Kidney disease and diabetes frequently coexist, with diabetes being one of the leading causes of kidney failure, accounting for 44% of new cases. In the U.S., kidney disease attributed to diabetes is a significant and often under-recognized contributor to the burden of disease. While the statistics may seem worrisome, there are multiple steps and interventions to take that may reduce the risk of end-stage renal disease or kidney failure.
- Diabetes is the leading cause of kidney failure; approximately 1 in 3 diabetic adults have CKD.
- With early diagnosis and treatment, diabetic nephropathy and additional health problems may be slowed.
- Regular kidney function testing is the most effective chance of identifying CKD in a timely manner.
Kidney Disease Overview
Kidney disease is a progressive chronic condition that more than 37 million adults in the U.S. have been diagnosed with. Chronic kidney disease is characterized by the kidneys being unable to filter blood as well as they should. This results in excess waste and fluid remaining in the body, potentially causing additional health problems such as stroke and heart disease.
Other health consequences of CKD may include:
- Loss of appetite
- Anemia (low number of red blood cells)
- Increased occurrence of infections
- Depression, or a reduced quality of life
- Decreased calcium levels, increased potassium levels, and increased phosphorus levels in the blood.
Risk factors for the development of CKD:
- Heart disease
- High blood pressure
- Family history of CKD
Not all patients with early-stage CKD will progress to kidney failure. However, controlling the risk factors for CKD is important to slow further disease progression. This can be done by checking your kidney function annually, making the necessary lifestyle changes, and regularly consulting with your healthcare team.
Diabetes is a chronic health condition that occurs when your blood sugar (blood glucose) levels are too high. It is estimated that more than 37 million adults in the U.S. have diabetes, with 1 in 5 adults not knowing they have it.
This chronic condition is characterized by the body not making enough of the hormone insulin or no longer being able to use the insulin effectively. Too much blood sugar stays in the bloodstream, which may cause serious health complications such as kidney disease, vision loss, and heart disease over time.
The most common types of diabetes are Type 1, Type 2, and gestational (diabetes while pregnant). Type 1 diabetes is caused by an autoimmune reaction and has no known preventative measures. In comparison, Type 2 diabetes develops over a period of time and is often caused by lifestyle choices. Type 2 diabetes may be prevented, delayed, and managed with healthy lifestyle changes. Gestational diabetes develops in those who are pregnant and have never had diabetes.
Prediabetes is characterized by high blood glucose levels that are not high enough to be diagnosed as type 2 diabetes. More than 96 million adults in the U.S. are estimated to have prediabetes.
Kidney Disease and Diabetes
Kidney damage caused by diabetes is referred to as diabetic nephropathy. Diabetes causes damage to the small blood vessels in the body, including the small blood vessels and nephrons in the kidneys. When the small blood vessels and nephrons in the kidneys are damaged, the kidney is unable to filter out waste products and water effectively.
The damage caused to the kidney’s filtering system results in too much blood being filtered, and the blood vessels can start to leak after a period of time. This is seen when protein is present in the urine. Extra water and sodium (salt) are also retained in the body, which presents as weight gain and ankle swelling.
Diabetes may also damage the nerves in the body, affecting how your brain sends messages to the rest of the body. This affects the kidneys; if the nerves in the bladder are damaged, you may not be able to feel it when it is full, placing additional pressure on the kidneys. You may also develop a kidney infection if urine sits in the urinary tract for extended periods.
Kidney Disease and Diabetes Type 2
Those with type 2 diabetes are at a greater risk of developing kidney disease. Those who have both kidney disease and type 2 diabetes have three times more risk of having a fatal heart attack or stroke compared to patients who only have type 2 diabetes. Kidney disease is a serious comorbidity to type 2 diabetes.
Type 2 diabetes is a disease characterized by the body’s inability to regulate sugar levels. Type 2 diabetes typically arises when your body can no longer use the hormone insulin effectively. Uncontrolled high blood sugar levels can lead to further complications, such as kidney damage.
Early diagnosis and intervention of kidney disease are vital to helping slow the disease progression. Early diagnosis of kidney disease is even more important if you have diabetes in an effort to slow or stop further damage to your body’s organs.
Prediabetes and kidney disease
If you have prediabetes, it is imperative to put in place steps to slow progressing to type 2 diabetes. This is an essential step in helping to slow the progression of kidney disease.
Early Diagnosis of Kidney Disease in Patients With Diabetes
Early signs of diabetic kidney disease are increased excretion of albumin in the urine, weight gain, ankle swelling, and high blood pressure.
Early diagnosis and management of kidney disease can help prevent complications, such as cardiovascular (heart) problems. Among people with diabetes, having kidney disease doubles the risk of developing cardiovascular disease.
If you have diabetes, it is recommended to have your urine, blood, and blood pressure checked annually. This will allow for early interventions and treatment as needed, as controlling diabetes may lower the risk of progressing to late-stage kidney disease.
Kidney Disease With Diabetes Management
Like CKD, diabetes cannot be cured, but disease progression may be slowed or stopped with a well-managed diet, lifestyle changes, and medical interventions.
Treatment and management for diabetic kidney disease may include:
- Controlling high blood pressure. Your healthcare provider will advise you what your blood pressure target is.
- Controlling blood sugar levels. This is typically done with lifestyle changes, such as diet and exercise. Hypoglycemic pills or insulin are prescribed if needed.
- Limiting the amount of dietary protein. Patients with CKD and diabetes may be recommended to reduce their protein intake to sustain good health. Your dietician will help you if you need to go on a low-protein diet.
- Reducing the amount of salt. This may help lower and control blood pressure and reduce swelling associated with high sodium levels.
- Controlling cholesterol and lipid levels. Controlling fat and cholesterol intake may help prevent further damage if you have damaged large blood vessels.
- Reducing or avoiding medications that might damage the kidneys. Certain medications, such as NSAIDs, may lead to decreased kidney function. Talking to your doctor before taking any medications or herbal supplements is important.
Your healthcare provider and care team will create a treatment plan based on your needs.
Panoramic Health is a physician-led value-based kidney care platform that allows our patients to get the most from our clinical expertise, as we understand CKD from all angles. Care decisions are made by people who understand the importance and realities of delivering patient care for chronic diseases.