What is the Relationship Between Kidney Issues and Diabetes?

What is diabetes?

Diabetes occurs when our body does not produce sufficient insulin or cannot use insulin properly. Insulin is a type of hormone. It controls the sugar amount in your blood. A higher level of sugar in your blood can cause problems in various parts of your body, including your kidneys, heart, brain, and eyes. With the passage of time, this can cause kidney disease and kidney failure. So, kidney issues are related to diabetes.

 

There are two major types of diabetes. Type 1 diabetes commonly begins when people are young. In this case, the body is not able to make enough insulin. Type 2 diabetes is commonly found in adults over 40, but nowadays diabetes is becoming more common in younger people. It usually tends to run in families and is linked with being overweight. In type 2 diabetes, the body can make insulin, but is unable to use it well.

 

What is chronic kidney disease (CKD)?

Our kidneys keep the rest of our body in balance. They:

 

• Remove waste products from our body

• Balance the fluids of body

• Help keep blood pressure under control

• Keep bones healthy

• Help make red blood cells

 

When you have chronic kidney disease, it means that your kidneys have been damaged. Kidneys can get damaged from diabetes. Once your kidneys are harmed, they cannot filter blood nor do other functions as well as they should.

 

Diabetic kidney disease stages

Diabetic kidney stages may include:

 

Stage 1

eGFR 90 or may be higher and some kidney damage (such as uACR 30 or higher) for about 3 months or more

 

Stage 2

eGFR 60-89 and mild kidney damage (such as uACR 30 or may be higher) for 3 months or more

 

Stage 3a

Mild to moderate loss of functioning of kidney (eGFR around 45-59 for 3 months or more)

 

Stage 3b

Moderate to severe loss of kidney functioning (eGFR about 30-44 for 3 months or more)

 

Stage 4

Severe loss of kidney functioning (eGFR 15-29 for about 3 months or more)

 

Stage 5

Kidney failure (eGFR less than 15 for about 3 months or more)
or you may need dialysis to survive

 

 Can kidney disease lead to high blood sugar?

Many people facing kidney disease also have diabetes. People with diabetes commonly experience high blood sugar, or hyperglycemia. So, kidney issues and diabetes are interrelated.

 

How does diabetes affect the kidneys? 

 Diabetes can affect the kidneys in negative way by causing damage to:

 

Blood vessels inside your kidneys

The filtering units of kidneys are filled with small blood vessels. Over time, high levels of sugar in the blood can cause these vessels to become clogged and narrow. Without sufficient blood, the kidneys become harmed and albumin (a kind of protein) passes through these filters and ends up in urine where it should not be.

 

Urinary tract

If urine remains in your bladder for a long time, you can get a urinary tract infection. This is due to bacteria. Bacteria are small organisms like germs that can cause disease. They grow quickly in urine with a high sugar level. Most commonly these infections affect the bladder, but sometimes they spread to the kidneys.

 

Nerves in your body

Diabetes leads to damage to the nerves in your body. Nerves bring messages between your brain and all parts of your body, including your bladder. They let your brain understand when your bladder is full. But if nerves of the bladder are damaged, you may be unable to feel when your bladder is full. The pressure from a full bladder may damage your kidneys.

 

How can someone know if he has kidney issues and diabetes?

Many people with early kidney damage do not experience symptoms. The best way to determine early kidney damage is to have a urine test once a year. This test checks for very minute amounts of protein in the urine known as albuminuria. It helps notice kidney damage at an early stage in people with diabetes. Not every person with kidney disease gets kidney failure. Right treatment can prevent kidney disease from getting worse.

Diabetic kidney disease treatment

The first step towards diabetic kidney disease treatment is to treat and control high blood pressure and diabetes. Treatment includes prescription medicines, diet,exercise, and lifestyle changes. Controlling blood pressure and blood sugar might prevent or delay kidney issues and diabetes.

