What Supplements Should I Take to Support My Kidneys? An Evidence-Based Overview

Many people with chronic kidney disease (CKD) ask whether supplements can protect their kidneys or slow disease progression. While a few supplements may have supportive roles in specific clinical situations, the strongest evidence continues to favor whole dietary patterns—particularly plant-based diets—over individual supplements. Below is an evidence-based review to help clarify what is actually useful and what remains unproven.

Supplements With Some Evidence in Select CKD Scenarios

1. Ketoanalogues of Amino Acids

Ketoanalogues may help when used together with very low–protein, plant-dominant diets under medical supervision. These diets (0.3–0.4 g/kg/day protein) require strict oversight by a renal dietitian or nephrologist. 

This approach is not recommended for all patients, and should only be considered in specific clinical scenarios. Read more about safe protein intake in CKD in our dedicated blog here.

2. Calcium Citrate

Calcium citrate may be appropriate for patients with:

• Hyperoxaluria

• Kidney stones

• Metabolic acidosis (as part of broader nutritional strategies)

It is not a universal CKD supplement and should be used based on individual biochemical needs.

3. Prebiotic Fibers (e.g., Inulin)

Prebiotics can support gut health and may reduce production of uremic toxins. Evidence suggests modest improvement in inflammation and stool quality.

While promising, their role in slowing CKD progression remains limited.

Supplements With Weak or Inconsistent Evidence

1. Vitamin D

Vitamin D is important for bone and mineral balance but does not slow CKD progression.In a large randomized trial, vitamin D supplementation (2,000 IU/day) did not improve eGFR decline or albuminuria over 5 years.

Supplement only to correct deficiency.

2. Omega-3 Fatty Acids

Omega-3s have documented cardiovascular and metabolic benefits, but effects on CKD progression are inconsistent.

• Low-dose omega-3s (1 g/day) do not appear to slow eGFR decline.

• Higher doses (>3 g/day EPA+DHA) may lower triglycerides and inflammation.

• Benefits are strongest in hemodialysis patients, where omega-3s may reduce cardiovascular events.

Who May Benefit from Omega-3 Supplementation?

Omega-3s may be reasonable for the following groups:

✔ Patients on hemodialysis

• Evidence suggests reduced cardiovascular event rates at higher doses.

✔ CKD patients with high triglycerides

• Omega-3s have consistent triglyceride-lowering effects.

✔ Patients with low baseline omega-3 levels

• CKD patients often have lower EPA/DHA levels.

✔ Patients focused on cardiovascular risk reduction

• Particularly those who cannot tolerate statins or need additional lipid lowering.

Not appropriate as:

• A standalone therapy to slow CKD

• A replacement for guideline-directed care (RAS blockade, SGLT2 inhibitors, BP control, sodium restriction)

3. CoQ10, Probiotics, Antioxidants

Systematic reviews conclude that evidence is low or very low quality, with no consistent improvement in kidney outcomes.

High-dose antioxidant supplements may cause toxicity and should be avoided unless specifically recommended.

Supplements With Population-Dependent or Mixed Evidence

1. Folic Acid

Benefits vary by region and underlying folate status.

• In areas without folic acid fortification, folic acid supplementation (800 μg/day) reduced CKD progression risk.

• In the U.S., where foods are fortified, high-dose folate trials show neutral or sometimes harmful results.

2. Antioxidant Therapies (e.g., Pentoxifylline)

Pentoxifylline may reduce proteinuria and inflammation; however, it requires a prescription and monitoring.

Other antioxidants lack consistent evidence.

What About Hydrogen-Rich Water (HRW)?

Hydrogen-rich water is gaining popularity online, but clinical evidence in CKD is extremely limited.

• Animal studies suggest HRW may reduce oxidative stress and inflammation.

• Human data are sparse—mostly small studies and case reports, not randomized trials.

• Some electrolyte-altered forms (like high-pH electrolyzed water) have been linked to hyperkalemia, which is unsafe for CKD patients.

Bottom line:

HRW is not recommended as a kidney-protective therapy due to insufficient evidence and potential safety concerns.

Avoid “Kidney Detox” or Herbal Supplements

Many herbal products marketed for “kidney cleansing” may actually harm the kidneys.

Examples of ingredients associated with nephrotoxicity:

• Aristolochic acid–containing herbs

• St. John’s wort

• Excess licorice

• High-dose turmeric

• High-dose vitamin C

Always avoid supplements not approved by your clinician.

Dietary Patterns Outperform Supplements

The most robust evidence for kidney protection comes from whole dietary approaches, not pills.

KDIGO 2024 recommends:

• Plant-forward eating

• Lower ultraprocessed food consumption

• Adequate fiber intake

• Moderating animal protein

In large CKD cohorts, healthy plant-based diets are associated with:

• 21–26% lower mortality

• Slower kidney decline

• Improved metabolic and cardiovascular outcomes

These benefits surpass what any individual supplement has demonstrated.

So, What Supplements Should You Take?

Reasonable Under Medical Supervision

• Ketoanalogues (when using a very low–protein diet)

• Calcium citrate (for select metabolic needs)

• Prebiotics like inulin

• Vitamin D only for deficiency

• Omega-3s for specific patients (dialysis, high triglycerides, low omega-3 status, CV risk)

• Prescription agents like pentoxifylline in certain cases

Not Recommended for Routine Kidney Support

• HRW

• High-dose antioxidants

• CoQ10, probiotics as primary therapy

• Herbal detox supplements

• Low-dose omega-3s as kidney protection

Most Beneficial Strategy

A personalized, plant-forward, whole-food diet supported by a renal dietitian or a nephrologist.