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Living with Chronic Kidney Disease

CKD and Diabetes

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Updated October 25, 2007

Kidneys are organs that act as filters for the body, ridding it of unnecessary waste that's eliminated via urine. One of the most debilitating complications of diabetes is when these organs - your body's natural filters - become damaged.

Kidney are composed of millions of tiny filter-cells called nephrons, which have even smaller vessels located within them. Prolonged high glucose levels can damage these small vessels. Even if glucose levels are reasonably well-controlled most of the time, kidney damage can still occur when someone has had diabetes for several years.

How Do Kidneys Become Damaged?

When glucose circulates in the blood, it binds to proteins, making the proteins "sticky." As these sticky molecules pass through the smaller blood vessels, they can stick to the vessel walls, causing inflammation, leaking and collapsing. When this happens in the kidneys, the tiny nephrons become damaged and the kidneys lose the ability to filter toxins out of the blood.

How Is Kidney Disease Diagnosed?

Chronic kidney disease can sometimes be a "silent" condition, where there are no obvious symptoms until the disease is quite progressed. Doctors recommend screening for kidney function if you have diabetes. There are screening tests that can help detect kidney disease.

  • High blood pressure can be an indicator of kidney disease.
  • A simple dipstick urinalysis can show if there is blood or excess protein in your urine
  • A separate urine test for the presence of "microalbumin," a type of protein found that is not normally found in the kidneys unless there is damage present.
  • A blood test for creatinine levels. A rising creatinine level indicates the degree of kidney failure.
  • The glomerular filtration rate (GFR) can show how much of the toxins are actually being filtered by your kidneys.

How Is Chronic Kidney Disease Managed?

Chronic renal disease is not reversible, but there are things you can do to slow the progression of the disease.

  • Maintain tight glucose control.
  • Take blood pressure medication. Two classes of blood pressure medications called ACE inhibitors and ARBs slow the progress of renal disease most effectively. Note: Even patients without high blood pressure can benefit from these drugs when taken during the early stages of kidney damage.
  • Eat a low protein renal diet - eating less protein reduces the stress on damaged kidneys.

What Is Dialysis?

Healthy kidneys clean your blood of toxins. If kidneys start to fail, the toxins aren't removed and they start to build up in your blood. Dialysis is a process which cleans your blood like your kidneys. While your kidneys used to function every minute of the day, dialysis is a three- or four-hour process that must be done every few days. People can live for many years on dialysis.

How Will I Know I Need Dialysis?

Doctors will keep a close eye on your creatinine levels and your GFR. When they reach a certain level, dialysis will be started.

Types of Dialysis

  • Hemodialysis - A machine filters your blood three times a week. It takes about 3 to 4 hours, and it must be done at a dialysis center.
  • Peritoneal dialysis - Basically this is dialysis that can be performed at home, independently. It doesn't filter the blood directly. It performs filtration through the abdomen using fluids instead. Some people prefer this method, because it can provide them with more freedom.

Kidney Transplants

Receiving a new kidney is sometimes an option. Discuss this with your doctor. There is a long evaluation process to make sure that you are able to have a kidney transplant and it can take years to receive a kidney. Investigating this option early can help you get a kidney sooner rather than later. There are a lot of things to consider when deciding on a kidney transplant. Although the transplant procedure has improved dramatically over the years, there are still risks involved.

Sources:

"Kidney Disease of Diabetes." Kidney & Urologic Diseases A-Z. Oct. 2006. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 25 Oct 2007.

"Nephropathy in Diabetes." Diabetes Care 27:S79-S832004 25 Oct 2007.

Vassalotti, Joseph A., MD, Stevens, Lesley A., MD, MS, and Levy, Andrew S., MD. "Testing for Chronic Kidney Disease: A Position Statement From the National Kidney Foundation." American Journal of Kidney Diseases (AJKD) Vol. 50. Issue 2, Aug. 2007 169-180. Oct. 2007.

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