Protecting your kidneys protects your entire future, because when you lose kidney function, this decline rarely stays just in your kidneys; it spills over and affects almost every system in your body. So your risk of heart disease goes up, and your bone health suffers, and you get hormonal imbalance and blood pressure issues.
That is why prevention matters so much for your kidneys. In this article, I want to go over critical steps you can start today to help protect your kidneys for decades to come. And if you already have kidney disease, these steps are especially important, as they can help slow and even stop further damage.
I am going to give you a simple checklist to go through to make sure you are protected. There will be three parts to this checklist. First, we will talk about common medications that you probably have in your medicine cabinet that are notorious for causing kidney damage, and these are both over-the-counter and prescription medications. Second, I will give you a framework for the foods you should eat and those you should avoid to maintain kidney health. And at the end, I will go over the best types of exercise that have been shown not only to slow the progression of your kidney disease but also to improve your kidney function numbers.
As always, this article is educational only and not medical advice. Please talk to your doctor before you make any changes to your health regimen.
Part 1: Medications That Can Damage Your Kidneys
Medications are a very common cause of kidney injury, and we are talking about both over-the-counter and prescription medications. A recent report published in The Lancet found that drug-associated kidney disease accounts for anywhere from 19 to 26% of all acute kidney injury cases in hospitalized patients.
NSAIDs: Ibuprofen and Naproxen
The first group of medications we need to be careful with is NSAIDs, or non-steroidal anti-inflammatory drugs, because these are some of the most commonly used over-the-counter medications that can cause kidney injury. Examples include ibuprofen (Advil or Motrin) and naproxen (Aleve).
Here is why NSAIDs can be so problematic. These drugs block a chemical called prostaglandin. Prostaglandins promote pain, fever, and inflammation, so blocking them makes you feel better. But inside your kidneys, prostaglandins do something very different. What they do is keep the tiny blood vessels open, ensuring a steady blood supply to the kidneys.
So if you take ibuprofen, you block prostaglandins, which will help with your headache or your joint pain, but it also pinches the blood supply your kidneys depend on. This is not to say never take ibuprofen or naproxen. Occasional use is pretty safe for most people. But if you do have to take it, there are things you can do to mitigate the risk of kidney damage.
First, if possible, always try to use topical NSAIDs like diclofenac gel over pills. Second, try to limit your NSAID use to the shortest duration possible. We just do not want to get into a routine of taking them around the clock or every day for long periods.
Now, what about people who suffer from chronic pain or inflammation and do not have any other options? Well, in that case, we just want to carefully monitor your kidney function with frequent blood tests. We also have to make sure that we are not taking NSAIDs on top of any other medications that can potentially cause damage. We have to be extra careful if you are also taking blood pressure medications and especially medications like ACE inhibitors, angiotensin receptor blockers, or diuretics, as this can increase the risk of injury by 3 to fivefold.
We want to avoid taking NSAIDs entirely if you already have any signs of chronic kidney disease, but especially if your estimated glomerular filtration rate is less than 30. We also do not want to take NSAIDs if you have conditions like heart failure or cirrhosis, or if you are at a higher risk for dehydration.
Proton Pump Inhibitors (PPIs)
Another very commonly used drug that can cause kidney injury is proton pump inhibitors, or PPIs, which people take for reflux or heartburn. These would be medications like omeprazole (Prilosec), esomeprazole (Nexium), and pantoprazole (Protonix), and there are many other variations of this drug.
This drug class is particularly concerning for kidney disease. According to the FDA adverse event reporting system data from 2019 to 2023, seven out of the top ten drugs suspected of causing serious acute kidney injury were PPIs. And they accounted for 86% of all reported cases of serious drug-induced kidney injury.
I approach PPI use the same way I approach NSAIDs. Sometimes you just cannot get around it, and some people really need to take this drug. But we always want to use it as a last resort and for the shortest duration possible. What we do not want is to start taking this drug for simple heartburn and then continue taking it for months or years, because these drugs do not actually fix the root cause of heartburn. What they do is they just cover up your symptoms.
