Kidney Disease and Diabetes
One of the more common long-term complications of diabetes is kidney damage. Also known as diabetic nephropathy or diabetic kidney disease (DKD), this condition is a result of vascular abnormalities that accompany diabetes and increases mortality risk. Furthermore, diabetes mellitus is a main risk factor for end-stage renal disease (ESRD), the most advanced stage of kidney disease.
Chronic Kidney Disease (CKD) Basics
Kidney disease means the kidneys can’t filter blood and make urine like they should. Chronic kidney disease occurs slowly over many years and usually cannot be reversed.
- Early kidney disease, sometimes called renal insufficiency, may have no signs or symptoms
You may not feel any different until the disease is advanced but the damage is still being done. Blood tests to check kidney filtration rate and urine tests to check for protein in your urine are the only ways to find out if you have kidney disease at this stage. It’s important to be tested for kidney disease if you have diabetes so it can be detected early and treated to slow progression of the damage. Keeping your blood sugar and blood pressure under control in your target range is very important to slow kidney disease. Losing weight, getting regular exercise and not smoking are great ways to help control blood sugar and blood pressure. - Kidney failure, or End-stage renal disease (ESRD)
Kidney failure means damage to the kidneys has progressed to the point that they are not doing a good job of filtering wastes such as urea and creatinine from the blood so it can be excreted in the urine. The waste buildup can make you sick and you may have these symptoms: swelling of the ankles, face or belly, vomiting, loss of appetite, fatigue, weakness, confusion and headaches. Treatments for kidney failure may include: hemodialysis, peritoneal dialysis, or kidney transplant. It’s important to work with your doctor to decide which treatment will be best for you.
How does diabetes increase the risk for kidney disease?
High levels of blood sugar make the kidneys work harder to do their job of filtering, which over time can damage them so that they start to leak small amounts of protein (albumin) into the urine. That's why detecting albumin in a urine test means that the kidneys are damaged. Not everyone with diabetes develops kidney disease. Factors that can influence kidney disease development include genetics, blood sugar control, and blood pressure. The better a person keeps diabetes and blood pressure under control, the lower the chance of getting kidney disease.
How are cardiovascular disease (CVD) and kidney disease related?
People with CKD have an increased risk for cardiovascular disease (CVD) mostly due to problems with the blood vessels. Most patients with CKD die as a result of cardiovascular complications rather than progress to ESRD.
Risks that are often associated with kidney disease are also associated with atherosclerosis, and contribute to the risk of developing cardiovascular disease and stroke.
- High blood pressure (hypertension)
- Diabetes
- High LDL ("bad") cholesterol
- Low HDL ("good") cholesterol
- Smoking
- Lack of physical Activity
- Older age
What should I do if I have diabetes?
Many of the risk factors for kidney disease and CVD are treatable. If you have diabetes, take these steps:
- Keep your blood sugar levels in the normal range.
- Control your blood pressure.
- Manage your weight.
- Work closely with your health care team to ensure your urine albumin levels are being monitored. (The American Diabetes Association suggests that people with type 2 diabetes should be screened for urine albumin levels at the time of diagnosis and once a year thereafter.)
