ADVICE
Dr. Roach on how to combat chronic kidney disease
Dr. Keith Roach
To Your Health
July 17, 2026, 5:04 a.m. ET
View Comments
Dear Dr. Roach: I read your column every day. I haven’t seen any information on chronic kidney disease (CKD). There are many articles on the internet about this subject, telling us how to combat it with easy, at-home remedies. Most articles discuss how to cleanse your nephron filters with things such as pumpkin seed oil, cinnamon, etc
I’m a borderline Type 2 diabetic, and I take Jardiance. My last eGFR was 52. My last creatinine level was 1.39 mg/dL. Could you possibly provide me with some useful information on this subject? Is there a simpler way to combat CKD? There are millions of people out here who have the same problem
Dear B.M.: CKD is common, especially in older adults, and can result from many different underlying conditions, especially diabetes. The treatment for people with diabetes and CKD is particularly well-established. Supplements aren’t a big part of the treatment program, and the idea that all you need to do is take a supplement is misleading. I don’t know of any supplement that has good data to support its use in slowing CKD. Instead, diet and medical care are key
One’s diet shouldn’t be too high in sodium. Expert groups recommend less than 2,000 mg of sodium daily. Protein shouldn’t be excessive and ideally be as much plant-based protein as possible. (About 0.8 grams of protein per day is a useful starting point for most people, but this needs to be individualized. A registered nutritionist who’s experienced in CKD and diabetes is the expert consultant.) A mostly plant-based diet altogether has been shown to reduce kidney failure risk and improve mortality in people with diabetes and CKD.
Blood pressure and diabetes control should be optimal. ACE inhibitors and angiotensin receptor blockers are preferred, and a goal of 130 mm Hg is reasonable, while a goal of 120 mm Hg might lead to even better outcomes. Finerenone (Karendia) is used by many specialists if one’s blood pressure doesn’t reach the goal with maximum doses of other treatments, as there are strong data that its use reduces the progression to kidney failure and also reduces the risk of heart failure and death
The A1C goal is usually between 6.5% to 7.5%, but this also needs to be individualized with your diabetes specialist. I agree with empagiflozin (Jardiance), as this is effective in slowing kidney disease. A GLP-1 drug like semaglutide protects both the heart and kidney, and it has the additional benefit of weight loss, which is important for most — but not all — people with Type 2 diabetes
Dear Dr. Roach: My urologist has prescribed 10 mg of oxybutynin to relieve my bladder symptoms. I have read that this is a medication that can lead to dementia. The medication makes my life more manageable. However, I don’t want dementia, and I’d stop taking it if it does cause dementia. What’s your opinion on this medication and its future effects?
— C.C.
Dear C.C.: Oxybutynin is in a class of medicine called the anticholinergics. There have been many observational studies suggesting that the long-term use of this type of medication does increase the risk of dementia when taken daily for three or more years. However, the absolute risk of taking this medication remains small. Estimates suggest a 1% to perhaps 5% increased lifetime risk of dementia, with other studies estimating a risk of less than 1%
Still, I can understand why people like to reduce any risk they can. Among the anticholinergics, trospium (Sanctura) probably has the least risk of dementia and is the one that I tend to prescribe when I use an anticholinergic. However, whenever possible (due to insurance reasons), I prefer to use one of the newer beta-3 agonists (mirabegron and vibegron) for overactive bladder symptoms, which have a more favorable side effect profile and approximately equal efficacy — without any known or expected risks for dementia.Readers may email questions to ToYourGoodHealth@med.cornell.edu.
