What Is Diabetic Kidney Disease?

Diabetic kidney disease refers to chronic kidney disease that occurs as a result of diabetes.e60dc2a1-f33c-4a05-9b50-8e3e8e597629dde0d1c9-eab6-481f-8220-22d2c9db6075 Chronic kidney disease (CKD) involves a slow decline in the kidneys’ ability to function.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296171d7cc-e315-4ba3-b5ed-70a860498e0b Hyperglycemia, or high blood sugar, is a significant risk factor for kidney damage in people with type 1 and type 2 diabetes, as are high blood pressure and obesity.e60dc2a1-f33c-4a05-9b50-8e3e8e59762991464e12-a61d-4082-9ec4-f4e2a7c92e97 While there isn’t a cure for diabetic kidney disease, and kidney damage is irreversible, certain treatments can help slow the progression of kidney function decline, including blood glucose management, medications, and lifestyle modifications.e60dc2a1-f33c-4a05-9b50-8e3e8e59762991464e12-a61d-4082-9ec4-f4e2a7c92e97 However, diabetic kidney disease can lead to kidney failure, which must be treated with either dialysis to filter the blood or kidney transplants.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299913a04d-b2bb-44bd-8d27-7f02497f1976
The Stages of Diabetic Kidney Disease Stages The progression of chronic kidney disease is categorized in five stages, each of which is defined by estimated glomerular filtration rate (eGFR), a measure of how well the kidneys filter blood. eGFR is measured in milliliters of cleansed blood per minute per body surface, which reads as mL/min/1.73m2. Using this method, chronic kidney disease progresses through the following stages:e60dc2a1-f33c-4a05-9b50-8e3e8e597629a8d967d6-9834-466f-9b35-9ae0411214ea
Healthcare providers also measure the levels of a protein called albumin present in the urine to assess the severity of chronic kidney disease, categorizing it in three levels. However, people with diabetic kidney disease don’t always present with albumin in the urine as an indicator of the condition.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d46242c9-02ed-424d-9aaf-e7fc9299ac60
Signs and Symptoms of Diabetic Kidney Disease Symptoms Early stages of diabetic kidney disease don’t typically present with clear symptoms, which is why it’s so important to test kidney function early and regularly when treating and managing diabetes .e60dc2a1-f33c-4a05-9b50-8e3e8e5976293ed4c795-9c02-410f-93c8-ef2801f7ee40 People can experience the following symptoms in more advanced stages of chronic kidney disease:e60dc2a1-f33c-4a05-9b50-8e3e8e5976293b72d4bf-5f96-4a56-bdad-e6a51ebd53a4 e60dc2a1-f33c-4a05-9b50-8e3e8e597629c57bbc13-7fdb-4b9a-a2bb-39240061673d Nausea and vomiting Loss of appetite Trouble sleeping Signs of fluid buildup, such as shortness of breath from fluid in the lungs or swelling in the feet Feeling weak and fatigued Abnormal urine output, including very small amounts of urine Itchiness In advanced diabetic nephropathy, or diabetic kidney disease, people can also experience:e60dc2a1-f33c-4a05-9b50-8e3e8e59762910963860-c04c-4ae5-b751-aadf1ec32c5a Fatigue Feet swelling Foamy urine Symptoms related to diabetes such as delayed wound healing and numbness or tingling Nephrotic syndrome, excess protein in the urine that leads to other symptoms like fluid buildup (edema)e60dc2a1-f33c-4a05-9b50-8e3e8e59762928a83a51-c8ef-4158-b3cc-d07ca3e4cc09
Causes and Risk Factors of Diabetic Kidney Disease Causes The main job of the kidneys is to filter the body’s accumulated waste products as well as salt and minerals your body needs — sodium, calcium, potassium, phosphorus — into tiny tubules, where they are either reabsorbed into the blood or passed into urine. Prolonged high blood sugar in diabetes can cause irreversible damage to the small blood vessels in the kidneys, as well as the structures responsible for filtering waste. As a result, people with diabetes can experience hyperfiltration, which is indicated by an elevated GFR rate. This stress on the kidneys contributes to the development and progression of diabetic kidney disease.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b6798dea-8b6c-4d6d-b35d-6d310d6d9946 When your kidneys aren’t able to filter waste products from the blood as well as they should, you can develop chronic kidney disease. Gradual loss of kidney function can worsen over time, eventually leading to kidney failure if left untreated.e60dc2a1-f33c-4a05-9b50-8e3e8e59762984bec480-67b9-409e-a894-a5b6ee55c142 Common risk factors for chronic kidney disease include:e60dc2a1-f33c-4a05-9b50-8e3e8e59762984bec480-67b9-409e-a894-a5b6ee55c142 Obesity A family history of chronic kidney disease High blood pressure Heart disease Other risk factors that may contribute to diabetic kidney disease include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629b6798dea-8b6c-4d6d-b35d-6d310d6d9946 e60dc2a1-f33c-4a05-9b50-8e3e8e59762994b2caa1-cfcd-42f5-a129-000b068b8767 Increased age Duration of diabetes Being a man or a postmenopausal woman Dyslipidemia (abnormal lipid levels) Smoking Sedentary lifestyle A diet high in animal protein High salt intake
