Diabetes and Nephropathy (Kidney Complications)

Diabetes is a disease that affects the body's ability to produce or respond to insulin, a hormone that allows blood glucose (blood sugar) to enter the cells of the body and be used for energy. Diabetes falls into two main categories: type 1, which usually occurs during childhood or adolescence, and type 2, the most common form of the disease, which usually occurs after age 45, but is increasingly being diagnosed in children and adolescents.

Diabetes is the fifth-deadliest disease in the United States, and it has no cure. The total annual economic cost of diabetes in 2002 was estimated to be $132 billion, or one out of every 10 health care dollars spent in the United States.

What kidney problems can be caused by diabetes?

Kidney disease, or nephropathy, is a frequent complication of diabetes, both type 1 and type 2, and often ends in end-stage renal disease (kidney failure).

• Ten to 21% of all people with diabetes have nephropathy.



• Diabetes is the leading cause of end-stage renal disease. Diabetic nephropathy is a progressive disease that takes several years to develop. Many tiny blood vessels in the kidney act as filters to remove wastes, chemicals, and excess water from the blood. In diabetic nephropathy, these blood vessels are damaged, become leaky, and protein eventually spills into the urine (proteinuria). Eventually, the damaged filters are destroyed, putting more stress on the remaining filters and eventually causing them to become damaged. When the entire filtration system breaks down, the kidneys fail to function, and this is called end-stage renal disease (ESRD). ESRD is a condition where the patient requires dialysis or a kidney transplant in order to live.



• Approximately 43% of new cases of ESRD are attributed to diabetes.



• In 2000, 41,046 people with diabetes initiated treatment for end-stage renal disease, and 129,183 people with diabetes underwent dialysis or kidney transplantation.



• ESRD incidence attributed to diabetes is increasing more rapidly than ESRD due to other causes. From 1988 to 1991, diabetes accounted for 33.8% of new ESRD cases, up from 23% of new cases in 1982. By 1999, this number reached 43%.



• In the United States, the incidence of reported ESRD in people with diabetes is more than 4 times as high in African Americans, 4 to 6 times as high in Mexican Americans and 6 times as high in Native Americans than in the general population of diabetes patients.



• The risk of ESRD is 12 times as high in people with type 1 diabetes as in those with type 2 diabetes.



• In patients with type 1 diabetes who develop persistent proteinuria (protein in the urine), ESRD or death usually follows after about 5-10 years.

Can diabetes-related kidney problems be prevented?

• The key to preventing diabetes-related kidney problems begins with good control of blood glucose levels, control of blood pressure and regular screening by a health care professional.



• The Diabetes Control and Complications Trial (DCCT), a 10-year study which ended in June 1993, proved among type 1 patients that improved blood glucose control can prevent the onset and delay the progression of diabetic nephropathy. Therapy that keeps blood glucose levels as close to normal as possible reduced damage to the kidneys by 35-56%. (New England Journal of Medicine, September 30, 1993)



• Because a person with diabetes can develop nephropathy and not know it, a regular visit with a health care professional is essential. Regular visits with a health care professional can detect proteinuria early and possibly prevent ESRD.

Research has shown that certain blood pressure drugs, called ACE-inhibitors, can reduce the progression of diabetic kidney disease.

What is needed?

In ideal circumstances, patients with diabetes will have their disease under good control and be monitored frequently by a health care team knowledgeable in the care of diabetes.

• Health care team education is vital. Because people with diabetes have a multi-system chronic disease they are best monitored and managed by health care professionals trained with the latest information on diabetes to help ensure early detection and appropriate treatment of the serious complications of the disease. A team approach to treating and monitoring this disease serves the best interests of the patient.



• Patient education is critical. People with diabetes can reduce their risk for complications if they are educated about their disease, learn and practice the skills necessary to better control their blood glucose, blood pressure, and cholesterol levels, and receive regular checkups from their health care team. Smokers should stop smoking, and overweight people with diabetes should develop moderate diet and exercise regimens under the guidance of a health care provider to help them achieve a healthier weight.