Studies have found that a small number of patients with chronic kidney disease actually maintain or improve their kidney function over time. For instance, long-term use of certain medications has led to remission in severe cases. Other studies have shown that while most patients' kidney function declines, it improves in a small percentage. This suggests that some patients can have positive outcomes.

Correcting these problems and maintaining recommended treatment targets, like controlling blood pressure and reducing protein in the urine, is important for keeping kidneys healthy. Better managing metabolic problems and and improving vitamin D deficiency could help improve kidney function. 

Protein

When a person eats protein, their body breaks it down into smaller parts called amino acids. The kidneys help filter out the waste products that are left over from using these amino acids.

If someone eats too much protein, it can make the kidneys work harder. This is because there are more waste products for the kidneys to filter out. Over time, if the kidneys are always working extra hard, it can cause them to wear out and not work as well.

For people with healthy kidneys, eating a normal amount of protein is usually not a problem. However, for those who already have kidney issues, too much protein can make their condition worse. It can lead to more damage and reduce the kidneys' ability to filter waste from the blood.

In short, while protein is important for the body, eating too much of it can put extra strain on the kidneys, especially if they are already weakened.  High protein intake should be avoided as it can worsen kidney function. In patients with reduced kidney function, protein intake should be limited to 0.8 grams per kilogram of body weight per day.

In summary, while phosphate is necessary for the body, having too much can be hard on the kidneys, especially if they are not functioning well. It's important to manage phosphate intake to help keep the kidneys healthy. Managing phosphate levels and reducing the body's acid load is important. High phosphate levels and acidosis are harmful in chronic kidney disease. Bicarbonate supplements or eating more fruits and vegetables can help.

Nicotine can lead to high blood pressure, putting extra strain on the blood vessels in the kidneys and making it harder for them to filter waste from the blood, which can eventually damage the kidneys. Additionally, nicotine reduces blood flow to the kidneys, depriving them of the oxygen and nutrients they need to function properly, further contributing to kidney damage. This increased risk of kidney damage from nicotine use heightens the likelihood of developing chronic kidney disease, where the kidneys gradually lose their ability to work well over time, potentially leading to treatments like dialysis or a kidney transplant. 

Alcohol

As a diuretic, alcohol increases urine production, potentially leading to dehydration if not enough water is consumed to compensate, which is detrimental to kidney health. Additionally, excessive alcohol consumption can raise blood pressure, putting extra strain on the kidneys and damaging the tiny blood vessels that filter waste from the blood, impairing their function over time. Moreover, alcohol can disrupt the balance of essential minerals like sodium and potassium, which the kidneys regulate, leading to issues such as kidney stones or other kidney problems.

Staying well-hydrated prevents kidney stones. Kidney stones are hard deposits that can form in the kidneys and cause a lot of pain. Drinking enough water helps dilute the substances in the urine that can form stones, reducing the risk of getting them.

Proper water intake helps maintain the balance of important minerals in the body, like sodium and potassium. The kidneys help regulate these minerals, and staying hydrated makes it easier for them to keep the right balance.

How much water?

1. General Guidelines:  The National Academies of Sciences, Engineering, and Medicine recommend a daily water intake of about 3.7 liters (125 ounces) for men and 2.7 liters (91 ounces) for women. This includes all fluids from drinks and food.

2. Weight-Based Formula: Some experts suggest drinking half an ounce to an ounce of water for each pound of body weight. For example, if a person weighs 160 pounds, they should drink between 80 and 160 ounces of water a day. This range allows for adjustments based on activity level and climate.

3. Activity Level: People who are very active or exercise a lot need more water. A good rule of thumb is to add 12 ounces of water for every 30 minutes of exercise

4. Climate and Environment: In hot or humid climates, the body loses more water through sweat, so people may need to drink more to stay hydrated. 

5. Health Conditions: Some health conditions, like kidney problems or heart issues, can affect how much water a person should drink. It's always a good idea to talk to a doctor for personalized advice. 

6. Listening to Your Body: Thirst is a natural indicator that the body needs water. Drinking when thirsty and keeping urine light yellow or clear can help ensure proper hydration.