Treatment for kidney disease focuses on slowing the damage, managing the conditions that caused it, and preventing complications that develop as kidney function declines. There is no cure for chronic kidney disease (CKD), but the right combination of medications, dietary changes, and blood pressure control can keep many people stable for years. When kidney function drops too low, dialysis or a transplant becomes necessary.
What treatment looks like for you depends largely on how much kidney function remains and what’s driving the damage. The core strategy stays the same at every stage: protect the kidneys you have left.
Blood Pressure and Blood Sugar Control
High blood pressure and diabetes are the two most common causes of kidney disease, and controlling both is the single most important thing you can do to slow progression. The blood pressure target for people with CKD is below 130/80. Even if your kidney disease has a different cause, keeping blood pressure in that range reduces the physical stress on the tiny filtering units inside each kidney.
If you have diabetes, tightly managing blood sugar limits ongoing damage to those same structures. Uncontrolled glucose essentially scars the kidney’s filtering system over time, so every improvement in blood sugar control translates directly into slower decline.
A class of blood pressure medications that block the renin-angiotensin system (often called ACE inhibitors or ARBs) is typically the first choice for people with CKD. These drugs do more than lower blood pressure. They reduce the pressure inside the kidney’s filtering units and decrease the amount of protein leaking into urine by roughly 35% to 40%, which is significantly more than other blood pressure medications achieve even at the same blood pressure levels. Protein in the urine is both a sign of kidney damage and a driver of further damage, so lowering it is a treatment goal in its own right.
Newer Medications That Protect the Kidneys
Over the past several years, a newer class of drugs originally developed for diabetes has become a cornerstone of kidney disease treatment. These medications, called SGLT2 inhibitors, work by changing how the kidneys handle glucose and salt, which reduces pressure inside the kidney and decreases inflammation. A pooled analysis of over 58,000 participants across eight large trials found that SGLT2 inhibitors reduced the risk of kidney disease progression by 35% in people with diabetes and 26% in people without diabetes. They also lowered the risk of acute kidney injury by 23% to 28% and reduced hospitalizations for heart failure by 25% to 32%.
These benefits held up regardless of whether the person had diabetes, which was a major shift in how kidney disease is treated. People with higher levels of protein in their urine saw the largest absolute benefit.
Another newer option targets a hormone called aldosterone, which contributes to inflammation and scarring in the kidneys. In people with CKD and type 2 diabetes, this type of medication reduced the risk of kidney disease progression by up to 34% and cardiovascular events by about 14% over roughly two and a half years of follow-up. It’s typically added on top of the other medications already described.
Dietary Changes
What you eat matters more as kidney function declines. Healthy kidneys filter out waste products from protein metabolism, balance sodium and potassium, and regulate phosphorus. When they can’t do that efficiently, adjusting your intake of these nutrients reduces the workload on whatever kidney function remains.
For most people with moderate to advanced CKD who aren’t on dialysis, the general guidance is to keep protein intake around 0.8 grams per kilogram of body weight per day. For a 150-pound person, that’s roughly 55 grams of protein daily, or about the amount in two chicken breasts. This is lower than what many people eat, but it’s enough to maintain muscle and nutrition while producing less waste for the kidneys to clear.
Sodium should stay at or below 2,300 milligrams per day, which is about one teaspoon of table salt. In practice, most excess sodium comes from processed and restaurant foods rather than the salt shaker. Depending on your lab results, your care team may also ask you to limit potassium and phosphorus, two minerals that build up in the blood when kidneys can’t excrete them properly. High potassium can cause dangerous heart rhythm problems, and excess phosphorus pulls calcium from bones over time.
Managing Anemia
Kidneys produce a hormone that tells bone marrow to make red blood cells. As kidney function drops, production of this hormone falls, and anemia develops. You might notice fatigue, weakness, or feeling cold all the time. This is one of the most common complications of CKD, and it tends to worsen as the disease progresses.
Treatment typically involves injectable medications that mimic the missing hormone and stimulate red blood cell production. The goal is generally to bring hemoglobin levels into the 11 to 12 grams per deciliter range, enough to relieve symptoms and avoid blood transfusions without pushing levels too high. Hemoglobin above 13 g/dL has been linked to increased cardiovascular risk in people with CKD, so treatment is carefully calibrated. Iron supplements are often needed alongside these injections, since the body needs adequate iron stores to build new red blood cells.
Bone and Mineral Problems
Failing kidneys can’t activate vitamin D properly or clear excess phosphorus from the blood. This triggers a chain reaction: phosphorus levels rise, calcium levels drop, and the parathyroid glands go into overdrive trying to compensate. Over months and years, this weakens bones and can cause calcium deposits in blood vessels and soft tissues.
Treatment involves phosphate binders, which are pills taken with meals that grab phosphorus from food before it enters the bloodstream. Several types exist, including calcium-based binders and non-calcium options. Your care team will choose based on your calcium levels and other factors. Active forms of vitamin D may also be prescribed to help suppress overactive parathyroid glands, though the dose is carefully managed because too much can raise calcium to dangerous levels.
Dialysis
When kidneys lose most of their filtering ability (typically below about 10% to 15% of normal function), dialysis takes over the job of removing waste, excess fluid, and balancing electrolytes. There are two main types.
Hemodialysis filters your blood through a machine, usually at a dialysis center three times per week for about four hours per session. Some people do hemodialysis at home, which allows for more flexible and sometimes more frequent schedules. Peritoneal dialysis uses the lining of your abdomen as a natural filter. A fluid is pumped into the abdominal cavity through a small catheter, absorbs waste products, and is then drained out. This can be done at home, often overnight while you sleep.
Neither type is universally better. The choice depends on your lifestyle, other health conditions, and personal preferences. Both require significant adjustments to daily life, but many people on dialysis continue working, traveling, and staying active.
Kidney Transplant
A transplant is the closest thing to restoring normal kidney function. A single healthy kidney from a living or deceased donor is surgically placed in the lower abdomen and connected to your blood vessels and bladder. Your original kidneys are usually left in place unless there’s a specific reason to remove them.
Outcomes have improved steadily. Five-year graft survival for first-time transplant recipients reached about 76.6% in 2019, with living donor kidneys performing somewhat better than deceased donor kidneys. Younger recipients and those without diabetes as the underlying cause tend to have higher success rates. People receiving a second or subsequent transplant have slightly lower five-year survival (around 71.5%), though that gap has narrowed over the years.
The tradeoff is that you’ll need to take anti-rejection medications for the life of the transplant. These drugs suppress your immune system to prevent it from attacking the new kidney, which means a higher risk of infections and certain cancers. Despite this, most transplant recipients report a significantly better quality of life compared to dialysis, with fewer dietary restrictions and more energy.
The biggest barrier to transplantation is the shortage of donor organs. Wait times for a deceased donor kidney vary by region but often stretch to five years or more. A living donor, whether a family member, friend, or even an altruistic stranger, can dramatically shorten that wait and typically provides a kidney that lasts longer.