Kidney Disease and Diabetes

Kidney damage is one of the long-term health problems that can happen with diabetes. This damage is often called diabetic kidney disease. It develops slowly because high blood sugar can harm the tiny blood vessels in the kidneys. If the damage becomes more severe, it can lead to kidney failure, the most advanced stage of kidney disease.

The cardiovascular, kidney, and metabolic (how the body creates, stores and uses energy) systems have different jobs, but together they affect your overall health. When blood sugar stays high, it can damage the blood vessels in the kidneys and heart.

Understanding chronic kidney disease

Your kidneys act as filters for the body. They remove waste and extra fluid from your blood through your urine. When the kidneys stop working the way they should over time, it is called chronic kidney disease (CKD). CKD usually develops slowly over many years, and once it reaches later stages, it cannot usually be reversed. That’s why finding kidney problems early is so important.

• Early kidney disease, sometimes called renal insufficiency
  In the early stages, kidney disease often has no symptoms, even though damage is happening. The only way to detect it early is through regular testing:
  • Blood tests to check how well your kidneys filter waste
  • Urine tests to look for protein called albumin

If you are living with diabetes, regular kidney testing gives you the best chance to catch kidney damage early so you can slow or prevent it from getting worse. You can help protect your kidneys by keeping blood sugar in a healthy range, controlling blood pressure, maintaining a healthy weight, being physically active and not smoking.

• Kidney failure, or end-stage renal disease
  Kidney failure means the kidneys can no longer filter waste properly. Waste builds up in the blood and can cause serious problems. Symptoms may include swelling in the legs or face, nausea or vomiting, loss of appetite, feeling very tired, trouble thinking clearly, headaches, and changes in urine or how often you urinate. Treatment options may include hemodialysis, peritoneal dialysis or a kidney transplant. Your health care team will help guide you in choosing the treatment that is right for you.

How does diabetes increase kidney disease risk?

High blood sugar makes the kidneys work harder than normal. Over time, this can damage the blood vessels and strain the kidneys that filter waste. One of the earliest signs of kidney damage is when a protein called albumin leaks into the urine. The American Diabetes Association recommends that people living with Type 2 diabetes get a urine test called urine albumin-to-creatinine ratio (UACR) when diagnosed with Type 2 diabetes and at least once a year after that. This test helps find kidney damage early, before symptoms appear.

What is the uACR test? (PDF)

Another important test is the estimated Glomerular Filtration Rate (eGFR), a blood test that shows how well your kidneys are working. The test checks your creatinine level. Learn more about the eGFR test (PDF)

Not everyone living with diabetes develops kidney disease. The better blood sugar and blood pressure are managed, the lower the risk. Learn more about managing risks with an annual kidney screening (PDF).

How are cardiovascular disease and chronic kidney disease related?

Kidney disease and cardiovascular disease (CVD) are closely linked because both involve damage to blood vessels. In fact, heart disease is one of the leading causes of death in people living with CKD.

Many risk factors for kidney disease also raise the risk of heart disease and stroke, including:

• High blood pressure
• Diabetes
• Abnormal lipids (cholesterol/triglycerides)
• Smoking
• Low physical activity
• Excess weight/obesity
• Older age
• Family history of kidney failure
• Having ancestry from Black American, Hispanic/Latino American, Native American, Asian American or Pacific Islander

This connection is why healthcare professionals focus on protecting heart health, kidney health and metabolic health together.

What should I do if I have diabetes?

Many risks for kidney and heart disease can be treated or managed. If you have diabetes, you can help protect your kidneys by:

• Keeping blood sugar in a healthy range
• Managing blood pressure
• Managing lipids (cholesterol & triglycerides)
• Eating a healthy diet
• Maintaining a healthy weight
• Staying physically active
• Not smoking
• Working with your healthcare team to monitor your urine albumin and kidney function

Small steps taken consistently can make a big difference in protecting your kidneys, heart and long-term health.

Fact sheet: The Link Between Type 2 Diabetes and Chronic Kidney Disease (PDF)