Fact sheet Diabetes and kidney disease
Diabetic kidney disease (also known as diabetic nephropathy) is a chronic, progressive disease characterized by:
- increasing amounts of protein albumin in the urine (known as microalbuminuria)
- rising blood pressure
- failing kidney function
The deterioration that characterizes diabetic kidney disease takes place in and around the glomeruli, the blood filtering units of the kidneys.
In diabetes, blood glucose levels in the blood affect small blood vessels in the whole body. These vessels can become damaged and stop working properly. When small vessels in the kidneys are damaged, the filtering process is affected. Waste builds up in the blood whereas other valuable substances such as proteins “leak” out into the urine.
If this progresses, kidney disease can ultimately lead to kidney failure (also called end-stage renal disease (ESRD)), which if left untreated results in death.
Diabetic kidney disease can be prevented or slowed down by controlling the following:
Blood pressure
- Antihypertensive drugs (drugs used to lower blood pressure) can help slow the progress of diabetic kidney disease significantly.
- ACE (Angiotensin-Converting Enzyme) inhibitors have proven effective in preventing the progression of kidney disease to its later stages.
- Diuretics, Beta-blockers, and Calcium channel blockers may all enhance blood pressure control in people with diabetes and help stop or slow the onset of diabetic kidney disease.
Diet
- Reduced amounts of proteins help lower blood pressure and reduce the rate of fall of the glomerular filtration rate.
Non-Smoking
- Stopping smoking can prove more effective than any pharmaceutical intervention. It significantly reduces the risk of disease progression.
Dyslipidaemia (abnormal amounts of lipids or fats in the blood)
- Cholesterol lowering agents (statins), which treat dyslipidaemia decrease the level of protenuria and preserve the kidney filtration function in people with chronic diabetic kidney disease.
Other factors
- Tight glucose control
- Weight loss
- Exercise
- Reduction of alcohol intake
The main treatment options for a person with end-stage kidney disease are:
Haemodialysis: the person is attached to a blood dialysis machine for several hours 2 or 3 times a week. The blood circulates around an artificial filter in the dialysis machine, so that waste products and toxins are removed and the ‘cleaned’ blood can be returned to the person.
Transplantation: A healthy kidney is transferred from one person to another. However, a transplanted organ will immediately be recognized as ‘foreign’ by the body’s immune system, leading to organ rejection and failure. Therefore, large doses of drugs that suppress the body’s immune system (immunosuppressants) are prescribed.
These treatments, however, are very expensive: dialysis costs around €30,000 per person per year, while a kidney transplant costs approximately €12,000 for the first year and then €5,000 per year thereafter.
- Diabetic kidney disease occurs in approximately one third of all people with diabetes.
- Kidney failure typically occurs after 20-30 years of diabetes.
- In type 2 diabetes, the risk of developing cardiovascular disease is 2-3 times higher in someone with microalbuminuria compared to a person with normal albumin excretion.
- Type 2 diabetes has become the most frequent condition in people with kidney failure in countries of the Western world. The reported incidence varies between 30% and 40% in countries such as Germany and the USA.
- Stopping smoking can reduce the risk of disease progression by 30%.
1. Diabetes and Kidney Disease - Time to Act; International Diabetes Federation, 2003
- Download the IDF leaflet 'Your Guide to Diabetes and Kidney Disease' (pdf file)
- Read the special issue of Diabetes Voice on diabetes and kidney disease.