How Is Diabetic Kidney Disease Diagnosed? Diagnosis Doctors use a few different tests to determine whether someone has chronic kidney disease: Measurement of Urine Albumin-to-Creatinine Ratio This urine test assesses how much albumin protein is present in the urine, an indication of kidney dysfunction.e60dc2a1-f33c-4a05-9b50-8e3e8e597629579752b6-cc6f-4126-a9b7-84716cdbefa0 Measurement of the Estimated Glomerular Filtration Rate (eGFR) This measurement of kidney function uses data from a person’s bloodwork to estimate how well the kidneys are filtering blood.e60dc2a1-f33c-4a05-9b50-8e3e8e59762901f12577-a2b3-40f7-a498-3c1f5368dd24 Kidney Imaging Ultrasounds and computerized tomography can help identify kidney changes and problems.e60dc2a1-f33c-4a05-9b50-8e3e8e59762901f12577-a2b3-40f7-a498-3c1f5368dd24 To determine whether diabetes is the cause of chronic kidney disease, healthcare providers can perform a kidney biopsy, although this procedure isn’t as common as other diagnostic tests. People with type 1 diabetes should be screened annually for diabetic kidney disease after they’ve had diabetes for five years.e60dc2a1-f33c-4a05-9b50-8e3e8e597629102e621c-eb9d-4f5b-9f81-aeb83e227426 Meanwhile, people with type 2 diabetes should get their eGFR and urine albumin levels tested at least once a year, starting when they are first diagnosed. If you already have a low stage of chronic kidney disease, your healthcare team may ask to run these tests one to four times each year.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294fdf171a-c5da-4f24-b70a-5774bf163fe1
Treatment and Medication Options for Diabetic Kidney Disease Treatment Because it’s not possible to repair kidney damage, chronic kidney disease treatment prioritizes slowing the progression of kidney damage. Strategies can involve medication, blood pressure and diabetes management, and lifestyle changes.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298ad0f404-6260-4220-814d-530fa3106da4 Medication Options Several medications can help manage kidney disease. Some may help slow or halt the progression of kidney disease, while others address additional issues like blood pressure or diabetes. ACE Inhibitors : These medications help decrease protein in the urine and can slow declines in kidney function, as well as reduce blood pressure.e60dc2a1-f33c-4a05-9b50-8e3e8e59762989c8a4d4-7781-4699-abc0-95d0300f7f69 Angiotensin Receptor Blockers : ARBs also help reduce protein in the urine, slow declines in kidney function, and decrease blood pressure.e60dc2a1-f33c-4a05-9b50-8e3e8e59762989c8a4d4-7781-4699-abc0-95d0300f7f69 Diuretics : These medications allow more fluid to leave the body via urine.e60dc2a1-f33c-4a05-9b50-8e3e8e59762940233e5b-f7a0-449a-b5bb-197b6a7bef82 GLP-1 Receptor Agonists : By supporting weight loss and blood sugar management, these medications can reduce risk of kidney disease, slow its progression, and improve outcomes in those with kidney dysfunction. Mineralocorticoid Receptor Antagonists: These medications help the kidneys remove excess water and salt via urine without depleting potassium levels, lowering blood pressure as a result.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ea05aef1-dd33-406b-8433-2425f0c03e40 SGLT-2 Inhibitors: These medications can help decrease blood sugar by allowing more sugar to leave the body via urine when someone’s kidney function is normal. When kidney function is reduced, SGLT-2 inhibitors can help decrease risk of further kidney disease progression.e60dc2a1-f33c-4a05-9b50-8e3e8e59762989c8a4d4-7781-4699-abc0-95d0300f7f69 Once you lose kidney function, you cannot restore it with medication.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f2760438-2f2f-40df-9c77-015f5904fdf1 At the most advanced stage of kidney disease, there are only two ways to restore fluid and waste product filtration from your blood: dialysis and kidney transplantation. Usually, a healthcare provider discusses these options when diabetic kidney disease reaches stage 4.