The Link Between Diabetes And Kidney Disease
People with diabetes are at high risk for kidney disease, but there are steps they can take to protect their kidneys.
Meda E. Pavkov, MD, PhD, medical epidemiologist in the Chronic Kidney Disease Initiative within the Division for Diabetes Translation at the Centers for Disease Control and Prevention , is a co-author of the Kidney Disease in Diabetes chapter in the NIDDK publication Diabetes in America, 3rd Edition. Here, she discusses the link between diabetes and kidney disease and the importance of early detection and management of kidney disease.
Q: What is the link between diabetes and kidney disease?
A: Diabetes is the most frequent cause of chronic kidney disease, not only in the United States but in most industrialized countries. Kidney disease in people with diabetes is caused by multiple factors, including diabetic changes in the kidneys as well as vascular changes due to hypertension. People with diabetes have high glycemia, or blood glucose, which can damage the kidneys and lead to kidney disease.
When people are diagnosed with diabetes, they may already have hypertension. Hypertension is an additional risk factor for diabetic kidney disease because high blood pressure damages the kidneys, which may prevent proper function.
Q: What are the benefits of talking about kidney disease risk factors with patients who have diabetes?
Q: Why is it so important to diagnose kidney disease in patients with diabetes as early as possible?
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.
How Do I Know If I Have Kidney Damage
Most people with early kidney damage do not have symptoms. The best way to find early kidney damage is to have a urine test once a year. This test checks for very small amounts of protein in the urine called albuminuria. It helps show kidney damage at an early stage in people with diabetes. Not everyone with kidney disease gets kidney failure. With the right treatment, you can prevent kidney disease from getting worse.
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Prevalence Of Diabetic Nephropathy By Race
The severity and incidence of diabetic nephropathy are especially great in blacks , Mexican Americans, and Pima Indians with type 2 DM. The relatively high frequency of the condition in these genetically disparate populations suggests that socioeconomic factors, such as diet, poor control of hyperglycemia, hypertension, and obesity, have a primary role in the development of diabetic nephropathy. It also indicates that familial clustering may be occurring in these populations.
How Does Diabetic Kidney Disease Develop And Progress
A raised blood sugar level that occurs in people with diabetes can cause a rise in the level of some chemicals within the kidney. These chemicals tend to make the glomeruli more ‘leaky’ which then allows albumin to leak into the urine.
In addition, the raised blood glucose level may cause some proteins in the glomeruli to link together. These ‘cross-linked’ proteins can trigger a localised scarring process. This scarring process in the glomeruli is called glomerulosclerosis. It usually takes several years for glomerulosclerosis to develop and it only happens in some people with diabetes.
As the condition becomes worse, scarred tissue gradually replaces healthy kidney tissue. As a result, the kidneys become less and less able to do their job of filtering the blood. This gradual ‘failing’ of the kidneys may gradually progress to what is known as end-stage kidney failure.
- Microalbuminuria is usually the first sign that diabetic kidney disease has developed. Over months or years, microalbuminuria may go away , persist at about the same level, or progress to proteinuria.
- Proteinuria is irreversible. If you develop proteinuria it usually marks the beginning of a gradual decline in kidney function towards end-stage kidney failure at some time in the future.
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Effects Of High Blood Pressure
High blood pressure, or hypertension, is a major factor in the development of kidney problems in people with diabetes. Both a family history of hypertension and the presence of hypertension appear to increase chances of developing kidney disease. Hypertension also accelerates the progress of kidney disease when it already exists.
Blood pressure is recorded using two numbers. The first number is called the systolic pressure, and it represents the pressure in the arteries as the heart beats. The second number is called the diastolic pressure, and it represents the pressure between heartbeats. In the past, hypertension was defined as blood pressure higher than 140/90, said as “140 over 90.”
The ADA and the National Heart, Lung, and Blood Institute recommend that people with diabetes keep their blood pressure below 130/80.
Hypertension can be seen not only as a cause of kidney disease but also as a result of damage created by the disease. As kidney disease progresses, physical changes in the kidneys lead to increased blood pressure. Therefore, a dangerous spiral, involving rising blood pressure and factors that raise blood pressure, occurs. Early detection and treatment of even mild hypertension are essential for people with diabetes.
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.
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The Connection Between Diabetes Kidney Disease And High Blood Pressure
It’s a triple health threat faced by tens of millions of Americans. But few think about it until they’re forced to.
