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Type 2 Diabetes and the Risk of Chronic Kidney Disease

How diabetes can damage the kidneys and what you can do to prevent this complication.

If you have diabetes, keeping your blood sugar levels well controlled can help you prevent complications, including CKD.

Medically reviewed in February 2022

Chronic kidney disease (CKD) is a condition where the kidneys become damaged and are no longer able to function the way the body needs them to. This damage typically occurs over a long period of time and has few or no obvious symptoms until it reaches an advanced stage.

A person can have CKD for a long time and not know it. Routine healthcare appointments that screen for signs of kidney problems are important, especially for anyone who is at a higher risk of CKD.

While there are a number of health conditions that can contribute to CKD, diabetes is the leading cause. Roughly one third of people who have diabetes have CKD.

Here, we look at why the kidneys are so important, how diabetes contributes to kidney disease, and what a person with diabetes can do to take care of their kidneys.

Why the kidneys are so important
The kidneys are a pair of organs that are located on either side of the lower spinal cord. They are sometimes described as having a “bean shape” and each is about the size of a fist.

These vital organs filter the blood, removing excess fluids and waste while also circulating proteins, minerals, and blood cells back into the blood. Waste includes substances produced during chemical reactions inside cells and nutrients your body doesn’t need.

Excess fluids refer mostly to water—removing excess fluids helps the body maintain normal blood pressure. All of this ends up in the urine so it can be expelled from the body.

Additionally, the kidneys also produce several hormones that the body needs to stay healthy, including hormones needed to make blood cells and hormones needed to maintain healthy bones.

How diabetes damages the kidneys
The vast majority of people who have diabetes have type 2 diabetes. This condition occurs when the body no longer responds well to insulin (this is called insulin resistance). A much smaller percentage of people with diabetes have type 1 diabetes, where the body does not produce enough insulin.

Insulin is a hormone that moves glucose into cells where it can be used as energy. Also known as blood sugar, glucose is the body’s main source of energy. It powers the muscles, brain, and many other organs.

When glucose cannot move into these cells, it stays in the blood, where it can cause damage to blood vessels and nerves—including blood vessels in the kidneys. Having diabetes also damages the kidneys by forcing the kidneys to work harder to filter out excess glucose.

Damage to the kidneys can cause a number of serious problems throughout the body, including higher blood pressure and lower blood cell counts.

The most severe stage of CKD is kidney failure. When this occurs, the kidneys are no longer capable of keeping a person alive. Treatment options at this stage are dialysis or, eventually, kidney transplants.

Screening and monitoring CKD
People with diabetes need to be screened for signs of kidney disease.

These screenings should include urine tests that look for a protein called albumin. Small amounts of this protein in the urine (called microalbuminuria) is a sign that the kidneys are not working properly.

Screenings should also include blood work to test levels of creatinine in the blood. Creatinine is a waste product produced by muscle cells that should be filtered out of the blood. Creatinine can also be used to estimate how quickly the kidneys are filtering blood (a calculation called estimated glomerular filtration rate, or eGFR).

These tests can be used to detect CKD early and to monitor CKD.

Imaging tests and biopsies may also be used to help assess the health of the kidneys.

Preventing CKD
If you have diabetes, keeping your blood sugar levels well controlled can help you prevent complications, including CKD. It is also important to keep your blood pressure and cholesterol at healthy numbers.

It’s important to remember that there are good management options for diabetes, including medications that can help prevent serious complications and allow you to maintain a good quality of life. There is also a medication to help prevent CKD in people who have type 2 diabetes.

Diabetes and CKD are a different experience for every person. Your best source of information about treatment will be your healthcare provider.

Article sources open article sources

National Institute of Diabetes and Digestive and Kidney Diseases. "What Is Chronic Kidney Disease?"
National Institute of Diabetes and Digestive and Kidney Diseases. "Your Kidneys & How They Work."
KidsHealth.org. "Your Kidneys."
YourHormones.info. "Kidneys."
Centers for Disease Control and Prevention. "What is Diabetes?"
MedlinePlus. "Blood Sugar."
National Kidney Foundation. "Diabetes and Your Eyes, Heart, Nerves, Feet, and Kidneys."
National Kidney Foundation. "What is Kidney Failure?"
National Kidney Foundation. "Chronic Kidney Disease Symptoms and Causes."
Mayo Clinic. "Diabetic nephropathy (kidney disease)."
National Institute of Diabetes and Digestive and Kidney Diseases. "Diabetic Kidney Disease."
National Kidney Federation UK. "Cholesterol and Kidney Disease."
National Institute of Diabetes and Digestive and Kidney Diseases. "Insulin, Medicines, & Other Diabetes Treatments."
Marissa Fox. "FDA OKs Finerenone for Chronic Kidney Disease Associated With Type 2 Diabetes." DrugTopics, 2021. Vol. 165, No. 8.

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