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ce61773b-96dc-489b-b96a-fed45d4dfa1c Dialysis Dialysis is usually recommended when around 90 percent of kidney function is lost. There are two types of dialysis: hemodialysis and peritoneal dialysis. Hemodialysis involves going to a dialysis center three times a week for several hours, where your blood is pumped through a machine that filters out waste products and excess fluids and then returned to your body. Sometimes, hemodialysis can be done at home, but such treatment may need to occur more frequently and take longer to complete. Peritoneal dialysis is self-administered at home and involves putting a dialysis solution in your abdomen through a catheter placed surgically near your navel. The solution remains in your abdomen for several hours before being drained and replaced with fresh dialysis solution. This process can be done manually throughout the day or by machine at night. Peritoneal dialysis may be the better option for people who want to continue to live an active lifestyle. However, it can require setting up the equipment yourself, which can be challenging for people with vision or dexterity problems.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f5b8b25d-4a42-425e-b123-8214e702057e Kidney Transplant A kidney transplant may help improve life expectancy and is often a better option than dialysis. A person with kidney disease might receive dialysis while waiting for a kidney transplant. Kidney transplants are major surgeries performed under general anesthesia that do carry a number of risks, including blood clots and bleeding, infection, and failure or rejection of the donated kidney. Following the procedure, most people spend several days to a week recovering in the hospital and require close monitoring and frequent checkups for several weeks to make sure the new organ is functioning properly.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292c8ee743-edc7-4c25-a849-0f500eb632fb After a person receives a new kidney, they must take certain medications for the rest of their life to ensure their body doesn’t reject the new organ.e60dc2a1-f33c-4a05-9b50-8e3e8e597629275d77fb-54bb-4af2-97e3-01afb2e4571a Not everyone is eligible for a kidney transplant, such as people who have had cancer recently, people with severe obesity, or those who haven’t adhered to recommended dialysis or medication treatments.
Prevention of Diabetic Kidney Disease Prevention The best way to prevent chronic kidney disease if you have diabetes is to carefully manage your blood sugar, as well as treat associated conditions such as high blood pressure and abnormal cholesterol levels. Managing these conditions effectively often involves using medications with the supervision of your healthcare provider. Lifestyle changes, such as maintaining a healthy weight, not smoking, and getting enough exercise, can also help decrease your risk for chronic kidney disease.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295dc46284-35e4-46ae-b064-fb9481784327 Talk with your doctor about your goals and how you can work to decrease your risk for chronic kidney disease. Diagnosing chronic kidney disease and getting treatment early can play a significant role in helping to improve outcomes.e60dc2a1-f33c-4a05-9b50-8e3e8e597629747119ee-b822-4f3e-9a91-f3852588fa8e For people with type 1 and type 2 diabetes, annual screenings for chronic kidney disease are recommended. It’s easier to prevent the development of advanced kidney disease if the condition is identified early. e60dc2a1-f33c-4a05-9b50-8e3e8e59762957ebf486-f325-4b8a-bb68-47eccd9afdfe
Lifestyle Changes for Diabetic Kidney Disease Lifestyle Changes Many of the healthy habits that can help you manage diabetes, such as eating a balanced diet and exercising regularly, can also help keep your kidneys healthy and slow the progression of chronic kidney disease. Eat a Healthy Diet Following a balanced diet that prioritizes whole, unprocessed food can help improve both blood sugar e60dc2a1-f33c-4a05-9b50-8e3e8e5976291c3401f0-0676-45de-8e88-ea210048e78f and blood pressure .e60dc2a1-f33c-4a05-9b50-8e3e8e59762922eca458-89a4-4146-bf95-7ed769cccfd6 A healthy diabetes diet may involve monitoring carbohydrate intake, choosing non-starchy vegetables, and limiting processed foods and sugary snacks. Similarly, if you have high blood pressure, eating a diet high in fruits and vegetables while limiting added sugar, salt, alcohol, and red meat can be helpful. If you have diabetic kidney disease, you may be asked to eat a specialized diet, which could include: Limiting salt and sodium consumption Limiting potassium or phosphorous intake Detailed protein goals and limits Create an individualized dietary plan with your healthcare team, and ask questions when you aren’t sure which food options are appropriate.e60dc2a1-f33c-4a05-9b50-8e3e8e597629240aa9ad-4887-45d5-a7fb-f6a57e66053e Watch Your Protein and Salt Intake Limiting salt in your diet