Diabetes Control In Patients With Established Ckd
Intensive management of diabetes, including concurrent control of glucose, lipids and blood pressure as well as diet and lifestyle modifications, can slow the progression of established DKD,,. Indeed, some data suggest such approaches can even reverse early glomerulopathy. For example, pancreatic transplantation, which restores normal glucose levels in patients with type 1 diabetes, is able to ameliorate the renal histological changes associated with diabetes. However, it takes at least 10 years to observe any regression, and metabolic control with standard therapy can seldom achieve that observed following pancreatic transplantation. Even with intensive management in the robust setting of clinical trials detailed below, many patients with diabetes still experience a progressive decline in renal function. This finding has led to the suggestion that, at best, current therapy simply delays the inevitable. Nonetheless, in the clinical setting, any delay in CKD has potentially profound effects on patient health.
What Causes Kidney Disease
One of the main jobs of your kidneys is to filter your blood. They get rid of extra fluid and waste products from your body through your urine.
High blood glucose levels can damage the small blood vessels and tiny filters in your kidneys. High blood pressure can also do this too. This can cause them to leak and not work as well. When this happens, abnormal amounts of protein from the blood can leave your body in your urine. This is often an early sign of kidney disease.
Screening For Diabetic Kidney Disease
DKD is primarily diagnosed on screening. All diabetic patients should receive annual screening for DKD, beginning five years after the diagnosis of Type 1 diabetes mellitus and at the time of diagnosis of Type 2 diabetes mellitus . DKD is identified in a diabetic patient by the presence of persistent albuminuria and/or reduced GFR, as well as the exclusion of other causes of kidney disease.
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How To Control Diabetes
It’s essential that you follow your doctor’s exact instructions for managing diabetes. Everyones health is different, and only your doctor or nurse can determine whats right for you. In general, there are certain steps that should be part of your daily routine to control blood sugar:
- Test and track your blood sugar levels.
- Take your medications as prescribed.
- Eat according to your nutrition plan.
Palliative Management Of Eskd
Some patients with ESKD decline renal replacement therapy due to advanced age, personal values and preferences, or social constraints. Other patients are unlikely to benefit from renal replacement therapy due to severe life-limiting illnesses or poor premorbid quality of life. Many symptoms of ESKD can be managed in primary care . Patients with more complex symptoms or who fail to respond to first-line measures may benefit from specialist palliative care or home hospice referral. Prognostication of ESKD patients who have never undergone renal replacement therapy is challenging, with median survival ranging from six months to two years. In contrast, for ESKD patients on longstanding renal replacement therapy in whom dialysis support is withdrawn, death can be predicted with relative certainty in less than two weeks.
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Prevention & Treatment Of Kidney Disease
Kidney disease is closely linked to high blood sugar, high blood pressure and smoking. The best way to prevent or delay kidney damage is to:
- keep your blood sugar and blood pressure at target
- avoid smoking
- take your medications as prescribed
- have your blood cholesterol checked annually and keep it at target
- follow a healthy meal plan
- exercise regularly
- talk to your doctor about getting screened
If you’ve already been diagnosed with kidney damage or kidney disease, you may need to limit certain foods to prevent waste products building up in your body. Your health-care team may suggest you limit protein foods or foods high in potassium, phosphate or sodium. Controlling your blood pressure is also very important. You should see a registered dietitian for diet advice that is right for you.
In advanced or “end-stage” kidney disease, dialysis may be needed to do the job of the kidneys.
How Common Is Diabetic Kidney Disease
Although diabetic kidney disease is more common in people with type 1 diabetes, there are more people with type 2 diabetes and diabetic kidney disease. This is because type 2 diabetes is much more common than type 1 diabetes.
Diabetic kidney disease is actually the most common cause of kidney failure. Around one in five people needing dialysis have diabetic kidney disease.
Note: most people with diabetes do not need dialysis.
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Switch: Kidney Disease Can Lead To Diabetes
Medical experts already knew that the reverse is true — that diabetes increases the risk for kidney disease. The authors of the new study, though, found that kidney dysfunction can lead to diabetes — and, that a waste product called urea plays a role in the two-way link between the two diseases.
Urea comes from the breakdown of protein in food. Kidneys normally remove urea from the blood, but poor kidney function can lead to increased levels of urea.
The study involved the analysis of medical records over a five-year period for 1.3 million adults who did not have diabetes. About 9 percent had elevated urea levels, a sign of reduced kidney function. That’s the same rate as in the general population, according to the researchers.
People with high urea levels were 23 percent more likely to develop diabetes than those with normal urea levels, the study found. The results were published online recently in the journal Kidney International.
“The risk difference between high and low levels is 688 cases of diabetes per 100,000 people each year — means that for every 100,000 people, there would be 688 more cases of diabetes each year in those with higher urea levels,” said study senior author Dr. Ziyad Al-Aly. He’s an assistant professor of medicine at Washington University School of Medicine in St. Louis.
