Treatment for Stage 3b Kidney Disease: Medications, Diet, and Kidney Care

Learning about a diagnosis of chronic kidney disease can be overwhelming. If your estimated glomerular filtration rate (eGFR) is between 30 and 44 mL/min/1.73 m², you may have stage 3b chronic kidney disease (CKD).

The good news is that stage 3b CKD does not automatically mean that dialysis is necessary. Treatment focuses on protecting the kidney function you still have, controlling conditions that can damage the kidneys, treating complications, and monitoring changes over time.

Understanding treatment for stage 3b kidney disease can help you ask better questions during medical appointments and understand why your healthcare team may recommend certain medications, laboratory tests, dietary changes, and lifestyle measures.

Medical disclaimer: This article is for educational purposes only. It is not a diagnosis or individualized medical advice. People with stage 3b CKD should work with a qualified healthcare professional before changing medications, supplements, diet, or fluid intake.

What Is Stage 3b Kidney Disease?

Chronic kidney disease means that the kidneys have persistent abnormalities that affect their structure or function.

One of the main measurements used to evaluate kidney function is the estimated glomerular filtration rate, or eGFR.

Stage 3b CKD generally corresponds to an eGFR of 30–44 mL/min/1.73 m².

However, eGFR is only part of the picture.

Healthcare professionals also consider the amount of albumin in the urine, commonly measured with the urine albumin-to-creatinine ratio (uACR). The underlying cause of CKD, blood pressure, diabetes, cardiovascular disease, medications, and other factors can also influence treatment decisions.

NIDDK identifies eGFR and urine albumin as key markers used to identify and monitor CKD.

What Are the Goals of Treatment for Stage 3b Kidney Disease?

There is no single treatment that works for every person with stage 3b CKD.

Instead, treatment usually has several goals:

• Slow further loss of kidney function
• Control high blood pressure
• Manage diabetes when applicable
• Reduce excessive albuminuria when appropriate
• Protect cardiovascular health
• Treat anemia and other CKD complications
• Maintain adequate nutrition
• Review medications for kidney safety
• Monitor eGFR and urine albumin
• Improve overall quality of life

NIDDK recommends a comprehensive approach that includes blood-pressure management, appropriate medications, nutrition therapy, physical activity, healthy weight management, adequate sleep, smoking cessation, and regular monitoring.

1. Control High Blood Pressure

Blood-pressure management is one of the most important parts of treatment for stage 3b kidney disease.

High blood pressure can damage the blood vessels and filtering structures inside the kidneys. At the same time, CKD can make blood pressure more difficult to control.

Your healthcare professional may recommend:

• Prescription blood-pressure medication
• Lower sodium intake
• Regular physical activity
• Home blood-pressure monitoring
• Weight management when appropriate
• Smoking cessation
• Regular follow-up

NIDDK states that controlling blood pressure can help protect the kidneys and reduce the risk of further kidney damage.

Your individual blood-pressure target should come from your healthcare professional because targets depend on your overall health and how blood pressure is measured.

Home Blood-Pressure Monitoring

If your healthcare professional recommends checking your blood pressure at home, an upper-arm monitor may be a useful tool for recording readings.

Use a blood-pressure monitor according to its instructions and keep a record of readings if your healthcare team asks you to do so.

A home reading should not be used on its own to change prescription medication.

2. ACE Inhibitors and ARBs

Some people with CKD, particularly those with albuminuria and high blood pressure, may benefit from medications that affect the renin-angiotensin system.

Two commonly used classes are:

• ACE inhibitors
• Angiotensin receptor blockers (ARBs)

These medicines can lower blood pressure and reduce albuminuria in appropriate patients.

NIDDK notes that ACE inhibitors and ARBs may slow kidney disease and delay kidney failure in appropriate patients.

They can also require monitoring of kidney function and potassium.

For this reason, never start, stop, or change an ACE inhibitor or ARB without medical guidance.

3. SGLT2 Inhibitors for Appropriate Patients

SGLT2 inhibitors are another important class of kidney-protective medication for selected people with CKD.

These medicines were initially developed primarily for type 2 diabetes, but research has demonstrated kidney and cardiovascular benefits in specific CKD populations.

The 2024 KDIGO CKD guideline recommends SGLT2 inhibitor treatment for adults with CKD who meet specific criteria, including certain patients with eGFR of at least 20 mL/min/1.73 m² and significant albuminuria, as well as people with heart failure irrespective of albuminuria. The guideline also suggests their use for some adults with eGFR 20–45 and lower levels of albuminuria.

