), cholesterol, blood pressure, blood sugar, and kidney health. Kidney tests may include a urine test (UACR) and a blood test to measure GFR.
  • Ask your health care team about the best options for over-the-counter pain relief. Many NSAIDs (ibuprofen or naproxen) can harm the kidneys if they are used too often.
  
  

  Medications

  Medications are often needed in addition to lifestyle changes to improve kidney function, weight, blood pressure, blood sugar, and/or heart health.

  Your health care team may recommend a combination of medications. Be sure they know about all the medicines you take and why.

  Medicines that help protect the heart and kidneys may include, but are not limited to:

  • Angiotensin converting enzyme inhibitors (ACE inhibitors) or angiotensin II receptor blockers (ARBs) to help open blood vessels, lower blood pressure, reduce protein in the urine and slow any worsening of existing cardiovascular and kidney disease.
  • An ACE inhibitor or ARB plus an SGLT2 inhibitor is usually a first step for patients with chronic kidney disease and type 2 diabetes or chronic kidney disease and protein in the urine. If protein is still in the urine, other medications may be added to further protect the kidneys and heart.
  • Diuretics or water pills to lessen any swelling, ease shortness of breath and help further lower blood pressure.
  • GLP-1 therapy (glucagon-like peptide-1) or bariatric surgery, if needed, to help with weight loss. These can also lower the chance of kidney or heart events.
  • MRAs (mineralocorticoid receptor antagonist), including non-steroidal MRAs, for some patients.
  • Statins and other therapies to help lower cholesterol.
  • SGLT2 inhibitor (sodium-glucose cotransporter-2 inhibitors), GLP-1 agonists or both may be used to help protect the heart, blood vessel and kidneys in people with diabetes who also have or are at risk for heart disease. The specific medicine recommended will depend on any other conditions you have, including excess weight, kidney disease, blocked or narrowed arteries, heart failure, and other conditions.
  
  

  If you already have heart disease or have had a stroke or heart event, other medications may be recommended.