Lifestyle Medicine and Chronic Kidney Disease in Viet Nam: Evidence, Dietary Safety, Physical Activity and Cardiometabolic Risk

Lifestyle Medicine and Chronic Kidney Disease in Viet Nam: Evidence, Dietary Safety, Physical Activity and Cardiometabolic Risk

Last reviewed: 24 September 2026

Chronic kidney disease is sometimes approached mainly as a problem of declining kidney function. In practice, it is much broader. Kidney disease is closely connected with hypertension, diabetes, cardiovascular disease, obesity, aging, medication safety and nutritional status. Chronic kidney disease substantially increases cardiovascular risk, and cardiovascular complications can occur long before kidney failure develops. At the same time, kidney disease is often silent in its earlier stages, so people may feel well while clinically important kidney damage or cardiovascular risk is already present. The World Health Organization emphasizes this close two-way relationship between kidney and cardiovascular disease and identifies slowing disease progression, reducing cardiovascular risk and preventing complications as central goals of chronic kidney disease management.

This is where Lifestyle Medicine has an important role, but also where clinical caution is essential. Healthy eating, physical activity, tobacco avoidance, healthy weight management, sleep and other health behaviors can support blood pressure, glucose control, cardiovascular health, physical function and overall well-being. Current Lifestyle Medicine competencies include evidence-based nutrition and physical activity within chronic disease treatment and emphasize clinical assessment and monitoring rather than lifestyle advice in isolation. But chronic kidney disease is not a condition in which generic advice such as “eat more fruit,” “increase protein,” “drink more water” or “use a salt substitute” can safely be applied to everyone. Kidney function, albuminuria, serum potassium, nutritional status, medications and other medical conditions can substantially change what is appropriate for an individual patient.

Why does this matter in Viet Nam?

Robust nationally representative estimates of chronic kidney disease prevalence in Viet Nam remain limited. One useful piece of local evidence comes from a population-based study conducted in Can Tho City in 2023 and published in 2025. The study included 1,490 adults and assessed estimated glomerular filtration rate and urine albumin-to-creatinine ratio, with repeat measurements after three months. Chronic kidney disease was identified in 13.1% of participants, and increasing age, hypertension and diabetes were important predictors. Because this was a population-based study from one city rather than a nationally representative survey, the 13.1% figure should not be presented as the national prevalence of chronic kidney disease in Viet Nam.

This matters because Viet Nam is also managing substantial burdens of hypertension, diabetes and cardiovascular disease, all closely linked with kidney risk. In April 2026, the World Health Organization emphasized that chronic kidney disease can often be detected in primary care using serum creatinine to estimate glomerular filtration rate together with urine testing for albuminuria, particularly among people with hypertension, diabetes and cardiovascular disease. Earlier identification creates an opportunity to address kidney and cardiovascular risk before advanced disease develops.

A single abnormal kidney result, however, does not necessarily establish chronic kidney disease. Chronicity matters. In general, abnormalities of kidney structure or function must persist for at least three months. Two estimated glomerular filtration rate values below 60 mL/min/1.73 m² obtained at least 90 days apart indicate chronic kidney disease, while persistent albuminuria, typically a urine albumin-to-creatinine ratio above 30 mg/g, can also indicate chronic kidney disease even when estimated glomerular filtration rate is 60 mL/min/1.73 m² or higher. This is one reason a Lifestyle Medicine program should not label someone as having chronic kidney disease on the basis of a single creatinine result from a health screening.

There is no single “kidney diet”

One of the most useful developments in contemporary kidney nutrition is the move away from assuming that everyone with chronic kidney disease needs the same restrictive renal diet. The 2024 Kidney Disease: Improving Global Outcomes guideline advises people with chronic kidney disease to adopt healthy and diverse dietary patterns with a higher proportion of plant-based foods relative to animal-based foods and lower consumption of ultra-processed foods. At the same time, it specifically recommends that adaptations involving protein, sodium, potassium and phosphorus be individualized according to the person's needs, severity of kidney disease and other medical conditions.

This distinction is particularly important for Lifestyle Medicine. A plant-predominant eating pattern can fit well with kidney care, but “plant-predominant” does not mean that every patient should immediately adopt an unrestricted vegan diet. The guideline discusses potential advantages of dietary patterns containing more minimally processed plant foods and fewer ultra-processed foods, including favorable cardiometabolic effects and possible benefits related to proteinuria, metabolic acidosis and the gut environment. The available evidence, however, does not justify presenting a particular eating pattern as a way to reverse established chronic kidney disease.

