McFarlane P, Gilbert R, MacCallum L, et al. Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: chronic kidney disease in diabetes. Can J Diabetes 2013;37(suppl 1):S129-S136. The Kidney Foundation of Canada, 2004. Diabetes and Kidney Disease. Available online: <a href="http://www.kidney.ca/diabetes-and-kidney-disease">http://www.kidney.ca/diabetes-and-kidney-disease</a> (Accessed May 2015).
As a complex chronic disease, diabetes can harm the healthy function of various organs in the body, including the kidneys – with the individual often unaware of the unfolding damage.
Diabetes is the leading cause of kidney disease in Canada and as many as 50 per cent of people with diabetes have some degree of kidney damage. Early detection of changes – for example, damage to small blood vessels in the kidney filters – can allow physicians to take steps to slow the decline in kidney function.
"One of the challenges in treating diabetes is that it's one of those 'silent' diseases. It can be wreaking havoc on different organ systems and you may not have any symptoms," says Dr. Tharsan Sivakumar, an endocrinologist at the Institute of Diabetes & Endocrinology in the Greater Toronto Area. "That's why it's extremely important to have your physician monitor your kidney function and check regularly for the leakage of protein in the urine. By testing for protein in the urine, we can determine if damage to the filtration system of the kidneys is present."
Dr. Sivakumar talks to his patients about the serious risks to their kidney health. "I explain that without intervention, the damage can lead to kidney failure, which will mean going on dialysis."
It is possible to slow the progression of kidney disease with good glycemic control (control of blood glucose levels), typically through use of oral diabetes drugs and/or insulin. Controlling blood pressure is vital, and physicians may also prescribe kidney-protective medications.
If a person's kidney function continues to decline, medication changes or changes to their insulin regimen may be needed, Dr. Sivakumar explains. "Some diabetes medications use the kidney itself to dispose of excess glucose. Because they need a functioning kidney to be effective, they are no longer useful if your kidney function goes below a certain threshold." Other medications that are metabolized in the kidneys may also need to be discontinued when kidney damage worsens.
"There are some diabetes medications that effectively control glucose levels at all levels of kidney function up until the patient has kidney failure," he says. "For some, the doses may need to be adjusted but some other medications can be continued at the same dose even if kidney function changes."
PREVENTION
TAKE ACTION TO PREVENT KIDNEY HEALTH COMPLICATIONS
The following tips can help manage diabetes and kidney disease:
- Take your diabetes medications as prescribed.
- Ask your doctor to check your kidneys every year following your initial diabetes diagnosis and when new medications are added.
- Keep your blood sugar at target. Talk to your doctor about what your target range should be.
- Keep your blood pressure at target. Talk to your doctor about your personal target.
- Eat a well-balanced diet.
- Exercise (ideally 45-60 minutes, four to five times per week).
- Don’t smoke.
1 McFarlane P, Gilbert R, MacCallum L, et al. Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: chronic kidney disease in diabetes. Can J Diabetes 2013;37(suppl 1):S129-S136.
2 The Kidney Foundation of Canada, 2004. Diabetes and Kidney Disease. Available online: http://www.kidney.ca/diabetes-and-kidney-disease (Accessed May 2015).
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