Antibiotics: Bactrim
Many antibiotics can cause kidney issues, but the one I want to highlight in particular is Bactrim. Bactrim is prescribed for many common infections, including urinary tract, ear, and skin infections.
Just like with other drugs we talked about, sometimes Bactrim is the best and safest antibiotic option that we have. But with my patients, I rarely prescribe Bactrim as my first choice, and I try to avoid it if I can. There is a study that looked at over 570 patients over a 3-year period who were treated with Bactrim for at least 6 days, and what they found was that 11% of those people developed acute kidney injury. So not an insignificant number.
Why Even Small Kidney Damage Matters
Before we talk about the best foods to eat to protect your kidneys and the foods you need to avoid, I want to emphasize why it is so important to be careful with these medications and why we want to minimize even the slightest damage to your kidneys.
Your kidneys are very different from every other major organ in your body. Each one of your kidneys is not just one big filter, the same way your heart, at its basic function, is just a pump. Your kidneys are made up of tiny filters called nephrons. Each nephron is a distinct functional unit capable of producing urine independently. And all those nephrons work together to coordinate and fine-tune filtration, blood pressure regulation, and hormone secretion.
The way I like to think about it is that each nephron works like an employee at a busy workplace. When the kidney is healthy, there are plenty of staff to share the workload, and everything works great. Now imagine the workplace becomes toxic, or you get your typical management move: cutting staff to save money. You still have the same amount of work, but this work has to be done by fewer people. The remaining workers now have to stay late, and they take work home. On the surface, the job still gets done, but now you have a toxic environment of burnout and systems breakdown, which then ultimately forces more people to quit, and the whole workplace just spirals.
This is exactly what happens inside the kidneys. If there is any damage, some nephrons scar or die, which puts more pressure on the remaining nephrons to keep up, which actually speeds up damage in the rest of the kidney. This model was described by Dr. Brenner back in the 1990s. Once the damage sets in, the surviving nephrons face even more pressure and overload, which can lead to further damage.
Part 2: Foods to Eat and Foods to Avoid
Potassium-Rich Foods
The first important nutritional change shown to prevent kidney disease is increasing intake of potassium-rich foods, such as vegetables and fruits. Potassium does a lot of amazing things. It eases tension in your blood vessel walls, allowing them to relax and dilate. Potassium also helps increase nitric oxide, and it helps excrete more sodium. All of those things combined naturally lower your blood pressure, which is important because high blood pressure is the second leading cause of kidney disease, just behind diabetes.
The foods you want to target are leafy green vegetables like spinach and kale, root vegetables like potatoes and beets, and things like tomatoes, broccoli, and Brussels sprouts. For fruits, go for avocados, mangoes, and papayas. Melons have a lot of potassium, and also many citrus fruits like oranges and kiwis.
One thing to clarify: potassium helps prevent kidney disease when the kidneys are working well. But we do have to be careful with high potassium foods once the damage has already set in and we are dealing with chronic kidney disease, because at that point, your kidneys may not be able to remove excess potassium, which can then lead to dangerous levels. If you already have kidney disease, it would be really helpful to work with a renal dietitian who can give you personalized guidance.
Sodium Intake
Beyond potassium, another mineral we need to be careful with is sodium. If you want to preserve your kidneys, and especially if you already have kidney disease, the recommendation is to eat less than 2,000 milligrams of sodium per day. And if you have issues with high blood pressure, I would actually try to get that number even lower to maybe below 1,500 milligrams per day.
This recommendation is supported by several societies, including the American Academy of Family Physicians and the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. As with the potassium data, the main benefit is reduced blood pressure. If you look at evidence from randomized control trials, reducing sodium intake by approximately 1,700 milligrams per day lowers your systolic blood pressure by almost 7 millimeters of mercury and diastolic blood pressure by almost 4 millimeters of mercury.