For Vietnamese patients, this approach can often be translated into familiar foods rather than imported “health foods.” Depending on kidney function, serum potassium and phosphorus, nutritional status and other conditions, vegetables, beans, tofu, suitable fruits, whole or less-refined grains, nuts and seeds, fish and other protein sources may all have a place. What matters more than whether an individual food carries a “kidney-friendly” label is the person's overall dietary pattern and clinical context. Fluid advice also needs to be individualized. Simply telling every person with chronic kidney disease to “drink more water” is not a treatment for chronic kidney disease and may be inappropriate in some clinical situations.

Protein needs require balance, not extremes

Protein is one of the areas where well-intentioned Lifestyle Medicine advice can unintentionally become unsafe. High-protein diets and protein supplements are not automatically appropriate for someone with chronic kidney disease. Kidney Disease: Improving Global Outcomes suggests maintaining protein intake at approximately 0.8 grams per kilogram of body weight per day in adults with chronic kidney disease stages G3 to G5 and advises avoiding high protein intake above 1.3 grams per kilogram per day in adults at risk of disease progression. In selected adults who are willing and able and are at risk of kidney failure, a very-low-protein diet may be considered under close professional supervision, but this is a specialist intervention rather than general Lifestyle Medicine advice.

The opposite mistake is excessive restriction. The guideline advises against low- or very-low-protein diets in metabolically unstable patients and notes that older adults with frailty or sarcopenia may require higher protein and calorie targets. Children have different nutritional requirements, and people receiving dialysis also have different protein needs from those with non-dialysis chronic kidney disease.

The goal, therefore, is not “as little protein as possible.” It is to avoid unnecessary protein excess while maintaining adequate energy intake, nutritional status, muscle mass and function. This becomes particularly important when Lifestyle Medicine is combined with weight loss or increased exercise, because poorly planned calorie and protein restriction can contribute to loss of lean mass and undernutrition.

Sodium reduction is important, but the Vietnamese context matters

Sodium is one of the most practical dietary targets. Kidney Disease: Improving Global Outcomes suggests a sodium intake below 2 grams per day, equivalent to less than approximately 5 grams of sodium chloride per day, for people with chronic kidney disease. The guideline also recognizes important exceptions, including sodium-wasting nephropathies.

In Viet Nam, reducing sodium needs to go beyond asking patients not to add salt at the table. Fish sauce, soy sauce, seasoning powders, instant noodles, preserved and pickled foods, processed meat and fish products, packaged sauces and meals eaten outside the home can all contribute to sodium intake. A useful clinical conversation therefore looks at how a person actually cooks and eats rather than simply handing out a list of forbidden foods.

Salt substitutes also deserve attention. Some products reduce sodium by replacing part of the sodium chloride with potassium chloride. This may be useful for some people, but it is not automatically safe in chronic kidney disease, particularly when potassium excretion is impaired or medications that increase serum potassium are being used. A product marketed as “low sodium” should therefore not automatically be assumed to be kidney safe.

Potassium should not mean automatically banning fruit and vegetables

Perhaps no area of kidney nutrition is more easily oversimplified than potassium. Traditional advice has sometimes resulted in people with chronic kidney disease avoiding bananas, oranges, tomatoes and many vegetables regardless of their serum potassium or individual risk. Current guidance is considerably more nuanced.

Kidney Disease: Improving Global Outcomes recommends an individualized approach for people with chronic kidney disease stages G3 to G5 who develop hyperkalemia. Dietary and pharmacological contributors, other medical conditions and quality of life should all be considered. In people with a history of hyperkalemia, or during periods when hyperkalemia risk is increased, particular attention should be given to foods containing highly bioavailable potassium.

This matters because potassium from different foods is not absorbed equally. Potassium additives in highly processed foods, potassium-based salt substitutes and some processed foods and beverages may provide more readily bioavailable potassium than many intact, minimally processed plant foods. Medications, metabolic acidosis, hyperglycemia, constipation and declining kidney function can also contribute to abnormal serum potassium.

The practical message is therefore neither “people with chronic kidney disease can eat unlimited high-potassium foods” nor “everyone with kidney disease should avoid fruit and vegetables.” Serum potassium, kidney function, medication use, dietary pattern and previous episodes of hyperkalemia should guide decisions. Blanket restriction can unnecessarily reduce fiber, food variety and overall dietary quality.

