What Everyone Should Know About Taking Care of Your Kidneys

Last updated 14 July 2026

Long hours. Meals eaten standing up, or skipped altogether. Three cups of coffee to get through the afternoon, and a painkiller whenever the back or the head starts complaining. For a great many people that is simply an ordinary week, and none of it feels like a risk to anything.

The kidneys are the organ that quietly absorbs that ordinary week, year after year, without ever sending a complaint. They do not ache when they are struggling. They do not swell up where you can see them. They simply carry on doing the work until, one day, a routine blood test says they have been failing for a very long time.

The scale of it is easy to miss. The Malaysian Dialysis and Transplant Registry, kept by the National Renal Registry, recorded 55,237 people on dialysis at the end of 2024, and 9,473 starting for the first time in that year alone. That is roughly 26 people beginning dialysis every day, and almost none of them saw it coming.

Which is why the advice most of us have absorbed, drink more water, eat more greens, cut down on protein, is at best incomplete, and in places simply wrong.

What your kidneys actually do

Two organs, together weighing less than one percent of your body, take in about a fifth of all the blood your heart pumps. The National Kidney Foundation of Malaysia sets out the basic facts about kidneys plainly: they filter roughly 180 litres of fluid a day to produce about two litres of urine. Everything else goes back. But filtering waste is only part of the job. Your kidneys also:

• Control blood pressure, by regulating fluid volume and releasing a hormone called renin. This is why kidney disease and hypertension feed each other in a vicious circle.
• Tell your body to make red blood cells, through a hormone called erythropoietin, which prompts the bone marrow to produce them. When kidneys fail, that signal weakens and anaemia follows.
• Activate vitamin D, converting it into calcitriol, which keeps calcium balanced in your bones. That is why advanced kidney disease brings bone problems with it.
• Keep the body’s internal chemistry steady: sodium, potassium, calcium, phosphorus, acid and base. Potassium matters most, because too much of it can stop the heart.

Notice what is not on that list. Your kidneys are not something you can “flush”. No drink increases their capacity. What you can do is avoid what wears them down.

Why Malaysia has a kidney problem

Among Malaysians who started dialysis in 2024, the National Renal Registry recorded diabetes as the cause of kidney failure in 54.6% of cases and hypertension in another 31.1%. Between them, those two conditions explain more than eight in ten new dialysis patients.

Now look at how common they are. The National Health and Morbidity Survey 2023, run by Malaysia’s Institute for Public Health, found that 15.6% of adults have diabetes, 29.2% have high blood pressure, and 54.4% are overweight or obese. And a great many do not know it: of the adults with hypertension, 11.9 percentage points had never been told, and among those with diabetes, 5.9 percentage points had raised blood glucose and no diagnosis. If you are diabetic, the blood vessel damage that threatens your kidneys is also working on your heart, which is why it helps to understand how diabetes increases heart risk and what you can do about it.

The disease you cannot feel

A nationwide study led by researchers at the Institute for Public Health, published in BMC Nephrology in 2020, found that 15.48% of Malaysian adults had chronic kidney disease in 2018, up from 9.07% in 2011. Most of it was early stage. The part that should stop you: of those found to have it, only 5% were aware of it.

That is not carelessness, it is biology. You can lose a great deal of kidney function and feel completely normal. Swelling, foamy urine, itching and fatigue arrive late, when much of that function is already gone. Waiting for symptoms is not a screening strategy.

Two cheap tests, and hardly anyone gets them

Kidney damage is picked up with two ordinary tests, neither exotic nor expensive. The Ministry of Health’s clinical practice guideline on chronic kidney disease in adults is unambiguous about who needs them: anyone with diabetes or high blood pressure should be screened at least once a year.

Test	What it is	What it tells you
eGFR (from blood creatinine)	A blood test, converted into an estimate of filtering speed.	How well your kidneys filter. A result below 60 that persists for three months or more points to chronic kidney disease.
uACR (urine albumin to creatinine ratio)	A urine test. The guideline asks for an early morning sample, which is the most reliable.	Whether protein is leaking through the filters. Albumin in urine is often the earliest sign, appearing before eGFR drops.

