What is Chronic Kidney disease (CKD)? Know the link between diabetes and kidney diseases

By Richa Barua | First Published Dec 27, 2022, 1:57 PM IST

India is touted to be the Diabetic Capital of the world with estimated 80 Million patients, and with 40% of them being affected with Kidney issues, we can expect many millions of Chronic Kidney disease (CKD) patients attributable to diabetes in our nation.

Everyone is aware that Diabetes Mellitus is a disease with increased blood sugar above and beyond normal levels as the defining feature. Many fail to realise that Diabetic patients tend to develop different ailments in every part of the body from the Eyes (retinopathy) to the Toes (peripheral vascular disease) and everything in between including but not limited to the Heart and Kidneys.

India is touted to be the Diabetic Capital of the world with an estimated 80 Million patients, and 40% of them being affected by Kidney issues we can expect many millions of Chronic Kidney disease (CKD) patients attributable to diabetes in our nation. While all of that may sound overwhelming, there is some good news; many of the steps you need to take to prevent one of those complications may help to prevent them all.

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The kidneys play an essential role in the body: they filter the blood, removing waste products and excess salt and water. If the kidneys become diseased, these toxic wastes and excess fluid build up in the body. CKD patients do not have any symptoms in the early stages; hence, it is important to do tests to diagnose the condition early.

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When the kidneys work normally, they prevent albumin from leaking into the urine, so finding it in the urine is a sign that the kidneys are in trouble. Urine tests are recommended once per year in people with type 1 diabetes, beginning about five years after diagnosis, and in people with type 2 diabetes, starting at the time of diagnosis and every six months thereafter.

Estimation of the Serum Creatinine is another simple test than can give us an estimated Kidney Function measured as Glomerular Filtration rate in ml/min. This is also called as Kidney count and a number below 60 indicates trouble said Dr Amol Mahaldar, Consultant Nephrologist, Manipal Hospitals Goa

Let us now look at some simple measures that can protect us from the scourge of Diabetes as well as CKD.

Lifestyle changes — changing your lifestyle can positively impact your kidneys' health. The changes that are strongly recommended are first to limit the amount of sodium (salt) you eat to less than 2 grams per day). In Goan diet context, this means reducing the salt used to cook by half and avoiding Pappad, Pickle and dried fish in diet. Smoking has a deleterious effect on every organ in the body. Smokers should quit whilst others should even avoid passive smoking while in the vicinity of a person smoking. Leading an active life with daily exercise for 45min to maintain a healthy weight is another measure that an help the heart, Kidney and diabetes control all at once.

Blood sugar control — keeping blood sugars close to normal can help prevent the long-term complications of diabetes mellitus. The ideal target for fasting blood glucose and blood glucose levels before each meal is 80 to 120 mg/dL; however, these targets may need to be individualised according to age and other associated conditions.

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A blood test called A1C is also used to monitor blood sugar levels; the result provides an average of blood sugar levels over the last one to three months. An A1C of 7 per cent or less is usually recommended; this corresponds to average blood glucose of 150 mg/dL. Even small decreases in the A1C lower the risk of diabetes-related complications to some degree. Self-home glucose monitoring and Continuous Glucose monitoring systems are now being employed, and you should seek help from your physician to know if you can benefit from these.

Managing blood sugar involves lifestyle changes (eg, diet and exercise) and medications. While a multitude of medications are available, some are not recommended for use in people with CKD, while others may be more adept to slow the progression of kidney disease. Your Physician will again be the best guide to determine what combination of medications is best for you.

Managing high blood pressure — Most people with diabetes have high blood pressure. While all people with diabetes are advised that it is important to control blood sugar, it should be noted that controlling blood pressure is at least as important. That's because high blood sugar and high blood pressure work in tandem to damage the blood vessels and organ systems. High blood pressure causes few symptoms and often goes easily unnoticed. Persistently elevated Blood pressure stresses the cardiovascular system and speeds the development of diabetic complications of the kidney and eyes. This is the basis for the practice of estimating Blood Pressure at every Clinic visit following certain prerequisites. A blood pressure reading below 130/80 is the recommended goal for most people with diabetic kidney disease, especially if you have more than 300 mg of albumin in your urine per day.

The initial approach to high blood pressure remains to encourage weight loss, exercise, decreasing the amount of salt in the diet, quitting smoking, and decreasing alcohol intake. When these measures fail to lower blood pressure to the goal or in some situations that need BP to be lowered quickly, we can use one or a combination of several blood pressure medications. The pros and cons of each medication and the treatment goals need to be addressed as per each patient’s profile. Certain Blood pressure medication help protect the kidneys specifically especially if the urine protein leakage is high. These are called Perils or Sartans and require close monitoring of the blood pressure and blood tests as they can be double-edged swords reducing kidney function dramatically in some patients.

Newer treatment options: SGLT2 inhibitors — In addition to the measures described above, some people with type 2 diabetes and kidney disease can be prescribed a relatively new medication called a sodium-glucose co-transporter 2 (SGLT2) inhibitor also named Gliflozins. These medications lower blood sugar by increasing the excretion of sugar in the urine. The physician will consider several factors to decide if a patient is a candidate for treatment with an SGLT2; this will depend on how advanced the kidney disease is and how much albumin is leaking in the urine.

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