Nutritional Interventions to Prevent and Manage Chronic Kidney Disease in Diabetes
March 09, 2025
Innovations in Diabetes & Metabolic Care | Spring 2025
The prevalence of chronic kidney disease (CKD) in people with diabetes mellitus (DM) is greater than 25 percent, and it is estimated that 20 to 40 percent of people with DM will develop CKD during their lifetime. The condition contributes to nearly half of end-stage renal disease (ESRD) cases that require dialysis or transplantation and significantly increases morbidity and mortality.
People with early-stage CKD usually do not exhibit symptoms, making regular screening essential for patients with DM. “According to the 2025 American Diabetes Association [ADA] Standards of Care, all individuals with type 1 and type 2 diabetes should be screened for kidney disease annually,” says Brandi Dobbs, CNP, a certified nurse practitioner within the University Hospitals Diabetes & Metabolic Care Center. “Patients with established CKD should be monitored up to four times each year, depending on the stage of the disease.”
- For type 1 diabetes, screening should begin five years after diagnosis
- For type 2 diabetes, screening should start at diagnosis
A Multifaceted Approach to Preventing and Managing CKD
Nutrition plays a critical role in managing diabetes-related CKD and slowing its progression. In line with ADA guidelines, the UH Diabetes & Metabolic Care Center offers patients a collaborative practice model to help them successfully adopt dietary lifestyle modifications shown to reduce CKD risks and improve health outcomes.
“We have three main focuses as we work with patients to prevent or manage diabetic kidney disease,” says Kimberly Karp, CDCES, a dietitian and certified diabetes care and education specialist within the UH Diabetes & Metabolic Care Center. “We educate people on how to implement a healthy eating plan that can help lower blood sugar levels, obtain a healthy weight and maintain good blood pressure control.”
Specific ADA targets include:
- Optimizing glucose levels: maintain a hemoglobin A1C of 7.0 or less in those without chronic disease for optimal glucose levels.
- Achieving a healthy weight: a BMI between 25 and 30 is generally considered optimal for kidney health; for individuals who are overweight or obese, a modest weight loss of five percent is recommended through dietary changes and increased physical activity.
- Stabilizing blood pressure levels (<130/80 mmHg) to reduce cardiovascular risk and protect kidney function.
Medication Recommendations for CKD
“Metformin and SGTL2 inhibitors are standard first-line therapies for glucose management, and SGLT2 inhibitors have been noted to reduce the progression of CKD and cardiovascular events,” Dobbs says. “We also rely on ACE inhibitors and angiotensin receptor blockers to control blood pressure.”
She adds that 2025 ADA guidelines include the use of GLP-1 receptor agonists as primary treatment options for individuals with diabetes. “Optimizing blood glucose is key with diabetes-related CKD. The ADA recommendations for GLP-1 agonists reflect this because the medications are highly effective in achieving blood glucose management, which helps reduce the risk or slow the progression of CKD and has the added benefit of reducing cardiovascular risk.”
Food as Medicine
“When I meet with people, we talk about healthy eating patterns, and I learn about what a typical day looks like with food and beverage choices, likes and dislikes, and time and financial considerations,” Karp says. “Then, we work together on what a healthy eating plan might look like for individuals to meet their goals.
UH Diabetes & Metabolic Care Center recommendations include:
- A Mediterranean Diet that focuses on fruits, vegetables, whole grains, lean proteins, beans and lentils, low-fat dairy, and nuts and seeds
- Limiting high-fat foods
- Reducing high-sugar foods and beverages
- Limiting sodium intake to 2300 mg or less by reducing processed foods, salty snacks, processed meats and table salt
- Aiming for intakes of lean protein food sources with specific amounts tailored to meet individual needs, considering current ADA Standards of Care recommendations of 0.8-1.5 grams per kilogram of body weight
Karp tailors strategies to individual patients. Some people prefer carbohydrate counting, and others respond to visual guidelines such as the healthy plate approach. “I meet with people initially and usually recommend at least one follow-up visit to discuss how they are doing meeting their goals with the behavior modifications we planned.”
Diabetes care providers at University Hospitals know that long-term lifestyle changes take time and teamwork. “We plan for touchpoints throughout the year to assess the adaptations we help put in place to control diabetes and kidney function and make sure our patients have access to the educational resources they need to achieve our recommendations,” Dobbs says.
For more information, call the UH Diabetes & Metabolic Care Center at 216-435-1071.
Contributing Experts:
Brandi Dobbs, CNP
Certified Nurse Practitioner
University Hospitals Diabetes & Metabolic Care Center
University Hospitals Cleveland Medical Center
Kimberly Karp, CDCES
Dietitian and Diabetes Care and Education Specialist
University Hospitals Diabetes & Metabolic Care Center
University Hospitals Cleveland Medical Center