How To Prevent Kidney Failure

Kidney failure, or end-stage renal disease (ESRD), is a condition characterized by irreversible kidney damage that leads to the loss of kidney function. Your kidneys help remove toxins along with excess fluids and minerals from your blood. When your kidneys don't function properly, toxins can build up and cause complications.

You are considered to have entered kidney failure when your kidneys function at less than 15% of their normal levels. Some cases of kidney failure may be sudden, like from an infection or injury, and may not be preventable.

Most cases of kidney failure are the last stage of chronic kidney disease (CKD, when damaged kidneys can't properly filter blood) caused by chronic conditions like diabetes and high blood pressure (hypertension). In these cases, the progression to kidney failure might be preventable, or at least delayed.

Who Is Most at Risk?

Kidney failure often occurs due to the worsening of chronic kidney disease. Kidney diseases can affect people of all ages, but the onset is more common in people who are 65 or older.

A few other factors that may increase your risk of developing kidney failure are:

• Diabetes: This condition is one of the most common causes of kidney failure, leading to about 47% of kidney failure cases in the United States.
• High blood pressure: Hypertension is the second most common cause of kidney failure, causing about 27% of cases in the U.S.
• Ethnicity: Kidney failure is more common among certain ethnic groups, including Black Americans, Hispanics, Afro-Caribbeans, and Asians.
• Family history: Having a biological parent or sibling with kidney failure can increase your risk of developing it too.
• Obesity: Having obesity or being overweight can increase your risk of developing kidney disease that can progress into kidney failure.
• Smoking: Smoking can increase your risk of developing kidney disease, which can eventually lead to kidney failure.
• Heart disease: Heart disease can increase the risk of developing kidney failure due to reduced blood flow to the kidneys.
• Alcohol intake: Drinking excessive alcohol regularly can double the risk of kidney disease, which can then lead to kidney failure.
• Infections: Infections that directly damage the kidneys, such as sepsis or acute pyelonephritis (bacterial infection of the kidneys), can lead to kidney failure.
• Medications: Intake of certain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), certain blood pressure medicines, or some cancer drugs can increase the risk of kidney failure.

Genetics

You may be at a higher risk of kidney failure if you have a parent or sibling with the condition. Research suggests that variations in particular genes may be linked to an increased risk of kidney failure.

Two such common genes are myosin heavy chain 9 (MYH9) and apolipoprotein L1 (APOL1) genes that may increase the risk of kidney failure, especially in communities of color. 

A few other genes associated with kidney disease and failure may include:

• Glutathione peroxidase 1 (GPX1)
• Glutathione S-transferase omega class 1, 2 (GSTO1, GSTO2)
• Excision repair cross-complimentary group 2 (ERCC2)
• Matrix Gla protein (MGP)
• Transforming growth factor beta 1 (TGFB1)
• Superoxide dismutase type 1, 2 (SOD1, SOD2)

Not all people with these genes or gene variations will have kidney failure, and people can still experience kidney failure even without such gene variations.

How To Reduce Risk 

The best way to reduce your risk of kidney failure is to take measures to prevent the development of chronic kidney disease in the first place.

If you already have CKD, you can reduce your risk of progressing into kidney failure. There are several treatment approaches that can slow disease progression and maintain kidney function as long as possible. Regular monitoring can also help inform care so that you know you're doing all you can to prevent progression to kidney failure.

Testing

If you have CKD, regular testing of your kidney function is key to understanding how healthy your kidneys are. The results could help your provider determine whether the current treatment is working or if something else is needed to prevent progression to kidney failure.

Your healthcare provider might recommend getting your kidneys checked at least once a year.

Estimated Glomerular Filtration Rate (eGFR) Test

The estimated glomerular filtration rate is a blood test that helps measure how well your kidneys work. This blood test detects the level of creatinine in your blood. Creatinine is a waste product in the body that the kidneys remove through urine. Creatine buildup in the body is a sign the kidneys are not working properly.