Both are done together, because each catches what the other can miss. Screening for non-communicable diseases is offered at government klinik kesihatan, and the Ministry of Health has been promoting its Jom Saring national screening initiative. The guideline tells doctors that a patient with diabetes whose urine dipstick shows no protein should still have an albumin-to-creatinine ratio done, because the dipstick misses the early leak. If you are diabetic and have never had one, raise it at your next visit. The guideline says screening is also worth considering if you are over 65, obese, have heart disease or gout, or take long-term painkillers. If none of that applies to you, routine kidney screening is less clearly useful, and that is worth saying honestly rather than telling everyone to test everything.

The painkiller problem

Non-steroidal anti-inflammatory drugs, or NSAIDs, are the painkillers many Malaysians buy without a prescription and take without a thought. The Ministry of Health guideline names them one by one as drugs to avoid in people with kidney disease: mefenamic acid, diclofenac, ibuprofen, naproxen, meloxicam, celecoxib and etoricoxib among them. They also hide inside combination flu and cold remedies. Among the most common causes of a sudden drop in filtering in someone who already has CKD, the guideline says, is exactly this group of drugs.

The mechanism is simple: NSAIDs reduce blood flow through the kidney. A healthy, well hydrated person usually absorbs that hit. Add a bout of gastroenteritis, a fever, or kidney function that is already reduced, and the same tablet becomes genuinely dangerous. On whether these drugs cause kidney disease in healthy people, the guideline is careful and says the evidence conflicts. The risk it is sure of is the risk to a kidney already struggling.

• Do not take NSAIDs regularly for chronic aches without a doctor knowing.
• Do not take them while vomiting, having diarrhoea, or clearly dehydrated. That is the highest risk moment.
• If you have kidney disease, diabetes or heart failure, ask your doctor or pharmacist first. Paracetamol is usually the safer everyday option, though it has its own limits.
• Read the box. Many products that do not sound like painkillers contain an NSAID.

Traditional remedies and the “detox” myth

Two things need saying plainly. First, the language of flushing out toxins is wrong. Your kidneys are not a drain that clogs and needs rinsing, and products sold as kidney cleanses or detox teas are, at best, an expensive way to make urine.

Second, some herbal products actively harm kidneys, and Malaysia’s own regulator has already acted on it. The National Pharmaceutical Regulatory Agency lists every species of the plant genus Aristolochia as totally banned from registered natural products, because it contains aristolochic acid, which the agency records as causing kidney toxicity and interstitial nephropathy. The same document lists other botanicals that may be adulterated with it, which is how the compound usually reaches people who never meant to take it. The International Agency for Research on Cancer, the World Health Organization’s cancer agency, classifies aristolochic acid and the plants containing it as Group 1, carcinogenic to humans, on the strength of urinary tract cancers. The Ministry of Health’s kidney guideline names these products too.

This is not an argument that all traditional medicine is dangerous. It is an argument about regulation. Unregistered products bought online or from overseas may contain heavy metals, undeclared steroids or nephrotoxic plant compounds, and nobody checked. Registered traditional products carry an MAL number you can verify with the regulator. If something promises to cleanse your kidneys or replace dialysis, treat that as a red flag, and tell your doctor everything you take.

How much water should you actually drink?

The “six to eight glasses a day” rule is repeated everywhere and rests on thin evidence. There is no strong scientific basis for a fixed number that suits every adult, since needs depend on body size, weather, sweat, illness and diet.

If your kidneys are healthy, the guidance is undramatic: drink when thirsty, drink more in heat or when active, and use urine colour as a rough guide. Pale is fine, consistently dark suggests you need more. Real dehydration does harm kidneys, and repeated episodes are a genuine risk for outdoor workers.

But here is what generic health articles get badly wrong. For many people with advanced kidney disease, and most people on haemodialysis, drinking more fluid is dangerous rather than helpful. As NKF Malaysia explains, when kidneys fail the body accumulates excess fluid, because the organ meant to remove it no longer can. That fluid collects in the legs, the abdomen and eventually the lungs, which is why a set daily fluid limit is standard in dialysis care. The honest answer to “how much water should I drink” depends entirely on whether your kidneys work. If you have been given a fluid limit, it is a treatment, not a suggestion.