Phosphorus requires similar individualization. A person with early, stable chronic kidney disease and normal laboratory results may need very different advice from someone with advanced disease and abnormalities of mineral and bone metabolism. This is another reason kidney nutrition works better as individualized clinical care than as a universal list of foods to avoid.

Physical activity is part of kidney care

People with chronic kidney disease are often less physically active as fatigue, anemia, cardiovascular disease, muscle loss and functional limitations accumulate. Chronic kidney disease itself, however, is not a reason to avoid exercise. Kidney Disease: Improving Global Outcomes recommends moderate-intensity physical activity for a cumulative duration of at least 150 minutes per week, or to a level compatible with the person's cardiovascular and physical tolerance. Recommendations should also take account of age, comorbidities, functional capacity and access to appropriate opportunities for activity.

The rationale for exercise is broader than trying to increase estimated glomerular filtration rate. Evidence is reasonably consistent that exercise can improve aerobic capacity, walking ability, physical function and some aspects of quality of life and cardiometabolic health. A broader 2023 meta-analysis of lifestyle interventions in non-dialysis chronic kidney disease found improvements in blood pressure, body weight, creatinine and albuminuria, although it did not find a statistically significant pooled improvement in estimated glomerular filtration rate. A 2024 meta-analysis focused specifically on exercise included 37 randomized controlled trials and 1,248 people with pre-dialysis chronic kidney disease and found improvements in aerobic capacity, functional measures and several cardiometabolic outcomes, together with a modest pooled improvement in estimated glomerular filtration rate. A larger 2026 meta-analysis of randomized exercise studies also reported benefits across multiple physical, cardiovascular and kidney-related outcomes.

These findings are encouraging, but they should not be interpreted as proof that exercise alone prevents progression to kidney failure. Studies differ considerably in their populations, interventions, duration and outcome measures, and many remain relatively short. The strongest current evidence supports physical activity for its benefits to physical function, cardiovascular health, metabolic risk and quality of life, while possible effects on long-term kidney disease progression continue to be studied.

For practice in Viet Nam, physical activity does not need to begin in a gym. Walking, cycling, resistance exercises, balance work and other accessible forms of movement may all be appropriate. The starting point should reflect cardiovascular status, current fitness, frailty, musculoskeletal disease, dialysis status where applicable, and what the person can realistically and safely sustain.

Kidney and cardiometabolic risk need to be managed together

Chronic kidney disease should not be managed by watching creatinine alone. Declining estimated glomerular filtration rate and increasing albuminuria are associated with progressively higher risks of cardiovascular disease, heart failure, kidney failure and death. Contemporary kidney care therefore treats kidney and cardiovascular protection as closely connected objectives.

Blood-pressure management is central. Kidney Disease: Improving Global Outcomes suggests treating adults with high blood pressure and chronic kidney disease toward a systolic blood pressure below 120 mmHg when tolerated and when measured using a standardized office technique. That qualification is essential. This target should not simply be transferred to casual or non-standardized readings, and less intensive treatment may be appropriate for people with frailty, high fall risk, very limited life expectancy or symptomatic postural hypotension.

Glucose management, body weight, tobacco avoidance, lipid management and treatment of heart failure belong within the same risk framework. Lifestyle treatment can improve several of these factors, but it is not an alternative to evidence-based kidney-protective medication. The 2024 guideline recommends sodium-glucose cotransporter 2 inhibitors for important groups of adults with chronic kidney disease, including adults with an estimated glomerular filtration rate of at least 20 mL/min/1.73 m² and a urine albumin-to-creatinine ratio of at least 200 mg/g, as well as people with heart failure irrespective of albuminuria. Other therapies, including renin-angiotensin system inhibitors, also remain important when appropriately indicated.

This is an important boundary for Lifestyle Medicine. Improvement in diet, activity, weight or blood pressure should not lead a patient to conclude that kidney-protective medication is therefore unnecessary. Some treatments reduce kidney and cardiovascular risk beyond what can be inferred from symptoms or a single biomarker. Lifestyle intervention and pharmacological treatment should therefore be integrated rather than placed in competition.

As of September 2026, the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease remains the current global standard. Kidney Disease: Improving Global Outcomes has initiated a focused update to Chapter 3 to reassess emerging evidence on sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1-based therapies and nonsteroidal mineralocorticoid receptor antagonists in people with chronic kidney disease without diabetes. Until that focused update is completed and published, it should not be treated as a replacement for the 2024 guideline.

