Diabetes, Nutrition

A Diabetic Looks at Kidney Disease

I take my kidneys for granted. Most of us do. But these two small organs are unbelievably important. And once they’re damaged, it’s hard to imagine how your quality of life can decline.

For people with diabetes, the risk for kidney (renal) problems is even higher. According to the Centers for Disease Control’s Diabetes Surveillance System, the number of people who began treatment for kidney failure attributable to diabetes increased 485 percent, from 7,000 in 1984 to 41,000 in 2001.

Researchers from the World Health Organization report that in 1995 there were 135 million people with diabetes; by 2025 at least 300 million will have it.  Obesity is a contributing factor. With obesity comes increased risk for many diseases, most of all type 2 diabetes, coronary artery disease, hypertension and arthritis. And diabetes and hypertension increase risk for kidney disease.

In 2000, care for patients with kidney failure cost the United States nearly $20 billion. The U.S. Renal Data System

researchers forecast that by 2010 the cost in just the United States for ongoing ESRD (End Stage Renal Disease) programs will top $28.3 billion.

Researchers at the Center for Biomedical Engineering report that as of July, 2001, over 1.1 million patients worldwide were on dialysis treatment; they anticipate the number will double by 2010. In the U.S., the total annual cost per patient is about $66,000. The worldwide cost of treating ESRD will surpass $1 trillion for the first decade of the 21st century.

There is a pattern. Obesity is a significant part of that pattern. Proper diet and exercise under a doctor’s supervision can help hold off the more serious aspects of diabetes and renal failure in most people. But, make no mistake about it … obesity is a factor. According to the American Diabetes Associations’ statistics from 2001, there are more than 18.2 million Americans with diabetes, but nearly one-third are unaware that they have the disease. The National Kidney and Urologic Diseases Information Clearinghouse estimates that each year, nearly 100,000 Americans are newly diagnosed with kidney failure. More than 100,000 currently have ESRD due to diabetes.

According to the U.S. Health and Human Services Agency for Healthcare Research and Quality, an estimated 650,000 Americans will have kidney failure by 2010 and will require renal replacement therapy, either ongoing renal dialysis or a kidney transplant. Without one of these therapies, ESRD is fatal.

According to the ADA, diabetes is the leading cause of ESRD…which develops slowly, over years, and is often silent. The kidney’s tiny nephrons, which act as filters to remove wastes, chemicals, and excess water from the blood, become damaged by chronic high blood sugars.

According to the National Kidney Foundation, new evidence suggests that the incidence of irreversible kidney failure may be about the same for both type 1’s and type 2’s.

Approximately 43 percent of new cases of ESRD are attributed to diabetes, double in the past 20 years. 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.

Although diet, exercise, and medications help control blood glucose, diabetes often leads to nephropathy and kidney failure.

American minorities are more likely to suffer from diabetes and kidney failure. The incidence of reported ESRD in

people with diabetes is more than four times as high in African Americans, four to six times as high in Mexican Americans, and six times as high in Native Americans than in the general population of diabetes patients.

About 95 percent of people with diabetes have type 2 diabetes. Type 2’s are either insulin resistant or produce insufficient insulin, and 80 percent or more are overweight. The American Obesity Association notes that obesity may be a direct or in-direct factor in the initiation or progression of renal disease.

Between 1993 and 1997, more than 100,000 people in the United States were treated for kidney failure caused by type 2 diabetes.

People with type 2 diabetes are not diagnosed, on average, for five to six years after getting the disease, and by that time damage has often occurred — damage to the tiny capillaries in the eyes, the nerves in the foot, and the vulnerable nephrons in the kidneys. Having diabetes does not mean you’ll automatically have kidney failure, but your risk is greater. There are some things you can do:

  1. Getting to a healthy weight is important. Depending upon your insurance coverage, consults with a registered dietitian for chronic kidney disease may be covered, or may be reimbursable.
  1. If you feel you are high risk for kidney problems…due to diabetes or obesity or hypertension, for example…see a doctor. Doctor consults for renal disease are covered by Medicare, so speak with your physician for a referral.

Why are your kidneys so important? The National Organization for Renal Disease describes the kidneys as our “internal filters,” cleaning our system of wastes through urine produced in the million nephrons in each of our two kidneys. Kidneys are also responsible for hormone and electrolyte balance. As they filter out waste, they also regulate sodium and potassium, and release hormones necessary for red blood cell production, to maintain calcium levels and regulate blood pressure.

When kidneys lose their ability to filter out wastes, a person must have the blood mechanically filtered, or get a kidney transplant. The process of dialysis is time consuming and may be uncomfortable; also, the patient must follow a strict diet and medication regime. Transplant means permanent treatment with anti-rejection drugs.

There are other causes of kidney failure besides diabetes: trauma, genetics, and environmental toxicity such as poison could also damage the kidneys. But, diabetes is the number one cause of renal failure, so take charge to reduce your risk. Intensive blood glucose control slows the progression of kidney disease.

  1. Work with your doctor to maintain normal blood glucose, by testing often and administering insulin based on diet and exercise.
  1. Have your doctor measure your A1C level at least twice a year. The test provides a weighted average of your blood glucose level for the previous three months. The ADA says aim for A1C of 7 percent or less.
  1. Have your urine albumin excretion (protein in urine, a sign of kidney damage) checked at least once yearly. This was the test that caused my doctor to first suspect diabetes in my case.
  1. Check your blood pressure regularly. Hypertension is a double edged sword. It contributes to kidney disease, and it’s caused by kidney disease. The American Diabetes Association and the National Heart, Lung, and Blood Institute recommend that people with diabetes and kidney disease keep their blood pressure below 130/80.
  1. Obesity increases risk for hypertension and type 2 diabetes: losing weight helps lower blood pressure and increases insulin sensitivity.
  1. Ask your doctor whether you might benefit from taking an ACE inhibitor or ARB. People with kidney disease should consume the recommended dietary allowance (RDA) for protein, and avoid high- protein diets. It’s extremely important to reduce your dietary sodium and phosphorus if you have renal disease. A reduced protein diet with advanced kidney disease may help delay progression.

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