What lifestyle modifications should I advise to patients with ADPKD to slow disease progression?

Advise patients with autosomal dominant polycystic kidney disease (ADPKD) to adopt lifestyle modifications that focus on slowing chronic kidney disease progression and reducing cardiovascular risk. Encourage maintaining a healthy body weight through balanced nutrition and regular physical activity, as obesity and sedentary lifestyle can exacerbate kidney damage and cardiovascular comorbidities. Recommend regular exercise tailored to the patient's ability to improve overall health and potentially slow disease progression. Advise a healthy diet with attention to salt intake reduction, aiming for less than 2g of sodium per day where appropriate, to help control blood pressure and reduce kidney workload. Specialist dietary advice may be needed for managing potassium, phosphate, calorie intake, especially in advanced stages of CKD. Discourage the use of over-the-counter NSAIDs and herbal supplements due to their nephrotoxic potential and risk of acute kidney injury, which can accelerate progression. Emphasize smoking cessation as smoking is a modifiable risk factor linked to faster CKD progression. Manage hypertension aggressively with target blood pressure levels individualized according to albuminuria status, using ACE inhibitors or ARBs as first-line agents to reduce proteinuria and slow progression. Educate patients about avoiding nephrotoxic insults such as dehydration and intercurrent illnesses that increase acute kidney injury risk. Provide tailored education and support to empower patients in self-management, including understanding their disease, monitoring, and lifestyle choices.

Recent literature highlights that modern diet, lifestyle, and environmental factors can trigger or accelerate ADPKD progression, reinforcing the importance of these lifestyle interventions. Although UK guidelines do not recommend routine low-protein diets, emerging evidence suggests that careful dietary management under specialist supervision may be beneficial in selected cases (Messing et al., 2024). Overall, lifestyle modifications that reduce cardiovascular risk factors, avoid nephrotoxins, and promote healthy weight and blood pressure control are central to slowing ADPKD progression ¹,²,³ (Messing et al., 2024).