Tests For Kidney Disease
The two tests for kidney disease are included in your annual review. You should normally have these tests every year but they might be happening differently at the moment because of the coronavirus pandemic. we’ve got more advice about what care you can expect during this time.
As part of your 15 Healthcare Essentials, you should have both of the tests for kidney disease every year.
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Avoidance Of Further Kidney Insult
Episodes of acute kidney injury accelerate the progression of CKD and should be avoided. A simple checklist could include:
Is my patients drug list appropriate for his/her kidney function? Nonsteroidal anti-inflammatory drugs predictably cause acute kidney injury in patients with DKD.
Are my patients drug doses appropriate for his/her kidney function? As estimated glomerular filtration rate falls, dose reductions or stopping drugs may be necessary.
Is my patient taking any potentially nephrotoxic traditional medicine or supplements?
Is my patient becoming dehydrated due to diuretics, or SGLT-2 inhibitors?
How Does Diabetes Cause Kidney Disease
High blood glucose, also called blood sugar, can damage the blood vessels in your kidneys. When the blood vessels are damaged, they dont work as well. Many people with diabetes also develop high blood pressure, which can also damage your kidneys. Learn more about high blood pressure and kidney disease.
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The Mechanism Is Unknown
It is clear that diabetes can lead to kidney disease, but just why high blood sugars should damage the glomeruli is unclear. High blood pressure is a known risk factor for kidney disease and people with diabetes are prone to hypertension. The renin-angiotensin system â which helps regulate blood pressure â is also thought to be involved in the development of diabetic nephropathy.Other risk factors include cigarette smoking and family history. Diabetic nephropathy progresses steadily despite medical intervention. However, treatment can significantly slow the rate of damage.
Symptoms Of Kidney Failure
For people with diabetes, kidney problems are usually picked up during a check-up by their doctor. Occasionally, a person can have type 2 diabetes without knowing it. This means their unchecked high blood sugar levels may be slowly damaging their kidneys. At first, the only sign is high protein levels in the urine, but this has no symptoms. It may be years before the kidneys are damaged severely enough to cause symptoms. Some of the symptoms may include:
- Fluid retention
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Most People Get Diabetes This Way Experts Say
Over 34 millions Americans live with diabetes, a condition that happens “when your blood glucose, also called blood sugar, is too high. High blood glucose can cause health problems over time,” the National Institute of Diabetes and Digestive and Kidney Disease states. While there are different types of diabetes, type 2 is the most common and “canlead to other chronic conditions such as heart disease and stroke, nerve damage, kidney disease, eye damage, and dementia. Managing diabetes and keeping your blood sugar under control can lower the risk of these complications,”Dr. Seema BonneyMD, Founder and Medical Director of the Anti-Aging and Longevity Center of Philadelphia tells us. Eat This, Not That! Health spoke with experts who revealed the common ways people get diabetes and how to help prevent it. Read onand to ensure your health and the health of others, don’t miss these Sure Signs You’ve Already Had COVID.
What Are The Complications
The main complication of diabetic kidney disease is developing chronic kidney disease. Chronic kidney disease can progress even further to kidney failure. People with kidney failure need treatment with dialysis or a kidney transplant.
All people with diabetes are at risk of high blood pressure and cardiovascular disease . Having kidney disease also increases the risk of these problems. So having both diabetes and kidney disease means your risk is even higher.
Having diabetic kidney disease can also make other diabetes complications worse.
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Causes Symptoms And Treatment
Singapore has the fourth highest incidence of kidney failure in the world. Every day, 4.7 new kidney patients were diagnosed, which means over 1,700 cases of kidney failure a year! Diabetes and hypertension are the two leading causes of kidney failure. The incidence is alarming, with 1 in every 9 adult Singaporeans afflicted with diabetes and 1 in every 4 adult Singaporeans having high blood pressure. While the National Health Survey 2010 revealed that the prevalence of these chronic diseases has declined, the large absolute number of patients is a potential time bomb. About 60% of new cases of End-Stage Renal Disease were due to diabetes.Continue reading > >
The Importance Of Insulin
Diabetes is a disease in which your body either can’t produce insulin or can’t properly use the insulin it produces. Insulin is a hormone produced by your pancreas.
Insulin’s role is to regulate the amount of glucose in the blood. Blood sugar must be carefully regulated to ensure that the body functions properly. Too much blood sugar can cause damage to organs, blood vessels, and nerves. Your body also needs insulin in order to use sugar for energy.
Eleven million Canadians are living with diabetes or prediabetes. Chances are, diabetes affects you or someone you know.
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What Can I Do In My Practice
As untreated DKD progresses inexorably towards ESKD, the goal of treatment is to prevent or delay the development of ESKD. The role of the family physician is, firstly, to make a timely diagnosis of DKD through screening of individuals with diabetes mellitus and secondly, to retard the progression of DKD through glycaemic control, blood pressure control, RAS blockade, SGLT-2 inhibition and avoidance of further kidney insults. Thirdly, the family physician has an important role in health promotion and in managing comorbidities, especially cardiovascular risk factors.
