Diabetes and the kidneys

Last update: 02/03/2021
  • Diabetes, hypertension, or a combination of both, cause 80% of end-stage renal disease globally.
  • Both diabetes and chronic kidney disease are strongly associated with cardiovascular disease. Controlling blood glucose and blood pressure can reduce associated risks.
  • The most effective strategies to reduce the impact of kidney disease in diabetes are to prevent type 2 diabetes and to diagnose and treat kidney disease early and effectively in people already living with diabetes.

Atlas 8e complications image kidneyKidney disease (nephropathy) is far more common in people with diabetes than in people without diabetes. It is caused by damage to small blood vessels, which can cause the kidneys to be less efficient, or to fail altogether. Diabetes is one of the leading causes of chronic kidney disease (CKD).

Based on data from the UK and USA, up to 40% of people with diabetes will develop chronic kidney disease.Pooled data from 54 countries reveal that more than 80% of cases of end-stage renal disease (ESRD) are caused by diabetes, hypertension or a combination of both.

Diabetes, hypertension and kidney failure are highly interlinked. On the one hand, type 2 diabetes is a leading cause of kidney failure, which is a risk for hypertension, and on the other, hypertension can often precede CKD and contribute to the progression of kidney disease.

Both diabetes and CKD are strongly associated with cardiovascular disease (CVD) and therefore, the major component in their management is control of CVD risk factors such as hypertension and high blood glucose (hyperglycaemia). It is important to control blood glucose and blood pressure to reduce the risk of kidney disease. Screening for abnormal quantities of albumin in the urine (albuminuria) and starting treatment with drugs that reduce the activity of the renin-angiotensin-aldosterone system when albuminuria is persistently found, even in the absence of hypertension, is very effective to prevent the development and progression of CKD in people with diabetes.

Screening for albuminuria should be done every year after diagnosis in people with type 2 diabetes and the same after the first five years in people with type 1 diabetes.

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