This blog was written by Cami Bremer, MPH, RD, LD, DCES
How does diabetes affect the kidneys? 40% of people living with diabetes will develop kidney disease. Diabetes is a disease that causes high blood sugar. This can be caused by lack of insulin or defects in the way the body uses insulin. Diabetes can cause damage to the kidneys, heart, blood vessels, and nerves, increasing the risk of progression of kidney failure in people with diabetes. It is the leading cause of kidney failure.
Kidney Function and Health
The kidneys play a vital role in the body. They are responsible for filtering blood. This removes waste and water (urine) and helps control blood pressure (BP). One function that Many people are not aware of is the role of kidneys in hormone production relating to bone health and red blood cell production.
The kidneys consist of nephrons, which are tiny filtering units. The nephrons filter blood to remove toxins and fluid resulting in urine production.
So, how does Diabetes impact Kidney Health?
Kidney damage related to diabetes is called diabetic nephropathy.
People living with diabetes have a higher risk of kidney failure due to multiple factors. Elevated blood sugar levels can cause weakening of blood vessels. This weakening leads to damage to the nephrons, resulting in less filtering abilities. People with diabetes with high blood pressure may also have hardening of the arteries (atherosclerosis) causing further damage to the vessels and nephrons. Elevated blood sugar can also impact urinary health, increasing the risk of a urinary tract infection (UTI). In addition, nerve related damage (neuropathy) can cause damage to the bladder, causing increased risk of UTIs and backed up urine, which can lead to kidney damage.
Stages of Diabetic Kidney Disease
Kidney disease in diabetes is identified by Stage 1-5. The stages are diagnosed through a routine blood test called glomerular filtration rate (GFR). The chart below describes the stages of chronic kidney disease (CKD) with a description of kidney damage and the GFR for each stage.
Stage 1 and 2: People in these stages generally have few or no symptoms and can maintain healthy kidneys by maintaining healthy habits, good blood sugar control and normal blood pressure. You should have routine blood work and urine tests done to manage progression of disease.
Stage 3 and 4: People in these stages may need to make some dietary and lifestyle changes to prevent progression of disease. You may experience mild to moderate symptoms related to declining kidney function. In these stages, you will need more frequent blood work and monitoring of symptoms. These stages may require some medical interventions.
Stage 5: This is End Stage Renal Disease (ESRD), generally requiring dialysis or a kidney transplant.
National Kidney Foundation
Early stages of kidney damage usually have no symptoms and may only be diagnosed through blood and urine tests. Later stages may have symptoms including nausea, vomiting, weakness, fatigue, itching, muscle cramps, anemia, swelling, and increased urination.
People with diabetes should routinely monitor GFR, blood urea nitrogen, creatinine, hemoglobin A1c (3 month blood sugar test), and blood pressure. In addition, urine tests should be done at least annually to monitor for protein loss in the urine.
Prevention and Management of Diabetic Kidney Disease
As with any chronic medical condition, it is important for people living with diabetes to make lifestyle changes to prevent further damage. As discussed earlier, controlling blood sugar and BP is important to prevent damage to the vessels of the kidneys. People living with diabetes should discuss these options with their provider or diabetes educator. The good news is that there are many options for diabetes management and you can find the right one for you. We will discuss some of those medications in the next section.
Diabetes has seen big changes in blood sugar management. People living with diabetes now have options of continuous glucose monitoring (CGM). These monitors can give you real time data on your phone or device and allow you to share data with your provider. There have been numerous advances in insulin pump technology, eliminating the need for multiple daily insulin injections. These technologies have allowed for improved blood sugar control, reducing the risk of complications.
As with all chronic medical conditions, it is important to make healthy lifestyle choices to help prevent further damage to the kidneys. This is our primary concern at Kidney Health Clarity. If you’re interested in learning how we can help you with this, please schedule a free call!
Recap
Diabetes is the leading cause of kidney failure due to elevated blood sugar that causes damage to the nephrons. In addition, people with diabetes have a higher risk of heart disease and high BP which can further damage the kidneys,
People living with diabetes should see their provider every 3 months and have regular blood work to monitor blood sugar, BP, and labs that indicate kidney disease. In addition, they should work with their diabetes educator, dietitian and other members of the health care team to discuss blood sugar management strategies and lifestyle changes that can help prevent complications. Their team can discuss management options that work best for the individual.
Want to find out how we can help you?
If you are ready to talk about how we can help you gain clarity in what to eat, overcome food fears, and stay off dialysis, just schedule a call. I would love to hear from you!
References
https://www.kidney.org/kidney-topics/chronic-kidney-disease-ckd
Thank you! Very informative.
Thank you. Very informative.
Thank you! Glad you benefitted from it.
Good summary of stages 1-5.
I want primary care physicians to begin alerting their patients at stage 2, instead of waiting until stage 3. I would have done more sooner.
My daughter had an eGFR of 89, early stage 2. When she asked her primary physician about it, he said they don’t act until stage 3.
I totally agree. Also, getting a diagnosis even at stage 3 can be challenging, because it requires a GFR of <60 for 3 months. If the doctor doesn't specifically follow up with repeat labs, CKD can go undiagnosed for quite a while. Some labs don't even flag a GFR of less than 60, so it can easily go unnoticed if the doctor isn't looking for it.