can help decrease blood pressure and reduce fluid buildup. To limit salt: Season foods with sodium-free herbs and spices. Avoid packaged food, fast food, and salty snacks. Check all food labels for sodium content. Consult your healthcare provider before using salt substitutes. Some contain high levels of potassium, and people with chronic kidney disease may also need to limit their intake of this mineral.e60dc2a1-f33c-4a05-9b50-8e3e8e597629591f47c0-1c79-4c85-835a-4715b3f63d8d A protein-heavy diet may make your kidneys work harder. Talk to your doctor about how much protein you should eat, and opt for lean sources such as fish or chicken. It’s important to ask about dietary restrictions and create a plan that works for your specific kidney function and needs. As chronic kidney disease progresses, the specifics of diet can become more meticulous, and it may help to work with a nutrition specialist.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a3599b71-4652-4e69-81f6-7932320d8fef For example, if you’re on dialysis, you might need more protein in your diet. Ask your doctor about what your protein, salt, and other food intake should look like to best manage your condition.e60dc2a1-f33c-4a05-9b50-8e3e8e59762926a64598-abbf-4899-a49b-7ab33ed268a6 Get Regular Exercise Exercise can help you manage your weight, improve your mental health, and achieve your blood sugar and blood pressure goals. The American Diabetes Association and the World Health Organization recommend adults with diabetes aim for 150 to 300 minutes of moderate-intensity aerobic physical activity per week, as well as engage in strength or resistance training at least twice a week.e60dc2a1-f33c-4a05-9b50-8e3e8e5976297e3c410f-0024-415d-a43c-3fb2da27cf26 For those with kidney dysfunction, the National Kidney Foundation stresses the importance of prioritizing aerobic activities like walking, biking, and swimming, sticking with lower weights and higher repetitions when resistance training, and gradually working up to exercise sessions lasting 30 minutes each. Exercising at least three times a week is ideal.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b5075a93-b87d-4167-b9cb-7b62b6754e98 For people with diabetes or diabetic kidney disease, lower intensity exercise may be best. Consult your healthcare provider prior to exercising to create a fitness plant that is safe for your condition and tailored to your specific goals. Address Your Sleep and Stress Issues Stress can raise blood sugar and blood pressure levels as a result of the body’s release of the hormone cortisol . In addition to everyday stress, you may also experience stress specifically related to managing your diabetes.e60dc2a1-f33c-4a05-9b50-8e3e8e59762941e28cbb-da80-49ae-94ab-ad606c5f540b A wide range of stress management strategies , including limiting your caffeine consumption, spending time with people you love, and going outside, can help provide relief.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a303a53e-538a-43d7-b87a-5ba8f1d5593d Techniques that allow you to practice mindfulness like meditation can also be helpful.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292e9ada4b-2df2-426e-a75e-271c5265fc07 Sleep is another important component of stress management, and getting enough sleep may also help reduce your risk of diabetes complications like kidney disease. Sleeping less than six hours a night is associated with a higher risk of developing chronic kidney disease than sleeping between six and eight hours per night.e60dc2a1-f33c-4a05-9b50-8e3e8e59762991bc4174-8ce6-40cd-8fc6-e3bc48e58f74 Adequate sleep can also support weight management and heart health, decreasing your risk of developing high blood pressure and heart disease.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294fb24e7e-d275-49ff-8146-d8a15fb4b584
Diabetic Kidney Disease Prognosis Prognosis and Outlook Early diagnosis and proper management of diabetic kidney disease can help prolong your life and extend your quality of life. In fact, only a small percentage of people experience the advanced stages of chronic kidney disease.e60dc2a1-f33c-4a05-9b50-8e3e8e59762969b7c85e-fc60-4c24-8d1d-05ecb771d88e However, chronic kidney disease remains a leading cause of death worldwide.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295e1f3d98-3913-4220-b958-f24e5e3e7a31 Heart disease, a complication of the condition, is the most common cause of death for individuals with chronic kidney disease.e60dc2a1-f33c-4a05-9b50-8e3e8e59762921e4041e-2ba0-4c80-8181-0ffc26cdc6df Continue working with your healthcare provider to explore care options relevant to your situation to best manage your chronic kidney disease.
