Modifiable Lifestyle Behaviors and Chronic Kidney Disease Progression: A Narrative Review

Living a healthy lifestyle is one of the safest and most cost-effective ways to improve one's quality of life and prevent and/or manage chronic disease. As such, current chronic kidney disease (CKD) management guidelines recommend that patients adhere to a healthy diet, perform ≥150 minutes per week of physical activity, manage their body weight, abstain from tobacco use, and limit alcohol. However, there are limited studies that investigate the relationship between these lifestyle factors and the progression of CKD among people with established CKD. In this narrative review, we examine the reported frequencies of health lifestyle behavior engagement among individuals with non-dialysis dependent CKD and the existing literature that examines the influences of diet, physical activity, weight management, alcohol consumption and tobacco use on the progression of CKD, as measured by decline in glomerular filtration rate, incident end-stage kidney disease, or elevated proteinuria or albuminuria in individuals with CKD. Many of the available studies are limited by length of follow up and small sample sizes, and meta-analyses were limited as the studies were sparse, had heterogenous classifications of behaviors and/or referent groups, and of CKD progression. Further research should be done to determine optimal methods to assess behaviors, to better understand the levels at which healthy lifestyle behaviors are needed to slow CKD progression, to investigate the impact of combining multiple lifestyle behaviors on important clinical outcomes in CKD, and to develop effective techniques for behavior change. Despite the lack of evidence of efficacy from large trials on the ability of lifestyle behaviors to slow CKD progression, maintaining a healthy lifestyle remains a cornerstone of CKD management given the undisputed benefits of healthy lifestyle behaviors on cardiovascular health, blood pressure control and survival.