Diabetes Is the Leading Cause of Kidney Failure

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Diabetes is the leading cause of kidney failure - National Kidney Foundation

Chronic Kidney Disease

Chronic Kidney Disease (CKD) usually develops slowly over a period of time with very few symptoms. Sometimes people do not realize there is a problem with their kidneys until the disease has advanced to a stage that requires dialysis or a kidney transplant to survive. 

If you have diabetes you should have your kidneys checked on a regular basis by your doctor or other healthcare provider.  They are able to check how well your kidneys are functioning with simple blood and urine tests.  Regular testing is the best chance of diagnosing CKD early if you do develop it, and early treatment of chronic kidney disease is the most effective and can help to prevent additional health problems. 

Diabetes

Diabetes is characterized by high levels of blood sugar resulting from insufficient production of insulin or defects in insulin action in the body.  Type 2 diabetes is much more common than Type 1. Type 2 accounts for 90-95 percent of the cases of diabetes.

Risk factors for type 1 diabetes include

• Autoimmune factors
• Genetic factors
• Environmental factors

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Risk factors for type 2 diabetes include

• Obesity
• Older age
• Family history of diabetes
• Prior history of gestational diabetes
• Impaired glucose intolerance
• Physical inactivity
• Race or ethnicity

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Diabetes and CKD

Chronic Kidney Disease is very common in people with diabetes. Approximately 1 in 3 adults with diabetes also has CKD. Both type 1 and type 2 diabetes can cause kidney disease.  

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How does diabetes cause CKD?

Over time high blood sugar from diabetes damages small  blood vessels throughout the body, affecting the kidneys as  as well as other organs. The damage to the kidneys worsens over time compromising their ability to filter waste product and remove excess fluids.  Many people with Diabetes also develop High Blood Pressure. High Blood pressure also causes damage to the kidneys leading to development of chronic kidney disease. 

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‍Keeping your kidneys healthy

You play the most important role in your health.  You can help to keep your kidneys healthy by managing your blood sugar, blood pressure, and cholesterol levels . (This is also very important for your heart and blood vessel health, since high blood sugar and blood pressure and high cholesterol levels are all risk factors for heart disease and stroke). 

• Keep blood sugar levels in your targeted range, As much as possible keep blood sugar levels down and in your target range. 
• Get an A1C test. Have your A1C test done twice a year, or more often if your medications change or if you develop other health conditions.  Talk with your healthcare provider about how often you should be tested.  
• Check your blood pressure often.  You can speak with your doctor or other healthcare provider about where your blood pressure should be. Then check it often and make sure you remain in that target range.  You may also speak with your provider to see if medications may be appropriate and discuss other ways you can lower your blood pressure.  (Some research suggests that high blood pressure may be the most important predictor for diabetics developing CKD).
• Stay in your target cholesterol range
• Control sodium intake. Limit the amount of sodium, or salt in the foods you are eating.
• Add fruits and vegetables. Your daily diet should have fruits and vegetables
• Be active. Add activities to your daily routine such as taking the stairs, walking to the store. Start an exercise program, choose something you enjoy and will want to stick with. Engage in pastimes you enjoy that also have the benefit of moving your body like dancing, or walks through the neighborhood. 
• Take medications as directed.  

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‍Signs Diabetics may be developing Chronic Kidney Disease:

• Protein in urine
• High blood pressure 
• Leg swelling or cramps
• Increased need to urinate
• Abnormal blood tests
• Less need for diabetic medications
• Nausea or vomiting 
• Weakness
• Pallor and anemia
• Itching

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Treatment for Diabetic Kidney Disease

Treatment includes: controlling blood sugar and blood pressure, reducing protein in the diet, avoiding medications that may damage the kidneys, treating urinary tract infections, and exercise and weight loss under the supervision of a health care provider.  

• More than 35% of adults age 20 and older with diabetes also have chronic kidney disease.
• Some experts estimate that by the year 2050 1 in 3 US adults will have diabetes

Diabetes is more common among some ethnic groups. 

