Myths and Facts of Kidney Complications of Diabetes: A Primer for Patients
Ria Mari Sebastian Siao, MD
Myth: Kidney disease in diabetes is rare.
Fact: Diabetes is the #1 cause of kidney disease. About one third of adults with diabetes will develop diabetic kidney disease.
How does diabetes cause kidney disease?
High blood sugar levels can damage the blood vessels in the kidneys. Over time, they start to leak small amounts of protein (albumin) into the urine, affecting the kidneys’ job of removing waste products and extra fluid from the body. This is known as Diabetic Kidney Disease (DKD), Diabetic Nephropathy, or Chronic Kidney Disease (CKD). This progressive damage can lead to renal failure or end-stage renal disease (ESRD).
Myth: You’d know if you have kidney disease.
Fact: Most people with diabetic kidney disease do not have symptoms. Kidney damage can begin 5 to 10 years before symptoms start.
How can I tell if I have diabetic kidney disease?
The kidneys try to compensate for the defective capillaries, so no symptoms are felt until almost all function is gone. For those with diabetes, regular screening should be done. Two key markers for kidney disease are urine albumin and estimated glomerular filtration rate (eGFR).
Urine albumin. The earliest sign of diabetic kidney disease is an increased excretion of albumin in the urine, measured by comparing the ratio of albumin to creatinine in a single urine sample. Kidney disease is present when urine contains more than 30 milligrams of albumin per gram of creatinine.
eGFR. This is calculated based on creatinine, a waste product. As creatinine levels in blood goes up, the eGFR goes down. Kidney disease is present when eGFR is less than 60 mL/ min/1.73 m2.
The American Diabetes Association (ADA 2019) recommends: At least once a year, assess urinary albumin and eGFR in patients with type 1 diabetes with duration of >5 years, in all patients with type 2 diabetes, and in all patients with comorbid hypertension.
In later stages of kidney disease, signs and symptoms may be present. Though the symptoms of kidney disease are not specific, these may include (but are not limited to): weight gain, swelling of feet, ankles, hands or eyes, increased need to urinate, worsening blood pressure control, difficulty concentrating, loss of appetite, nausea and vomiting, persistent itching, and fatigue.
Myth: There’s nothing you can do about getting kidney disease.
Fact: Most cases of kidney disease could be prevented.
Who Gets Kidney Disease?
Not everyone with diabetes develops kidney disease. Risk factors include family history, poor blood glucose control, high blood pressure, smoking, and obesity.
How to prevent it?
The best way to prevent diabetic kidney disease is to keep blood glucose and blood pressure under control. Lifestyle habits like maintaining a healthy weight, keeping active, limiting salt and sodium in the diet, taking medicines as prescribed, and stopping smoking also can help to reach blood glucose and blood pressure goals.
Myth: Oral medications such as metformin destroy the kidneys.
Fact: Oral medicines for diabetes can keep your sugar level at a target range.
Antidiabetic medicines should be started as soon as a doctor advises, in order to prevent kidney damage and complications in the other organs.
How to treat Diabetic Kidney Disease?
Early treatment by maintaining a healthy lifestyle and managing the diabetes and high blood pressure may prevent or slow disease progression and reduce the chance of complications.
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Some of the treatment recommendations of the ADA 2019 for diabetic kidney disease include:
Blood pressure levels <140/90 mmHg are generally recommended. Lower blood pressure targets (e.g., <130/80 mmHg) may be considered for patients based on individual anticipated benefits and risks.
For those not on dialysis, dietary protein intake should be approximately 0.8 g/kg body weight per day (the recommended daily allowance). For patients on dialysis, consider higher levels of dietary protein intake.
In nonpregnant patients with diabetes and hypertension, either an ACE inhibitor or an angiotensin receptor blocker is recommended for those with modestly elevated urinary albumin-to-creatinine ratio (30–299 mg/g creatinine) and is strongly recommended for those with urinary albumin-to-creatinine ratio >300 mg/g creatinine and/ or estimated glomerular filtration rate <60 mL/min/1.73 m2.
Patients should be referred for evaluation for renal replacement treatment if they have an estimated glomerular filtration rate <30 mL/min/1.73 m2.
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The American Diabetes Association (ADA 2019) recommends: At least once a year, assess urinary albumin and eGFR in patients with type 1 diabetes with duration of >5 years, in all patients with type 2 diabetes, and in all patients with comorbid hypertension.
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