Kidney protection: how to prevent or delay chronic renal failure

In patients at risk for chronic renal failure, early clinical interventions have been shown to prevent or delay progression of the disease. A low-protein diet is recommended when the serum creatinine is between 1.5 and 2.5 mg/dl. Benefit from protein restriction can only be achieved if energy intake is greater than 35 kcal/kg/d. To preserve skeletal muscle, correct metabolic acidosis with oral sodium bicarbonate supplementation. For hypertension control and renal protection, start ACE inhibitors when serum creatinine is less than 2 mg/dl. Correct anemia with erythropoietin to improve or maintain quality of life when the hematocrit falls below 30%. For the diabetic, ACE inhibitors and glycemic control have been shown to show the rate of renal failure.