You probably know someone who has diabetic kidney disease (DKD) or you may even have it.
Why? Because diabetic kidney disease is the number one cause of kidney disease around the world. One in three patients with diabetes develop diabetic kidney disease. Genetic factors are important. It is more common among African-Americans, Latinos and Native Americans than in Caucasians. It is also commoner in some families than others.
How does diabetic kidney disease develop?
The long-standing presence of high blood sugar causes changes in the blood vessels throughout the body, including the kidneys. Over time, these changes cause some of the cells in the kidneys to die off. When enough of the cells in the kidneys drop off, the overall function of the kidneys decrease.
This shows up in your bloodwork as a drop in kidney function, that is, a higher than normal creatinine level in the blood. Remember, this is a late feature, the kidney damage has gone on for years before the creatinine level begins to increase.
You may also have protein leak in the urine, which shows up as a high albumin level in the urine. Most patients with the diabetic kidney disease have albuminuria, but this is by no means universal. You may have diabetic kidney disease without albuminuria.
How does High Blood Pressure affect diabetic kidney disease?
High blood pressure, or hypertension, significantly worsens the risk of kidney disease in someone with diabetes. Especially if it is not well controlled. The goal blood pressure for patients with diabetic kidney
disease is less than 130/80 mmHg.
Other factors that may worsen diabetic kidney disease are smoking, obesity, not adhering to medications or healthy food habits such as a high salt diet, being physically inactive or other health conditions that worsen kidney disease, such as heart disease.
How do we treat Diabetic Kidney Disease?
The first order of business is to treat the diabetes well, so that your A1c is at goal. Work with your primary care physician and/or your endocrinologist to control the diabetes optimally.
Lifestyle modifications are first-line and should be continued even when medications are added. Eat a healthy low salt diet, drink enough fluids, stay physically active, do not smoke and reduce weight. Tall order, but certainly doable!
See an eye doctor every year to make sure you do not have any effects of the diabetes on the eyes, called diabetic retinopathy.
Remember also to treat high blood pressure optimally. There are certain blood pressure medications that are protective for the kidneys and heart.
Talk to your doctor to make sure you are on an ace inhibitor or ARB, or find out why these medications may not be suitable for you.
Alongside, treat high cholesterol with a statin.
New Developments in the Treatment of Diabetic Kidney Disease
Likewise, there are some exciting new developments in the treatment of diabetes.
For decades, the mainstay of diabetes treatment has been drugs like metformin, glipizide or another medication of the same class, and insulin.
These medications are still very important in the treatment of diabetes but there are certain new medications that are also protective for the heart and kidneys, apart from lowering your blood sugar.
If you have Type 2 diabetes and any evidence of diabetic kidney disease or protein leak in your urine, you should ask your physician whether one or more of these may be right for you.
There is a new class of medicines called SGLT2 inhibitors, examples of which are Invokana, Farxiga and Jardiance. They can be added on to your other diabetes meds.
If your diabetes control is far from goal, GLP1 agonists are a group of medications that may be right for you. These are also protective against kidney and heart disease. Some examples are Rybelsus, Ozempic,
Trulicity, Byetta, Bydureon, Victoza, and Adlyxin. Many of these need to be self-injected.
Lastly, Kerendia is the newest kid on the block to have shown to be protective of the kidneys and heart. There are side effects, risks and contraindications to each of these classes of medications. For example, SGLT2 inhibitor increase your risk of amputation, urinary tract/genital infections. If you are high risk for
these conditions, these medications may not be right for you.
If you have risk factors or a history of thyroid cancer or other endocrine syndrome or are pregnant, GLP1 agonists are contraindicated.
Both SGLT2 inhibitors and Kerendia, as well as ace inhibitors/ARB can raise your serum potassium level. High potassium is a dangerous, even life threatening, condition.
For all of these reasons, it is very important to work closely with your physicians to determine the right drug regimen for you.
If you are in search of a nephrologist to help care for your diabetic kidney disease, we are here to help! Call our office at 407-205-8507 to make a new patient appointment.