The normal range of eGFR is 60-89. An eGFR of less than 60 for three months or more may indicate your kidneys are not working properly. In some cases, you may have kidney disease even if you have normal eGFR.

Urine Albumin-To-Creatinine Ratio (UACR) Test

For a UACR test, a healthcare provider will collect a urine sample. The sample will be measured for albumin, a protein. If the protein is present, it could be an indicator of kidney damage.

Medications

Your healthcare provider may recommend one or more medications based on the underlying cause of your CKD. These medications can help manage the underlying cause to prevent kidney damage.

If type 2 diabetes is causing your chronic kidney disease, you may be prescribed any of the following medications:

• Metformin: Sold under brand names like Fortamet and Glumetza, this popular type 2 diabetes medication is an oral pill that can help control blood sugar. In doing so, kidney damage can be slowed or prevented.
• Kerendia (finerenone): This oral tablet is for people who have type 2 diabetes and CKD. It is taken to reduce the risk of kidney function decline.
• Glucagon-like peptide-1 receptor agonists (GLP-1 RAs): They help to treat diabetes which can prevent kidney disease and failure.
• Sodium-glucose cotransporter-2 (SGLT2) inhibitors: These medications help lower high blood sugar for people with type 2 diabetes, which is a common risk factor for CKD and failure.

If type 1 diabetes is causing your kidney disease, insulin (a hormone that helps regulate blood sugar) can help control your blood sugar and prevent kidney damage.

If high blood pressure is causing your kidney disease, the following medications might help:

• Diuretics: Referred to as water pills, these medications help the kidneys remove extra salt and water from your body by increasing urine production.
• Angiotensin-converting enzyme (ACE) inhibitors: These help lower blood pressure and can prevent kidney damage.
• Angiotensin receptor blockers (ARBs): These medications also lower blood pressure but are used in people who can't take ACE inhibitors because of side effects.
• Beta-blockers: These medications lower blood pressure by blocking the effects of adrenaline, helping to slow your heart rate.

Some types of diabetes and high blood pressure medications are approved to help slow the progression of kidney disease even in people without diabetes or hypertension. Certain SGLT2s, as well as ACE inhibitors and ARBs, may prevent kidney failure in people with CKD.

Lifestyle Habits

Certain lifestyle changes can prevent kidney failure, including the following:

• Avoid or limit alcohol intake
• Eat a balanced diet
• Avoid smoking
• Get regular physical activity (at least 30 minutes a day)
• Maintain the weight you and your healthcare provider have decided is optimal for you
• Get adequate sleep
• Manage stress
• Visit your healthcare provider at regular intervals to monitor kidney function

Not only can these lifestyle habits directly help your kidney health, but they can also help you manage the conditions that might be causing the kidney disease, such as diabetes or hypertension.

Discuss With Your Healthcare Provider

Most often, symptoms of CKD do not appear until later stages. If you start experiencing any symptoms of later-stage kidney disease, reach out to your healthcare provider. Prompt attention can delay progression to kidney failure.

Symptoms of kidney disease you should monitor for include:

• Nausea
• Vomiting
• Loss of appetite
• Muscle cramps
• Swelling of ankles and feet
• Fatigue
• Sleep disturbances

Your healthcare provider can recommend different tests, such as blood and urine tests, to gauge how severe your kidney damage is. With proper diagnosis, they can determine suitable treatment approaches that can help slow the progression of your kidney disease and lower your risk of kidney failure. 

A Quick Review

Kidney failure is a condition where your kidneys can no longer function on their own. It is the last stage of chronic kidney disease (CKD). While kidney failure might not always be preventable, there are some steps you can take to lower your risk of developing it.

Regular testing of your kidney health can help monitor disease progression and inform when new treatment approaches may be needed.

Managing your diabetes and high blood pressure—the two main causes of kidney failure—can also help prevent the progression of CKD to kidney failure. This means taking your medication as prescribed and implementing lifestyle changes like eating a balanced diet and getting regular activity.

Other lifestyle changes that can promote kidney health and prevent kidney failure include stress management and adequate sleep.