How Diabetes Causes Kidney Disease
Each kidney is made up of millions of tiny filters called nephrons. Over time, high blood sugar from diabetes can damage blood vessels in the kidneys as well as nephrons so they dont work as well as they should. Many people with diabetes also develop high blood pressure, which can damage kidneys too.
CKD takes a long time to develop and usually doesnt have any signs or symptoms in the early stages. You wont know you have CKD unless your doctor checks you for it.
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Does Diabetes Lead To Kidney Disease
Diabetes is the number one cause of adult kidney failure. This means that years of uncontrolled or unmanaged diabetes can damage your kidneys. To prevent this, you must be actively engaged and participate in your diabetes management. This includes consistent measurements of your blood glucose as discussed by you and your physician. There are devices available that allow you to measure your blood glucose levels throughout the week with the least amount of discomfort.
It also includes “knowing your numbers.” Your numbers are hemoglobin A1C, your blood pressure, and your eGFR. Your healthcare team should discuss your readings with you and help you identify where you need to be based on your individual plan of care. A regular exercise schedule that considers your competing demands will help you better manage your diabetes and sustain an exercise plan that is part of your daily or weekly routine.
Diabetes does not have to lead to kidney failure. You must be 100% committed to taking the necessary steps that will keep your diabetes managed and your kidneys healthy.
Glycemic Goal To Attain A1c ~70 %
Glycemic control is essential to delay or possibly prevent nephropathy. In general, the recommended target A1c for diabetes control by the ADA has been less than or around 7 % . The ADA advises both higher or stricter A1c goals for certain populations . AACE suggests a goal A1c of 6.5 % in healthy patients who are at low risk for hypoglycemia but also acknowledges the goals need to be individualized . The 2007 Kidney Disease Outcomes Quality Initiative guidelines for Diabetes and CKD endorse a target A1c of < 7.0 % but their updated 2012 guidelines instead recommend an A1c of ~7.0 % .
The ACCORD study showed higher risk of hypoglycemia and mortality in patients with type 2 diabetes treated with intensive glucose control , without any risk reduction on CVD. The increased mortality could not be attributed to hypoglycemia . In the ADVANCE trial, more intensive glycemic control showed no reduction in CVD. However, the intensive group had a 21 % reduction in nephropathy . The VADT study also showed no benefit on CVD risk with stricter glucose control .
The data clearly show that lowering A1c leads to benefit in regards to nephropathy. Benefits in A1c reduction are also seen on rates of retinopathy and neuropathy. However, the effect of lowering A1c is much less in regards to macrovascular disease. Thus, it is reasonable that a target A1c ~7.0 % offers an optimal risk to benefit ratio rather than a target that is considerably lower.
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Glycemic Control In Ckd
Glycemic control is essential to delay the onset of complications from diabetes, and it can be challenging for even the most experienced physician. Blood sugar control in those with CKD adds another level of complexity. It requires detailed knowledge of which medications can be safely used and how kidney disease affects metabolism of these medications. In addition, the glycemic target needs to be individualized for each patient, acknowledging that our ability to interpret the data can be altered in the setting of kidney disease.
What Will Happen If My Kidneys Have Been Damaged
First, the doctor needs to find out if your diabetes has caused the injury. Other diseases can cause kidney damage. Your kidneys will work better and last longer if you:
- Control your diabetes
- Get treatment for urinary tract infections
- Correct any problems in your urinary system
- Avoid any medicines that may damage the kidneys
If no other problems are found, your doctor will try to keep your kidneys working as long as possible. The use of high blood pressure medicines called angiotensin converting enzyme inhibitors has been shown to help slow the loss of kidney function.
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The Burden Of Kidney Failure
Each year in the United States, more than 100,000 people are diagnosed with kidney failure, a serious condition in which the kidneys fail to rid the body of wastes. Kidney failure is the final stage of chronic kidney disease .
Diabetes is the most common cause of kidney failure, accounting for nearly 44 percent of new cases. Even when diabetes is controlled, the disease can lead to chronic kidney disease and kidney failure. Most people with diabetes do not develop chronic kidney disease that is severe enough to progress to kidney failure. Nearly 24 million people in the United States have diabetes, and nearly 200,000 people are living with kidney failure as a result of diabetes.
People with kidney failure undergo either dialysis, an artificial blood-cleaning process, or transplantation to receive a healthy kidney from a donor. Most U.S. citizens who develop kidney failure are eligible for federally funded care. In 2009, care for patients with kidney failure cost the United States nearly $42 billion.
People with diabetes should be screened regularly for kidney disease. The two key markers for kidney disease are eGFR and urine albumin.
Kidney disease is present when eGFR is less than 60 milliliters per minute.
The American Diabetes Association and the National Institutes of Health recommend that eGFR be calculated from serum creatinine at least once a year in all people with diabetes.