When it comes to reducing your sodium, the salt shaker is usually not the problem. For most people, excess sodium usually comes from ultra-processed foods. We are talking about things like packaged snacks, frozen meals, and many sauces, fast food, and deli meats. These foods offer a lot of convenience because they are easy to grab on the go. And in many places, these ultra-processed foods are cheaper to buy and store than whole foods. But it is well worth the effort and the cost to try to minimize your intake of these foods, which will then help lower our sodium intake, because it is not just kidney disease that we are talking about. Greater exposure to ultra-processed foods is also associated with things like heart disease, diabetes, and anxiety, and there is an association with an increase in all-cause mortality, which is death from any cause.
Part 3: Best Exercise for Kidney Health
What is the best type of exercise when it comes to preserving your kidney function? Well, the good news is that it does not take much exercise to see marked improvements. The LIFE study, published in JAMA Internal Medicine, showed that even modest increases in physical activity led to a slower decline in kidney function among sedentary older adults. You start seeing benefits even at low levels of activity.
If you look at a systematic review, a meta-analysis of 12 randomized controlled trials, it looks like any aerobic exercise longer than 30 minutes significantly improved kidney function. It showed improvement in serum creatinine levels. And atAnd, at least according to this study, walking and running seem more effective than cycling. That is splitting hairs. If you look at the totality of evidence, any movement and aerobic exercise will help you preserve your kidney function.
FAQ
Q1. What are the most dangerous over-the-counter medications for kidney health? NSAIDs like ibuprofen and naproxen are among the most commonly used over-the-counter medications that can cause kidney injury. They block prostaglandins, which reduces blood supply to the kidneys. Occasional use is generally safe for most people, but long-term or high-dose use carries significant risk.
Q2. Can heartburn medications damage the kidneys? Yes. Proton pump inhibitors like omeprazole, esomeprazole, and pantoprazole have been linked to serious acute kidney injury. According to FDA data from 2019 to 2023, PPIs accounted for 86% of all reported cases of serious drug-induced kidney injury.
Q3. Is potassium good or bad for the kidneys? Potassium is beneficial for healthy kidneys because it helps lower blood pressure by relaxing blood vessel walls and promoting the excretion of excess sodium. However, if you already have chronic kidney disease, your kidneys may not be able to remove excess potassium safely, which can lead to dangerous levels. Always consult a renal dietician if you have kidney disease.
Q4. How much sodium should a person with kidney disease consume per day? The recommendation is less than 2,000 milligrams of sodium per day for people who want to preserve kidney health. If you also have high blood pressure, aim for below 1,500 milligrams per day.
Q5. What type of exercise is best for kidney health? Any aerobic exercise longer than 30 minutes has been shown to significantly improve kidney function. Walking and running appear slightly more effective than cycling, according to available studies, but any consistent movement will help preserve your kidney function.
Q6. Why can even small kidney damage become a serious problem? The kidneys are made up of millions of tiny filters called nephrons. When some nephrons are damaged and die, the remaining ones take on extra workload, which accelerates further damage. This cycle, described by Dr. Brenner in the 1990s, explains why even small, early damage should be taken seriously.
Q7. What foods should I eat to protect my kidneys? Focus on potassium-rich foods like spinach, kale, potatoes, beets, tomatoes, broccoli, avocados, mangoes, oranges, and kiwis. Avoid ultra-processed foods high in sodium, such as packaged snacks, frozen meals, fast food, and deli meats.
Conclusion
Protecting your kidneys comes down to three things: being careful with the medications you take, making smart food choices, and staying physically active. Medications like NSAIDs, PPIs, and certain antibiotics can cause significant kidney damage even at normal doses if used long-term. Eating potassium-rich whole foods while reducing sodium from ultra-processed sources helps maintain healthy blood pressure, which is the second leading cause of kidney disease. And even modest aerobic exercise lasting more than 30 minutes has been shown to slow the decline in kidney function and improve key markers, such as serum creatinine.
Your kidneys work silently every day to keep every other system in your body functioning. The steps you take today to protect them will determine your health for decades to come. Stay healthy.
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Longevity Science