The impact of Chronic Kidney Disease in Type 2 Diabetes is far-reaching
The prevalence of Type 2 Diabetes (T2D) and Chronic Kidney Disease (CKD) are increasing worldwide. Individually, these conditions are linked to mortality, high cardiovascular risk, and the development of macro- and microvascular complications.
Research suggests high blood pressure may be the most important predictor for diabetics developing chronic kidney disease. Specific high blood pressure medications such as angiotensin converting enzyme (ACE) inhibitors and the angiotensin-2 receptor blockers (ARBs) may be the most effective in preventing diabetic kidney disease. It is important for diabetics to keep their blood pressure lower than 130/80.
Signs that diabetics may be developing chronic kidney disease include protein in the urine, high blood pressure, leg swelling or cramps, increased need to urinate (especially at night), abnormal blood tests (glomerular filtration rate, GFR), less need for insulin or anti-diabetic pills, nausea and vomiting, weakness, pallor and anemia, itching and diabetic eye disease.
Treatment for diabetic kidney disease includes controlling blood pressure and blood sugar levels, reducing dietary protein intake, avoiding medications that may damage the kidneys, treating urinary tract infections and exercise and weight loss (under the supervision of a physician).
Facts About T2D and CKD
• 29 million Americans have T2D
• 40% of Type 2 Diabetes patients will develop CKD
• Diabetes damages small blood vessels throughout the body, affecting the kidneys as well as other organs and tissues including skin, nerves, muscles, intestines and the heart
• Increased risk of cardio vascular events appears early in CKD and grows over time
• Chronic kidney disease can shorten life expectancy of T2D patients by up to 16 years
• Prevalence of end-stage kidney disease is 10 times higher in patients with diabetes compare to those without
• Patients with CKD and T2D are 3 times more likely to die from cardio vascular disease than patients with T2D alone
• Once a patient has reached end-stage kidney disease, 60% will die within the next 5 years
Even with adequate control of contributing factors such as hyperglycemia and hypertension in T2D, inflammation and fibrosis have also been found to play a significant role in kidney disease progression. Patients with chronic kidney disease often experience chronic inflammation that can lead to cardiovascular disease and even an increased rate of death.
Inflammation prevention and treatment in people with CKD usually begins with a healthy, kidney-friendly diet. To prevent malnutrition, focus should be on adequate calorie and protein intake and foods that contain antioxidants.
Some additional considerations in treating chronic inflammation include correction of anemia and vitamin D deficiency, increased exercise and weight loss. Obesity is known to increase CRP (creatine reactive proteins) and cytokines. Weight loss in obese individuals decreases inflammation by decreasing CRP and cytokine levels.
Research continues to identify potential treatments for fibrosis in chronic kidney disease patients.