Chronic kidney disease (CKD) is quite common among the diabetes population. In fact, it’s estimated that as many as 40% of people with diabetes will develop CKD within their lifetime.
Perhaps more alarming, however, is the number of people who are unaware that they are at risk for kidney disease, simply because the topic has never been brought up in a healthcare appointment.
“I was diagnosed with CKD in 2009 and was already at stage 3b. I did not know anything before that since my doctor and I never had a conversation,” said Jane DeMeis, a patient advocate, peer mentor, and ambassador for the National Kidney Foundation and the Know Diabetes by Heart initiative.
“It wasn’t until I started passing kidney stones that I had the conversation. For those at higher risk, getting a simple kidney test should be automatic at the doctor’s office. For patients who don’t understand CKD, the conversation should happen early. Early detection is the best solution to this problem,” she said.
Researchers continue to work toward pinpointing the causes of CKD and its link to diabetes. While there is still no cure, there are ways to detect, prevent, and help stop the progression of this complication.
What do kidneys do?
The kidneys are two organs that filter blood, balance the body’s fluids, and regulate blood pressure. The kidneys are responsible for cleaning out waste, which is excreted from the body as urine. They also help keep bones healthy and produce several vital hormones.
Most people have two kidneys, located near the lower back. When a kidney is damaged, it can no longer filter blood as effectively. Many people lead healthy, happy lives with just one kidney if the other is damaged or injured and needs to be removed.
What is chronic kidney disease?
Also known as chronic renal disease or nephropathy, CKD occurs when the kidneys cannot properly filter the fluids that pass through them. Diabetes can lead to CKD as high blood sugar levels over time can damage tiny blood vessels in the kidneys. Other major causes of CKD include high blood pressure and heart disease.
CKD is divided into five stages:
Symptoms of chronic kidney disease
CKD can cause a wide variety of symptoms due to excess waste in the blood, including:
- Itching
- Muscle cramps
- Nausea and vomiting
- Loss of appetite
- Swelling in the feet and ankles
- Too much urine or not enough urine
- Trouble catching your breath
- Trouble sleeping
However, oftentimes there are no symptoms until significant kidney damage has occurred, which is why CKD is sometimes referred to as a “hidden” complication. This is why it is so important to get regular testing done.
How is chronic kidney disease detected?
Healthcare professionals do a blood and urine test to check kidney health. Ask your healthcare professional to measure both:
- UACR: A urine test that measures your urine albumin-to-creatinine ratio
- eGFR: A blood test that calculates your estimated glomerular filtration rate
The combination of these two numbers allows your clinician to determine the overall condition of your kidneys and the appropriate intervention. Based on these results, you may be referred to a registered dietician, diabetes educator, or nephrologist (kidney specialist).
What is UACR?
UACR measures the amount of albumin, a protein that can be present in the urine when the kidneys are damaged. A UACR of more than 30 mg/g is a marker for kidney disease. This can be an early marker of kidney damage and may occur before eGFR declines. It’s also important to note that sometimes people with CKD will not have albumin in the urine. Therefore, both eGFR and UACR should be measured in all adults with diabetes.
What is eGFR?
eGFR is the rate at which fluids are filtered through the kidneys. eGFR is the main measurement used to determine how well the kidneys are working. eGFR is measured by ml/min/1.73m2. Those units refer to how many milliliters (ml) of fluid are filtered every minute, adjusted for the standard value for the body’s surface area (1.73m2). In adults without kidney disease, the standard eGFR is 100-130 ml/min/1.73m2. Someone who has an eGFR below 60 ml/min/1.73m2 for at least three months is considered to have CKD.
How often should kidney function be tested?
People with kidney disease often do not show symptoms until their kidneys are damaged, so regular kidney testing is important.
“One of the most important insights we’ve had about diabetes is that kidney damage starts early and is silent,” said Dr. James Gavin, clinical professor of medicine at Emory University School of Medicine and former president of the American Diabetes Association (ADA).
“As many as 10% of people already show signs of kidney damage when they are diagnosed with diabetes,” Gavin said. “We now have tools to help us start early treatment. In order to address a problem, you have to know that it’s there and how severe it is. You’d want to know that there’s a leak in your roof when it’s small, so you can act on it before it gets worse.”
If you have diabetes, ask your healthcare team to test your kidney function every year. People with type 2 should get tested every year, and those with type 1 every year after they’ve had diabetes for five years.
How is chronic kidney disease treated?
CKD can ultimately result in kidney failure (also known as end-stage renal disease), which can only be treated with dialysis or a kidney transplant. While there is no cure for CKD, treatments today can dramatically slow the progression of CKD, especially if started early.
If you are diagnosed with CKD, your healthcare team will work to slow further damage to your kidneys. Several glucose-lowering drugs called SGLT-2 inhibitors – including Farxiga, Invokana, and Jardiance – are approved for CKD and can help slow or prevent loss of kidney function in people with type 2 diabetes (they are not currently approved for people with type 1 diabetes without CKD due to an elevated risk for diabetic ketoacidosis). SGLT-2 inhibitors work by blocking your kidneys from reabsorbing glucose and sodium back into your bloodstream. This can lead to better metabolism, lower blood pressure, and improved heart function.
GLP-1 receptor agonists for managing blood sugar, like Ozempic, can also be used to prevent CKD from worsening. Your healthcare team may also prescribe medications to lower your blood pressure (like ACE inhibitors or ARBs), which can help slow the progression of CKD.
Medications are not the only treatment option, however. In particular, lifestyle changes like exercise and balanced nutrition may be one of the first things that your healthcare team will focus on. A healthy diet and physical activity can work together with your medications to help control CKD.
“In 2017, I went back to my nephrologist, who said I should be preparing for dialysis within six months,” DeMeis said. “I changed my lifestyle, lost about 38 pounds, and felt much better. After struggling again in 2020, I visited a renal dietician and started on a plant-based diet. I have felt great since and have yet to start dialysis.”
Preventing chronic kidney disease
Though there is no cure for CKD, the good news is that there are steps you can take to prevent it. If you live with diabetes, managing your blood sugar (and blood pressure) can significantly delay CKD. Getting regular exercise and eating a nutritious diet are also important for protecting the kidneys.
As mentioned, screening is critical – if your healthcare provider hasn’t mentioned regular testing, bring it up in your next appointment. Getting your kidney function tested each year can catch any issues early and allow for more timely treatment to prevent further damage.
What can you do to support healthy kidney function?
Whether or not you already have kidney disease, there are several ways you can support kidney health:
- Have your healthcare provider test your kidney function (UACR and eGFR) at least once per year
- Manage your blood glucose levels and keep them in range (70-180 mg/dL)
- Keep your blood pressure at target levels (commonly below 130/80 mmHg)
- Exercise regularly (150 minutes of exercise per week or 10,000 steps per day are great targets)
- Lose weight, if needed
- Eat a healthy, balanced diet. Choose foods low in sodium, phosphorus, and potassium, and avoid foods with added sugar
- Take your medications consistently and as directed by your healthcare team. Ask about SGLT-2 inhibitors and GLP-1s if you are not already taking them.
- Avoid or quit smoking
The bottom line
Chronic kidney disease is one of the most common diabetes-related complications. It’s often called a silent complication as its symptoms can go unnoticed until the disease has progressed to later stages. For people with diabetes, it’s important to get screened every year. Other things you can do to protect your kidneys include getting regular exercise, eating foods that support kidney health, and keeping your blood pressure at target levels.
Learn more about diabetes and kidney health here:
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