Can comprehensive lifestyle change alter the course of chronic kidney disease?

Comprehensive lifestyle change can impact health favorably in many domains, from prevention and treatment of various diseases to improved functional status and quality of life. Although habitual behaviors clearly influence chronic kidney disease (CKD), lifestyle change often is not stressed in the clinical setting. The purpose of this review is to provide a critical appraisal of the scientific basis for effects of lifestyle on CKD and practical strategies that promote healthy behaviors. This review begins with a clinical case presentation to provide context for the scientific discussion. Dietary composition of macronutrients, particularly protein intake, is highlighted. Clinical evidence is presented for avoiding protein excess, a contemporary problem in the typical overeating environment of the developed world. Concomitant approaches to balancing intake of carbohydrates and fats also are presented. Integration of sodium reduction with macronutrient adjustment is reviewed within the framework of managing blood pressure in the setting of CKD. Considering the emerging body of evidence for obesity-related CKD and associated complications, weight control is addressed from the standpoint of decreasing calories and increasing exercise. Finally, effects of smoking and alcohol use on CKD are discussed. In the spirit of active participation, which is essential to lifestyle change, the discussion returns full circle to a concluding statement from the clinical case patient who provides his point of view on lifestyle change while living with CKD.