Even then, the interplay between diabetes, high blood pressure and kidney disease can be a challenge for people to grasp. But doctors say having an understanding is key for anybody who wants to reduce their risk or already has the conditions, or who helps a family member with them.
It’s especially important for people who could benefit from new medications but face barriers slowing their use.
More than 34 million people, or 10.5% of the U.S. population, have diabetes, according to the Centers for Disease Control and Prevention. Most cases are Type 2, or adult-onset. When someone has diabetes, they can’t make or use insulin as well as they should. That causes blood sugar to rise, which leads to various complications throughout the body.
Dr. Vivek Bhalla, an associate professor of medicine and nephrology at Stanford University School of Medicine in California, summed it up: “Diabetes can affect small blood vessels. And that can result in hypertension. And that can also result in kidney disease.”
It can be a vicious cycle, said Bhalla, past chair of the American Heart Association’s Council on the Kidney in Cardiovascular Disease.
Much of that cycle goes on invisibly, Bhalla said.
A new generation of diabetes drugs could radically improve that.
Rangaswami said that highlights the need for doctors to better communicate with one another.
Types Of Kidney Disease
Damage to Kidneys may be caused by diabetes, high blood pressure, and various other chronic conditions. Kidney disease can lead to other health problems, including weak bones, nerve damage, and malnutrition. If the disease gets worse over time, your kidneys may stop working completely. This means that dialysis will be required to perform the function of the kidneys. Dialysis is a treatment that filters and purifies the blood using a machine. It cant cure kidney disease, but it can prolong your life. Tatkshana offers Ayurvedic treatment for kidney failure.
Depending on the type of kidney diseases, it can be chronic kidney disease, kidney stones, Glomerulonephritis, polycystic disease or urinary tract infections.
The most common form of kidney disease is chronic kidney disease. Chronic kidney disease is a long-term condition that doesnt improve over time. Its commonly caused by high blood pressure. High blood pressure is dangerous for the kidneys because it can increase the pressure on the glomeruli. Glomeruli are the tiny blood vessels in the kidneys where blood is cleaned. Kidney function will eventually deteriorate to the point where the kidneys can no longer perform their job properly. In this case, a person would need to go on dialysis. A kidney transplant may be another treatment option depending on your circumstances.
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Prediabetes And Kidney Disease
If you have prediabetes, taking action to prevent type 2 diabetes is an important step in preventing kidney disease. Studies have shown that overweight people at higher risk for type 2 diabetes can prevent or delay developing it by losing 5% to 7% of their body weight, or 10 to 14 pounds for a 200-pound person. You can do that by eating healthier and getting 150 minutes of physical activity each week. CDCs National Diabetes Prevention Program lifestyle change program can help you create the healthy lifestyle habits needed to prevent type 2 diabetes. Find a program in your community or online.
What Increases My Chances Of Developing Diabetic Kidney Disease
Having diabetes for a longer time increases the chances that you will have kidney damage. If you have diabetes, you are more likely to develop kidney disease if your
- blood glucose is too high
- blood pressure is too high
African Americans, American Indians, and Hispanics/Latinos develop diabetes, kidney disease, and kidney failure at a higher rate than Caucasians.
You are also more likely to develop kidney disease if you have diabetes and
- smoke
- have heart disease
- have a family history of kidney failure
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Workup In Diabetic Nephropathy
Diabetic nephropathy is characterized by the following:
- Persistent albuminuria that is confirmed on at least two occasions 3-6 months apart
- A relentless decline in the glomerular filtration rate
- Elevated arterial blood pressure
A 24-hour urinalysis for urea, creatinine, and protein is extremely useful in quantifying protein losses and estimating the GFR.
Blood tests, including calculation of GFR , are helpful in monitoring for the progression of kidney disease and in assessing its stage.
Renal ultrasonography is performed to observe for kidney size, which is usually normal to increased in the initial stages and, later, decreased or shrunken with chronic renal disease. Rule out obstruction. Perform echogenicity studies for chronic renal disease.
What Is The Treatment For Diabetic Kidney Disease
Treatments that may be advised are discussed below. Treatments aim to:
- Prevent or delay the disease progressing to kidney failure. In particular, if you have early diabetic kidney disease it does not always progress to the proteinuria phase of the disease.
