How are kidney failure and diabetes related?

Diabetes - damage to the kidneys

The kidneys in diabetes

The kidneys have many vital functions in the body, such as detoxifying the blood. You can think of the kidney as a sieve or filter, which sifts out pollutants and excretes them in the urine. High blood sugar and blood pressure can damage the kidney's filters: the holes get bigger and bigger. Other substances also increasingly find their way into the urine, such as blood protein albumin. If there is too much albumin in the urine, this can indicate kidney disease due to diabetes.

Course of disease

When diabetes damages the kidneys, it is usually insidious and goes undetected for a long time. Those affected often have hardly any complaints for years. Over time, the kidneys are no longer able to adequately cleanse the blood of harmful substances. Permanent kidney weakness develops. Without treatment, this can be life threatening.

Risk factors for your kidneys

Various influences can promote kidney disease in diabetes, for example:

  • older age

  • long diabetes disease duration

  • Smoke

  • blood lipid levels that are too high

  • too much body weight

  • male gender

  • Family history of kidney disease or high blood pressure

Investigations

To detect kidney disease early, your doctor may check your urine for the protein albumin. He will also examine the filter function of the kidneys using a blood sample. If kidney damage is suspected, further physical examinations will be performed and various laboratory tests will be carried out in the blood and urine. Your doctor will also look out for signs of other complications that may be associated with diabetes, such as problems with your eyes.

The treatment

To prevent damage to the kidneys or to prevent further damage, your blood sugar should not be too high if possible. Adjusting blood sugar levels in people with impaired kidney function is not always easy: some drugs that lower blood sugar work differently for them than they do for people without kidney disease. Too strict blood sugar control can also lead to hypoglycaemia more quickly. Agree with your doctor to determine which blood sugar level is most suitable for you.

Treatment always includes ensuring that your blood pressure is well controlled and checked regularly. Studies have shown that lowering blood pressure with medication helps the kidneys function well. If your blood lipid levels are too high, they should also be reduced.

When the kidneys can barely perform their functions, treatments are required that take over the work of the kidneys - in technical terms: kidney replacement therapies. On the one hand, this includes blood washing (dialysis) and secondly the replacement of the kidney with a new one (Kidney transplant).

There are special structured treatment programs for people with diabetes (DMP diabetes for short). The aim is that your care by general practitioners and specialists is coordinated with one another. Talk to your doctor about this program.

What you can do yourself

Kidney disease doesn't have to happen if you have diabetes. There are several things you can do to prevent kidney damage or to aid treatment:

  • Measure your blood pressure at rest and during exertion. In patient training courses, you can learn how to monitor and document your blood pressure yourself.

  • If your doctor has prescribed medication for high blood pressure for you, take them regularly at the prescribed dose.

  • Smoking damages your kidneys. The medical guideline advises you to stop smoking.

  • Experts recommend maintaining a normal body weight and a balanced diet. Try not to consume too much table salt and protein. Special dietary requirements apply to patients on renal replacement therapy.

    Discuss your diet and the amount you drink with the doctor treating you.

  • Exercise and sport are good for body and soul. A first step might be to climb stairs instead of taking the elevator. You can also cover shorter distances on foot instead of by car. The best thing to do is to look for a sport that you enjoy and that is good for you.

October 2016, published by the German Medical Association and the National Association of Statutory Health Insurance Physicians