 

Medications

In the early stages of diabetic nephropathy (kidney disease that results from diabetes), your treatment plan might include various medicines to manage the following:

 

• Blood pressure: Medicines known as  angiotensin 2 receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors are used for the treatment of high blood pressure.

 

• Blood sugar: Medicines help control high blood sugar in individuals with diabetic nephropathy. These include older diabetes medicines like insulin. Newer drugs include  glucagon-like peptide 1 (GLP-1) receptor agonists, Metformin (Fortamet, Glumetza, others), and SGLT2 inhibitors.

 

• Ask your doctor if treatments like GLP-1 receptor agonists or SGLT2 inhibitorsmight work for you. All these treatments can protect the kidneys and heart from damage due to diabetes.

 

• High cholesterol: Cholesterol-lowering drugs known as statins are used for the treatment of high cholesterol and lower protein amountsin urine.

 

• Kidney scarring: Finerenone (Kerendia) might help in reducing tissue scarring in patients with kidney issues and diabetes at the same time. Some researchhas shown that the medication might lower the risk of kidney failure. It can also lower the risk of having heart attacks, dying from heart disease, and needing to move to a hospital for treatment of heart failure in adults having CKD linked to type 2 diabetes.

 

If you take all these medicines, you need regular follow-up testing. The testing is performed to find out if your kidney issues and diabetes are stable or getting worse.

 

Treatment options for advanced diabetic nephropathy

The treatment of kidney failure, also known as  end-stage kidney disease, focuses on either making you more comfortable or replacing the work of your kidneys. Options include:

 

Kidney dialysis

This treatment removes extra fluid and waste products from the blood. Hemodialysis uses a machine that does the work of kidneys to filter blood outside the body. You might need to visit your dialysis center about 3 times a week for hemodialysis. Or a trained caregiver can perform your dialysis at home. Each session takes around 3-5 hours.

 

Peritoneal dialysis uses the inner lining of the abdomen, known as the peritoneum, for filtering waste. A cleansing fluid usually flows through a tube to the peritoneum. This treatment can be performed at home or at work. But not every person can use peritoneal dialysis.

 

Transplant

Sometimes,  a kidney-pancreas transplant or a kidney transplant is the best treatment choice for kidney failure. If you and your doctor decide on a transplant, you’ll be forced to find out if you can have the surgery.

 

Symptom management

If you have renal failure and you do not want kidney transplant or dialysis, you’ll more likely live only a few months. Treatment can help keep you comfortable.

 

How to improve your kidney issues and Diabetes?

 

You can keep your kidneys healthy by managing your cholesterol levels, blood pressure, and blood sugar. This is also very important for your blood vessels and heart because high cholesterol level, blood pressure, and blood sugar are all risk factors for stroke and heart disease. Some tips are helpful to manage kidney issues and diabetes, such as:

 

• Keep your blood sugar levels under control as much as possible

• Get an A1Cat least twice a year, more often if you have other health issues or your medicine changes. Talk to your healthcare provider about how often is right for you

• Check your blood pressure on a regular basis and keep it below 140/90 mm/Hg. Talk to your doctor regarding medicines and other possible ways to lower your blood pressure

• Eat more fruits and vegetables

• Take your medicines as prescribed

• Limit protein intake

• Be physically active

• Control your lipid and cholesterol level

• Eat foods that are lower in sodium

• Don’t use medicines that may damage your kidneys

 

How to reverse your kidney damage from diabetes?

You can’t reverse your kidney damage from diabetes that’s already been done. However, you can reduce the risk of further kidney damage. Diabetes management, healthy lifestyle habits, and keeping blood sugars under control can help you reduce your risk of kidney damage. Some medications can also improve kidney issues such as chronic kidney disease and diabetes.

 

Diabetes kidney failure life expectancy

Life expectancy for patients with diabetes complicated by early chronic kidney disease  was shortened by an average of about 16 years.