“Natural” does not automatically mean kidney safe

Another issue deserves particular attention in Viet Nam because a complete medication history may extend well beyond prescription medicines to over-the-counter pain medicines, vitamins, supplements and traditional or herbal products. Kidney Disease: Improving Global Outcomes recommends reviewing non-prescription medicines, dietary supplements and herbal remedies that may be harmful in chronic kidney disease. Nonsteroidal anti-inflammatory drugs are an important example of medications with potential nephrotoxicity, particularly in susceptible patients.

The appropriate message is not that all traditional or herbal products are harmful. It is that impaired kidney function changes the margin of safety, and a product should not be assumed to be safe simply because it is described as “natural,” “detox,” “herbal” or “kidney cleansing.” Healthcare professionals should routinely ask about non-prescription medicines, traditional and herbal products, vitamins, protein powders and other supplements rather than limiting medication review to prescribed drugs. Kidney Disease: Improving Global Outcomes also emphasizes medication review and reconciliation, particularly when kidney function changes, during transitions of care and in people with complex medication regimens.

What does the Vietnamese legal and healthcare framework mean for this?

In Viet Nam, nutrition delivered as part of medical care is not simply general wellness advice. The current consolidated text of the Law on Medical Examination and Treatment is Document No. 26/VBHN-VPQH, issued by the Office of the National Assembly on 26 February 2026. Article 67 defines nutrition in medical examination and treatment as clinical nutrition together with counseling and guidance on dietary regimens. Its professional activities include assessment and classification of malnutrition, professional counseling and guidance on disease-related nutrition, nutritional monitoring, and nutrition education and communication.

The Law also lists clinical nutrition among the professional titles that require a practice license. Article 120 provides that the National Medical Council begins competency assessment for clinical nutrition, medical laboratory and other medical-technical professionals, pre-hospital emergency professionals and clinical psychology professionals from 1 January 2029. Importantly, that date concerns the start of the national competency-assessment requirement; it does not mean that clinical nutrition only becomes a licensed professional title in 2029.

For hospitals, Circular No. 18/2020/TT-BYT on nutrition activities in hospitals remains partially in force. Circular No. 08/2024/TT-BYT repealed Articles 6 and 8, but the core clinical nutrition provisions remain. Article 2 continues to require hospitals to integrate nutrition with medical care, screen outpatients for nutritional risk, assess nutritional status in inpatients and provide dietary regimens appropriate to nutritional and disease status. It also states that the treating doctor or a doctor in the nutrition department decides the patient's dietary regimen.

For chronic kidney disease, the practical implication is that individualized therapeutic nutrition should be clinically governed. General education about healthy eating and physical activity can be provided broadly, but decisions about protein restriction, potassium or phosphorus modification, fluid management and other kidney-specific dietary changes should be based on appropriate clinical assessment and delivered by appropriately qualified professionals within their professional scope. From a patient-safety and scope-of-practice perspective, a public Lifestyle Medicine program should therefore avoid presenting a universal “chronic kidney disease meal plan” that people could apply without knowing their kidney function, laboratory results, medication regimen and nutritional status.

What should Lifestyle Medicine care for chronic kidney disease look like?

A useful model begins by establishing whether chronic kidney disease is actually present and how much risk the person carries. Estimated glomerular filtration rate should be interpreted together with albuminuria, chronicity, blood pressure, diabetes status, cardiovascular disease and other relevant clinical information. Lifestyle assessment can then explore eating patterns, physical activity, sleep, tobacco and alcohol use, stress, social circumstances and access to healthy food, but these findings need to be connected with kidney-specific clinical information rather than treated as a separate wellness assessment.

Nutrition should focus first on dietary quality and safety. For many patients, this will include reducing sodium and ultra-processed foods, avoiding excessive protein intake and moving toward a more plant-predominant dietary pattern. It does not mean automatically restricting potassium, phosphorus, fruit, vegetables or plant protein. Those decisions should follow laboratory results, severity of disease, medications, nutritional status and other conditions. Kidney Disease: Improving Global Outcomes specifically recommends renal dietitians or appropriately accredited nutrition providers for individualized dietary adaptations involving sodium, phosphorus, potassium and protein.

Physical activity should be treated as part of clinical care rather than optional advice. Blood pressure, glucose, body weight and cardiovascular risk should be actively managed, while kidney-protective medications are reviewed and optimized when indicated. The care team should also look for medication and supplement risks, particularly when kidney function changes or several clinicians are involved in treatment.