This in turn puts those at greater risk to develop CKD. Among US adults aged 20 and older, diabetes has been diagnosed in 13.2% of non-hispanic blacks, 12.8% of hispanics, 9% of Asian Americans, and 7.6% of non-hispanic whites. 

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Pre-diabetes and kidney disease

If you have pre-diabetes you should take preventive steps to halt or slow down the progression to type 2 diabetes, preventing your development of kidney disease.  According to recent research, overweight people at higher risk of developing type 2 diabetes can prevent or delay developing it by losing 5% to 7% of their body weight.  (That is approximately 10-14 pounds for a person weighing 200 pounds).  Eating healthier and exercising for 20 minutes a day is a good way to start.   

The Centers for Disease Control (CDC), has a diabetes prevention program called Lifestyle Change Program.  The goal of the program is to help people make healthy changes to prevent type 2 diabetes. You can find a program in your own community or online. 

Chronic Kidney Disease is largely preventable, but only if we are effective in preventing the health conditions that lead to it developing. Those conditions including diabetes are about educating ourselves as to how our bodies work, and what we need to do in order to keep our bodies as healthy as possible, to live a healthy and happy life.

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Video

This video by Alila Medical Media provides an overview of how diabetes can lead to Chronic Kidney Disease.

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Video Transcript

Diabetic kidney disease, or diabetic nephropathy, is kidney disease caused by diabetes. It’s a very common diabetic complication, affecting about one third of people with diabetes type 1, and half of those with diabetes type 2. Diabetic kidney disease is responsible for most of the excess mortality associated with diabetes.

Because the kidneys remove metabolic wastes, control blood pH, regulate fluid and electrolyte balance, as well as produce several hormones; loss of kidney function results in accumulation of toxic wastes, electrolyte imbalances, and a number of other health problems. The disease develops slowly over time, progressing from renal insufficiency to end-stage renal failure.

Often, initial loss of renal tissue does not produce any symptoms. Symptoms typically appear when a significant portion of kidney function is already lost. The ability to concentrate urine is usually the first to be impaired, resulting in frequent trips to the bathroom, especially at night. Other early signs include fatigue, loss of appetite, and decreased mental ability.

Chronic high blood glucose levels, together with high blood pressure caused by diabetes, bring damage to tiny blood vessels in the kidneys, affecting their functions. Cellular degeneration in the functional units of the kidneys, the nephrons, in particular the podocytes of renal glomeruli, further contributes to the impairment of renal functions.

Diabetes, especially when poorly managed, is the biggest risk factor for chronic kidney disease. Other risk factors are the same as those for high blood pressure and include smoking, having high cholesterol levels, and being overweight. Because initial loss of renal tissue does not produce any symptoms, it is important for diabetic patients to test annually for kidney functions. The tests typically include blood and urine analysis.

Prevention and management strategies consist of controlling blood sugar levels, blood pressure, and cholesterol levels; all of which can be achieved with a combination of lifestyle changes and medications.

Lifestyle measures typically include a healthy diet with low salt intake, increased physical activity, weight management, and smoking cessation. Among all blood pressure lowering medications, ACE inhibitors and angiotensin receptor blockers, which block the renin–angiotensin–aldosterone system, work best to protect kidney functions. End-stage kidney disease requires dialysis or kidney transplantation.

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References

The Center for Disease Control

The National Kidney Foundation

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About the Author

Monica McCarthy has bachelors in Political Science and Criminal Justice from Central Washington University.  A majority of her career was spent as a political consultant.   She currently works at KidneyLuv as a staff writer.

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Patient Education Disclaimer

This material is for informational purposes only. It does not replace the advice or counsel of a doctor or health care professional. KidneyLuv makes every effort to provide information that is accurate and timely, but makes no guarantee in this regard. You should consult with, and rely only on the advice of, your physician or health care professional.

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