Complications of Diabetic Kidney Disease Complications Chronic kidney disease doesn’t just affect the kidneys, but can also lead to a number of complications that may require specialized treatment, such as: Abnormalities in salt and fluid balancee60dc2a1-f33c-4a05-9b50-8e3e8e597629c3b02020-82b8-4e95-9382-3b770c08b504 Anemia e60dc2a1-f33c-4a05-9b50-8e3e8e597629c3b02020-82b8-4e95-9382-3b770c08b504 Bone and mineral disordere60dc2a1-f33c-4a05-9b50-8e3e8e5976296b5eeee6-0404-45b9-bfab-5b562eacfaa7 Cardiovascular disease e60dc2a1-f33c-4a05-9b50-8e3e8e597629b4c9b523-327b-4cce-a59a-cfe749f55fae High blood pressure e60dc2a1-f33c-4a05-9b50-8e3e8e597629c3b02020-82b8-4e95-9382-3b770c08b504 High phosphorus levelse60dc2a1-f33c-4a05-9b50-8e3e8e59762937ba955c-0a08-4f59-985f-39419048edbb High potassium levelse60dc2a1-f33c-4a05-9b50-8e3e8e597629553e8e5c-dab0-4305-b54b-8924c8b31607
Research and Statistics: How Many People Have Diabetic Kidney Disease? Research and Statistics In the United States, about 35.5 million people have chronic kidney disease.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298c212648-1f5a-4ad7-b425-b848803f9d3b Worldwide, over 840 million people have chronic kidney disease.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290ee6038b-49a1-4f4c-8ccf-7d5f8f258db9 However, not everyone with chronic kidney disease has diabetes. In the United States, just under 30 million people are diagnosed with diabetes.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e204578c-3a01-4f9f-98ed-f4917cd9ee4b About half of the people with type 2 diabetes, as well as one in three people with type 1 diabetes, will also experience diabetic kidney disease.e60dc2a1-f33c-4a05-9b50-8e3e8e59762941f9c08c-d504-4498-9e59-9cc3e8048489 Ultimately, an estimated 750,000 people have stage 4 kidney disease, while approximately 325,000 people have stage 5 kidney disease, or kidney failure, in the United States.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d47a3003-bcf2-4cee-8af6-69d3f7c28e18
Disparities and Inequities in Diabetic Kidney Disease Disparities and Inequities While diabetic kidney disease can affect anyone, some people are more likely to develop the condition or struggle to receive appropriate diagnosis and treatment. People in low-income countries may have limited access to preventive care and are less likely to receive early treatment for chronic kidney disease.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294b1cf22d-18b8-4a5a-916a-784aa306b549 Non-Hispanic Black adults have the highest rates of chronic kidney disease in the United States.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d40a7264-7b08-4a35-b70a-c82572c3c0d5 Additionally, Native American and Hispanic adults in the United States have experienced increased rates of end-stage kidney disease from diabetic kidney diseasee60dc2a1-f33c-4a05-9b50-8e3e8e5976294b1cf22d-18b8-4a5a-916a-784aa306b549 It’s possible that these disparities are due to inequalities in the social determinants of health, such as healthcare access and economic stability. In the United States, people with financial insecurity, limited access to quality nutrition, limited access to green spaces, increased exposure to air and water pollution, limited access to medical care, and a lack of health insurance may also be at an increased risk for diabetic kidney disease.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290ad185ff-fc52-4b94-8e5f-57b02001268e
Support for Diabetic Kidney Disease Support Renal Support Network (RSN) This nonprofit helps people with kidney disease nationwide, helping connect them with others who are going through similar health experiences. It provides resources like virtual support groups, a peer support hotline, a blog, and a podcast all focused on providing support to people with chronic kidney disease. American Association of Kidney Patients Founded in 1969, AAKP serves as an advocate for people with kidney disease to help improve patients’ treatment. It provides educational resources and seeks to foster community among people with kidney disease by connecting them with renal support groups in five states, as well as virtual support group options. National Kidney Foundation This group helps raise awareness of kidney disease and helps fund advancements in kidney disease research and treatment. It hosts a number of events in several states annually and provides a number of community resources, such as NKF Peers, which connects those affected by kidney disease with a mentor.
The Takeaway Diabetic kidney disease is chronic kidney disease that occurs as a complication of diabetes. Early stages of diabetic kidney disease are often asymptomatic, but more advanced stages are typically marked by nausea, vomiting, fluid buildup, fatigue, and abnormal urine output. While there isn’t a cure for diabetic kidney disease, blood glucose management, medications, and lifestyle modifications can all play a significant role in managing the condition and maintaining quality of life. Early intervention is the best way to slow or halt the progression of diabetic kidney disease, so annual screenings for people with diabetes are critical.
Resources We Trust Mayo Clinic: 5 Nutrition Tips for Chronic Kidney DiseaseNational Kidney Foundation: Diabetes – A Major Risk Factor for Kidney DiseaseAmerican Diabetes Association: Keep Your Kidneys HealthyCleveland Clinic: Improving Management of Diabetes and Chronic Kidney DiseaseAmerican Heart Association: The Connection Between Diabetes, Kidney Disease and High Blood Pressure

Read the full article here