The diet advice that reverses itself

Advice for protecting healthy kidneys and advice for living with damaged kidneys are not the same, and in places they are opposites. Food that is good for a healthy person can be harmful to someone with advanced chronic kidney disease.

Food or nutrient	If your kidneys are healthy	If you have advanced CKD or are on dialysis
Potassium-rich vegetables and fruit (bayam, kangkung, sawi, banana, durian, tomato, potato)	Good for you. Potassium supports healthy blood pressure. Eat freely.	May need strict limits. Failing kidneys cannot clear potassium, and high blood potassium can cause dangerous heart rhythms. Amounts must be set by your doctor or dietitian.
Protein (fish, chicken, eggs, beans, tofu)	Normal intake does not damage healthy kidneys. You need it.	Often moderated to limit waste build-up, but never cut drastically without supervision. People on dialysis usually need more protein, not less.
Salt and sodium	Limit it. Excess sodium raises blood pressure, a leading cause of kidney damage.	Limit it more strictly. The Ministry of Health guideline asks CKD patients to stay below 2,400 mg of sodium a day, about a teaspoon of table salt.
Phosphorus (processed foods, colas, phosphate additives)	Handled without difficulty.	Builds up in the blood, weakening bones and damaging blood vessels. Additives are the worst offenders.
Fluids	Drink to thirst.	Often restricted to a set daily amount.

On spinach and leafy greens. Spinach and the local greens grouped with it are nutritious, but they are not a universal “kidney food”. Spinach is high in oxalate, the main building block of the commonest type of kidney stone, so people prone to those stones are advised to go easy on it. Leafy greens are also a meaningful source of potassium, exactly the mineral that turns dangerous in advanced kidney disease. Recommending spinach and kangkung to kidney patients without qualification is not merely unhelpful, it can be harmful. Where potassium is a problem, boiling vegetables and throwing away the water lowers their potassium.

On protein. The idea that meat “strains” a normal kidney is one of the most persistent myths in health writing. Healthy kidneys clear the waste from dietary protein without difficulty, and there is no good evidence that ordinary protein intake causes kidney disease in people with normal function. The effect of very high intakes over many years is genuinely debated, and honest sources say so instead of pretending it is settled. What is not debated: protein restriction is a treatment for people who already have kidney disease, not a preventive measure for people who do not. The Malaysian guideline that recommends a low protein diet for CKD stages 3 to 5 also demands it be supervised by a dietitian, precisely because the risk on the other side is malnutrition.

On salt, sugar and fat. These matter because they drive the blood pressure and diabetes that damage kidneys. If you want one dietary lever with real evidence behind it, it is cutting sodium. Our guide to how much salt, sugar and fat is too much sets out practical targets.

What actually protects your kidneys

• Control your blood pressure. The single most powerful thing you can do. Take the medicine every day, including on days you feel fine.
• Control your blood sugar. Diabetes causes more than half of Malaysia’s kidney failure.
• Get screened if you are at risk. eGFR and uACR, once a year if you have diabetes or hypertension.
• Be careful with painkillers, especially when you are unwell or dehydrated.
• Do not smoke. Smoking damages the small blood vessels kidneys depend on.
• Keep a healthy weight and stay active. Obesity is an independent risk factor and worsens both diabetes and blood pressure.
• Tell your doctor about every supplement and remedy you take.

None of that needs a special tea or an expensive supplement. It needs a blood pressure reading, a blood test, a urine test, and the willingness to act on the results.

When to see a doctor

Get checked without delay if you notice persistent swelling of the ankles, feet or face, urine that is consistently foamy, blood in your urine, a marked change in how often you pass urine, unexplained fatigue or breathlessness, or persistent itching. These have many possible causes, and kidney disease is one of them.

If you have diabetes or high blood pressure and have never had your kidneys checked, do not wait for symptoms, because there probably will not be any until it is late. You can read more in our kidney health section, and it is worth knowing the early warning signs that your heart might be in trouble, because kidney disease and heart disease travel together.

Malaysia has more than 55,000 people on dialysis. Almost all of them once had early kidney damage that nobody found. A blood test and a urine test are all it takes to find it while there is still something worth protecting.