For healthcare organizations in Viet Nam, these elements can also become measurable quality processes: whether people at increased kidney risk receive appropriate assessment of estimated glomerular filtration rate and albuminuria where clinically indicated, whether nutritional risk is assessed, whether kidney-specific dietary advice is individualized, whether physical activity is addressed, whether medicines and supplements are reviewed, and whether cardiovascular risk factors are actively managed. This provides a more meaningful measure of care than simply documenting that someone was advised to “eat healthy and exercise.”

The central question is not “What foods are bad for the kidneys?”

A more useful question is: “What pattern of eating, activity and clinical treatment is safest and most appropriate for this person's kidney function, cardiovascular risk, nutritional status and life circumstances?”

For one person, reducing sodium may be a major priority. For another, preventing malnutrition or muscle loss may matter more. Someone with stable serum potassium may be able to eat a wide variety of minimally processed plant foods, while another person with recurrent hyperkalemia may require targeted modification. A younger adult with obesity and diabetes may benefit from weight reduction and increased physical activity, while a frail older adult may need greater emphasis on preserving strength, adequate energy intake and functional independence.

This is where Lifestyle Medicine can contribute to chronic kidney disease care. It should not promise to reverse established kidney damage or replace appropriate medical and nephrology care. It can help address dietary, behavioral and cardiometabolic factors that influence kidney health, cardiovascular outcomes, physical function and quality of life, while making those interventions safer, more individualized and more sustainable.

For Viet Nam, this may be the most useful direction: earlier recognition of kidney risk, better integration with hypertension and diabetes care, culturally appropriate nutrition, safe physical activity, careful medication and supplement review, and stronger multidisciplinary management. Lifestyle Medicine adds the greatest value when it becomes part of evidence-based kidney care, not an alternative to it.

References

1. Kidney Disease: Improving Global Outcomes. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney International. 2024;105(Suppl 4S):S117-S314. doi:10.1016/j.kint.2023.10.018.

2. Kidney Disease: Improving Global Outcomes. CKD Evaluation and Management. Current guideline status and 2026 focused update information. Accessed 24 September 2026.

3. World Health Organization. Kidney disease. 20 April 2026.

4. Vo NH, Pham BV, Nguyen NN, Nguyen BT. A Predictive Nomogram for Selective Screening of Chronic Kidney Disease: A Population-Based Study. Canadian Journal of Kidney Health and Disease. 2025;12. doi:10.1177/20543581241309979.

5. Neale EP, Do Rosario V, Probst Y, Beck E, Tran TB, Lambert K. Lifestyle Interventions, Kidney Disease Progression, and Quality of Life: A Systematic Review and Meta-analysis. Kidney Medicine. 2023;5(6):100643. doi:10.1016/j.xkme.2023.100643.

6. Traise A, Dieberg G, Pearson MJ, Smart NA. The effect of exercise training in people with pre-dialysis chronic kidney disease: a systematic review with meta-analysis. Journal of Nephrology. 2024;37(8):2063-2098. doi:10.1007/s40620-024-02081-9.

7. Chen Y, Ren S, Yao X, et al. Benefits of physical exercises in chronic kidney disease: a systematic review and meta-analysis of randomized controlled trials. Renal Failure. 2026;48(1):2654288. doi:10.1080/0886022X.2026.2654288.

8. Office of the National Assembly of Viet Nam. Document No. 26/VBHN-VPQH consolidating the Law on Medical Examination and Treatment. 26 February 2026.

9. Ministry of Health of Viet Nam. Circular No. 18/2020/TT-BYT on nutrition activities in hospitals. 12 November 2020.

10. Ministry of Health of Viet Nam. Circular No. 08/2024/TT-BYT partially repealing legal documents issued by the Minister of Health. 24 May 2024.

11. Rea BL, Cheema S, Lanza S, et al. Lifestyle Medicine Core Competencies: 2025 Update. American Journal of Lifestyle Medicine. 2026;20(3):443-451. First published online 28 October 2025. doi:10.1177/15598276251379821.

This article is intended for professional education and general information. It does not provide an individual kidney, dietary, exercise or medication treatment plan. People with chronic kidney disease should discuss substantial dietary changes, protein restriction, potassium or phosphorus restriction, use of salt substitutes, supplements and major changes in physical activity with an appropriately qualified healthcare professional.

Privacy Policy and Personal Data Protection Notice

Terms and Conditions

VLMA is operated by Vietnam Lifestyle Medicine Alliance Company Limited, Enterprise Registration Number 0318902666.

VLMA is a Sister Organization of the Lifestyle Medicine Global Alliance and a Member Organization of the Planetary Health Alliance.

VLMA is not a medical service provider and does not issue medical licenses or IBLM certification.