Whether this treatment is appropriate depends on factors such as:

• eGFR
• Urine albumin
• Diabetes
• Heart failure
• Cardiovascular health
• Other medications
• Overall medical condition

A healthcare professional should determine whether an SGLT2 inhibitor is appropriate for you.

4. Manage Diabetes if You Have It

Diabetes is one of the leading causes of CKD in adults.

If you have both diabetes and stage 3b CKD, managing blood glucose is an important part of your overall kidney-care plan.

Your healthcare team may monitor:

• Blood glucose
• A1C
• eGFR
• Urine albumin
• Blood pressure
• Cholesterol

Diabetes medications may also need to be reviewed as kidney function changes.

The goal is not simply to lower one number as much as possible. Your healthcare professional can establish individualized glucose targets based on your age, health, medications, and risk of complications.

5. Follow an Individualized Kidney-Friendly Diet

Nutrition is a major component of treatment for stage 3b kidney disease, but there is no universal CKD diet.

Your dietary needs may depend on:

• Potassium level
• Phosphorus level
• Blood pressure
• Diabetes
• Protein intake
• Nutritional status
• Fluid balance
• Other medical conditions

NIDDK recommends working with a dietitian who understands kidney disease to create an individualized meal plan.

Sodium

Reducing excessive sodium may help with blood-pressure control and fluid management.

Common high-sodium foods include:

• Processed meats
• Packaged soups
• Fast food
• Instant noodles
• Salty snacks
• Processed sauces
• Some frozen meals

Cooking at home can make it easier to control sodium.

Protein

Protein is essential for maintaining muscles and other tissues, so people with CKD should not automatically eliminate protein.

At the same time, excessive protein intake may not be appropriate for some people with CKD.

NIDDK notes that adequate rather than excessive protein intake can be part of CKD nutrition management, with dietary needs individualized by a healthcare professional or dietitian.

Potassium and Phosphorus

Not everyone with stage 3b CKD needs the same potassium or phosphorus restrictions.

Some people may need to reduce these nutrients if laboratory tests show elevated levels, while others may not.

This is another reason an individualized diet is preferable to following a generic online CKD diet.

Kidney-Friendly Meal Planning

Planning kidney-friendly meals can be challenging when you need to consider sodium, protein, potassium, phosphorus, and portion sizes.

A cookbook can provide meal ideas, but recipes should always be adapted to your personal dietary requirements.

You can also browse low-sodium and kidney-friendly cookbooks on Amazon.

Remember that a recipe labeled “kidney-friendly” is not automatically suitable for everyone with stage 3b CKD. Ask a renal dietitian which foods and portions are appropriate for you.

6. Monitor eGFR and Urine Albumin

Regular testing is an important part of treatment for stage 3b kidney disease.

Your healthcare professional may monitor:

• eGFR
• Serum creatinine
• Urine albumin-to-creatinine ratio
• Potassium
• Sodium
• Bicarbonate
• Hemoglobin
• Calcium
• Phosphorus
• Blood glucose
• Cholesterol

NIDDK recommends monitoring trends in eGFR and urine albumin-to-creatinine ratio to assess kidney disease progression and response to interventions.

One abnormal test does not necessarily mean that your CKD has suddenly become worse.

Your healthcare team will generally consider changes over time.

7. Treat Albuminuria When Appropriate

Albuminuria means that albumin is present in the urine at an elevated level.

Persistent albuminuria can provide important information about kidney damage and future risk.

Treatment may include blood-pressure management and medications that reduce albuminuria in appropriate patients.

NIDDK identifies RAAS-blocking medications as one intervention that can lower urine albumin and potentially slow CKD progression.

If your urine test shows elevated albumin, ask your healthcare professional what your uACR result means and whether it has changed compared with previous tests.

8. Avoid Medicines That May Harm the Kidneys

Medication review is particularly important when kidney function is reduced.

Some medications are eliminated through the kidneys and may require dose adjustments.

Certain over-the-counter pain medicines, especially nonsteroidal anti-inflammatory drugs (NSAIDs), can increase the risk of kidney problems in people with CKD.

Examples include ibuprofen and naproxen.

NIDDK specifically advises people with CKD to be cautious with NSAIDs because they can damage the kidneys and contribute to acute kidney injury.