- Reduce the risk of developing cardiovascular diseases such as heart disease and stroke.
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Management Of Diabetic Nephropathy
Several issues are key in the medical care of patients with diabetic nephropathy. These include glycemic control, management of hypertension, and reducing dietary salt intake and phosphorus and potassium restriction in advanced cases.
Agents for glycemic control in patients with diabetes who have kidney disease include the following:
- Dipeptidyl peptidase inhibitors
- Sodium-glucose cotransporter 2 inhibitors
- Glucagonlike peptide-1 receptor agonists or incretin mimetics
- Amylin analogs
- Nonsteroidal, selective mineralocorticoid receptor antagonists
What Are The Early Signs Of Kidney Disease In Patients With Diabetes
The earliest sign of diabetic kidney disease is an increased excretion of albumin in the urine. This is present long before the usual tests done in your doctor’s office show evidence of kidney disease, so it is important for you to have this test on a yearly basis. Weight gain and ankle swelling may occur. You will use the bathroom more at night. Your blood pressure may get too high. As a person with diabetes, you should have your blood, urine and blood pressure checked at least once a year. This will lead to better control of your disease and early treatment of high blood pressure and kidney disease. Maintaining control of your diabetes can lower your risk of developing severe kidney disease.
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How Diabetes Can Damage Kidneys
Diabetes is the leading cause of CKD: Approximately 1 in 3 people who have diabetes also have kidney disease, according to the Centers for Disease Control and Prevention . People with diabetes often have elevated levels of sugar in the blood, which can cause damage to many tissues in the body over time, including in the kidneys.
The working units of the kidneys, called nephrons, contain networks of tiny blood vessels that filter waste products from the blood.
When sugar is high in the blood, the sugars can bind to different proteins in the nephrons and change the structure of those proteins, says Staci Leisman, MD, a nephrologist and associate professor of medicine and medical education at Icahn School of Medicine at Mount Sinai in New York City. This can make the nephrons less effective at filtering and lead to protein in your urine a key sign of CKD.
Lowering blood sugar levels, which is the number one goal of diabetes management and treatment, can help prevent or slow kidney damage.
Live Vs Deceased Donor
A live donor is preferred in all cases because of improved kidney graft functioning, among other things. It is definitely the preferred method for pre-emptive dialysis as mentioned above. Still, no matter how long a person has had to be on dialysis, they are better off with a transplant organ from a live donor.
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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.
Stages Of Kidney Disease
Early treatment can help slow down the progression of kidney disease. There are five stages of kidney disease. Stage 1 is the mildest stage and kidney functionality can be restored with treatment. Stage 5 is the most severe form of kidney failure. At stage 5, the kidney is no longer functional, and you will need to have dialysis or a kidney transplant.
Your glomerular filtration rate can be used to help your doctor determine the stage of your kidney disease. Knowing your stage is important because that will affect your treatment plan. To calculate your GFR, your doctor will use the results from a creatinine blood test along with your age, gender, and physique.
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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.
Signs And Symptoms Of Diabetic Nephropathy
Diabetic nephropathy should be considered in patients who have diabetes mellitus and a history of one or more of the following:
- Passing of foamy urine
- Fatigue and foot edema secondary to hypoalbuminemia
- Other associated disorders such as peripheral vascular occlusive disease, hypertension, or coronary artery disease
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The Connection Between Diabetes And Kidneys
Diabetes is the leading cause of chronic kidney disease , responsible for 44% of CKD cases. Diabetesespecially type 2 diabetesis also the number one cause of kidney failure in the US. If youre living with diabetic kidney disease, its extremely important to stay in control of and care for both your diabetes and kidneys so you can be your healthiest.
How High Blood Pressure Can Damage Kidneys
High blood pressure the second leading cause of CKD is an increase in the force of blood as it flows through your blood vessels. Over time, that force can damage the tiny vessels in the nephrons, just as it can damage blood vessels throughout the body.
The vessels in the kidney are delicate, explains Dr. Leisman. Imagine two hoses: one is high pressure and one is low pressure. Both have water coming out, but the water coming from the high-pressure hose, over time, can lead to damage.
Leisman notes that treating high blood pressure is one of the cornerstones of preventing or slowing kidney damage. In fact, some of the most common drugs used to lower blood pressure are considered a standard treatment for CKD.
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