Before taking a new prescription medicine, over-the-counter medicine, vitamin, herbal product, or supplement, ask your doctor or pharmacist whether it is appropriate for your kidney function.

9. Treat Anemia and Other CKD Complications

Stage 3b CKD can be associated with complications such as anemia, mineral and bone disorders, cardiovascular disease, electrolyte abnormalities, and nutritional problems.

Anemia may cause:

• Fatigue
• Weakness
• Reduced energy
• Shortness of breath
• Difficulty concentrating

If anemia is suspected, your healthcare professional may check hemoglobin, iron status, vitamin levels, and other markers.

Treatment depends on the underlying cause.

Other complications should also be identified through appropriate blood tests and clinical evaluation.

10. Stay Physically Active

Physical activity can be an important part of overall CKD management.

NIDDK recommends making physical activity part of your routine and notes that activity can help with stress, weight management, blood pressure, and blood glucose.

The appropriate amount and type of activity depends on your age, fitness level, symptoms, cardiovascular health, and other medical conditions.

If you are currently inactive, ask your healthcare professional what type and amount of activity is appropriate for you.

11. Maintain a Healthy Lifestyle

Other lifestyle measures may support kidney and cardiovascular health.

These can include:

• Maintaining a healthy weight when appropriate
• Getting adequate sleep
• Avoiding tobacco
• Managing stress
• Following prescribed medications
• Attending regular medical appointments

NIDDK includes healthy weight, adequate sleep, smoking cessation, and healthy stress management among important components of CKD care.

These measures do not replace medical treatment, but they can complement it.

Can Stage 3b Kidney Disease Be Reversed?

Established chronic kidney damage generally cannot simply be reversed.

However, treatment can help slow further loss of kidney function and manage complications.

The outlook varies from person to person.

Important factors include:

• The cause of CKD
• eGFR and its trend
• Urine albumin
• Blood pressure
• Diabetes
• Cardiovascular health
• Medication use
• Other medical conditions

Having stage 3b CKD does not automatically mean that dialysis is needed.

The goal is to identify and manage risk factors before kidney function declines further.

When Should You See a Nephrologist?

A nephrologist is a physician who specializes in kidney disease.

Some people with stage 3b CKD may benefit from nephrology care, particularly when:

• eGFR is declining rapidly
• Albuminuria is significant
• The cause of CKD is unclear
• Blood pressure is difficult to control
• Complications are difficult to manage
• Electrolyte abnormalities develop
• There are concerns about the diagnosis

NIDDK notes that nephrology referral may be beneficial when CKD management becomes complex or when there are diagnostic or treatment challenges.

Ask your primary healthcare professional whether seeing a nephrologist is appropriate for your situation.

Can a CKD Support Program Help?

Managing stage 3b kidney disease can involve many questions about diet, lifestyle, blood pressure, medications, laboratory testing, and kidney health.

Educational resources can help you learn more about CKD and prepare questions for your healthcare team.

Learn More About CKD Support

👉 Explore this CKD support program and learn more about kidney-health and lifestyle strategies

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This resource is intended for educational purposes and should not replace medical diagnosis, prescription treatment, or care from a qualified healthcare professional.

Frequently Asked Questions About Treatment for Stage 3b Kidney Disease

What is the main treatment for stage 3b kidney disease?

There is no single treatment. Management may include blood-pressure control, appropriate kidney-protective medications, diabetes management, nutrition therapy, lifestyle changes, and regular monitoring.

Can stage 3b kidney disease get better?

Temporary kidney-function changes can sometimes improve when an underlying problem is treated. However, established chronic kidney damage generally cannot simply be reversed. Treatment focuses on protecting remaining kidney function and reducing complications.

Is stage 3b kidney disease serious?

Stage 3b indicates a significant reduction in kidney filtration, but the outlook varies. eGFR trends, urine albumin, the cause of CKD, blood pressure, diabetes, and other health conditions all influence risk.

Should someone with stage 3b CKD avoid protein?

Not necessarily. Protein is an essential nutrient. Some people with CKD may benefit from avoiding excessive protein intake, but dietary needs should be individualized rather than based on a one-size-fits-all restriction.

What medications can protect the kidneys?

Depending on the individual’s condition, healthcare professionals may use ACE inhibitors, ARBs, SGLT2 inhibitors, and other treatments. These medicines are not appropriate for everyone and may require monitoring.

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