Diabetic Kidney Disease (DKD), also known as Diabetic Nephropathy is a chronic, progressive condition that occurs in people with diabetes. It is characterized by damage to the kidneys caused by high levels of glucose in the blood over a long period of time. In DKD, the small blood vessels in the kidneys become damaged and lose their ability to filter waste products from the blood. This leads to a buildup of waste in the blood and a decline in kidney function. As DKD progresses, it can lead to end-stage kidney disease (ESKD), which requires dialysis or a kidney transplant to maintain life. DKD is a serious complication of diabetes and a leading cause of kidney failure worldwide.
Prevalence of Diabetic Kidney Disease
According to the World Health Organization (WHO), India has the second highest number of people with diabetes in the world, with an estimated 77 million people living with the condition. This, coupled with the rapidly growing burden of diabetes in the country, has led to a significant increase in the number of people with diabetic kidney disease (DKD) in India.
The prevalence of DKD in India is estimated to be around 25-30% of all people with diabetes, and the number of patients with end-stage kidney disease (ESKD) due to DKD is also on the rise. According to a study published in the Journal of the Association of Physicians of India, around 20-30% of patients with ESKD in India have DKD.
The impact of DKD in India is significant, as it not only affects the health and well-being of those with the condition but also places a heavy burden on the country’s healthcare system. The cost of managing DKD and ESKD, including dialysis and transplantation, can be financially debilitating for many families in India.
Overall, the high prevalence and impact of DKD in India highlight the urgent need for better management and control of diabetes, as well as increased public awareness and access to healthcare for people with this debilitating condition.
Causes of DKD – The link between diabetes and kidney disease
Diabetic kidney disease (DKD) is a chronic condition that occurs in people with diabetes and is caused by high levels of glucose in the blood over a long period of time. The link between diabetes and kidney disease is well established and is due to the damaging effects of high blood sugar on the small blood vessels in the kidneys.
In people with diabetes, high blood sugar levels can damage the tiny blood vessels in the kidneys, impairing their ability to filter waste products from the blood. Over time, this can lead to a buildup of waste in the blood and a decline in kidney function. This can result in a range of symptoms, including fatigue, swelling, and high blood pressure, and can eventually progress to end-stage kidney disease (ESKD) if left untreated.
In addition to high blood sugar, other factors can also contribute to the development of DKD, including high blood pressure and unhealthy lifestyle habits and in certain cases – usage of certain medications. Maintaining good control of blood sugar levels, managing high blood pressure, and adopting a healthy lifestyle can help to prevent or slow the progression of DKD.
Other risk factors
In addition to uncontrolled diabetes, there are several other risk factors that can increase the likelihood of developing diabetic kidney disease (DKD). Some of these risk factors include:
- High blood pressure: High blood pressure is a common complication of diabetes and can significantly increase the risk of DKD.
- Family history: A family history of kidney disease, especially in first-degree relatives, increases the risk of developing DKD.
- Long duration of diabetes: The longer a person has diabetes, the greater their risk of developing DKD.
- Poor glycemic control: Poor control of blood sugar levels can increase the risk of DKD.
- Smoking: Smoking can increase the risk of developing DKD, as well as other complications of diabetes.
- Obesity: Being overweight or obese can increase the risk of developing DKD, as well as other complications of diabetes.
- Ethnicity: Certain ethnic populations, such as African Americans, Hispanics, and Native Americans, have a higher risk of developing DKD compared to other populations.
- Advanced age: The risk of developing DKD increases with age, particularly in older adults with diabetes.
It’s important to note that having one or more of these risk factors does not necessarily mean that a person will develop DKD, but they may increase the likelihood of the disease occurring. Regular monitoring and management of these risk factors, as well as good control of blood sugar levels, can help to prevent or slow the progression of DKD.
How does diabetes impact kidneys?
High blood sugar levels can damage the kidneys by impairing the tiny blood vessels that filter waste products from the blood. The kidneys are responsible for removing waste products from the blood and producing urine, but high levels of glucose in the blood can cause damage to the small blood vessels in the kidneys, impacting their function.
This damage can occur in several ways:
- Hyperfiltration: High blood sugar levels can cause an increase in the amount of glucose that filters through the kidneys, leading to increased workload and stress on the kidneys. Over time, this can result in damage to the small blood vessels in the kidneys.
- Glomerular basement membrane thickening: High blood sugar levels can cause the thickening of the glomerular basement membrane, a delicate structure in the kidneys that is critical for filtering waste products from the blood. This thickening can impair the ability of the kidneys to filter waste products, leading to a buildup of waste in the blood.
- Inflammation: High blood sugar levels can trigger an inflammatory response in the kidneys, which can further damage the small blood vessels and impair kidney function.
- Advanced glycation end-products (AGEs): High blood sugar levels can cause the formation of advanced glycation end-products (AGEs), which can accumulate in the kidneys and cause further damage to the small blood vessels.
The gradual accumulation of damage to the small blood vessels in the kidneys can lead to a decline in kidney function and the development of diabetic kidney disease (DKD).
Also Read: Kidney Failure & Diet
Stage of Diabetic Kidney Disease
eGFR (estimated glomerular filtration rate) is used as a measure to understand how well is the kidney functioning. eGFR is calculated based on various parameters such as age, sex, serum creatinine levels, and body type. eGFR is a reasonably reliable number that is often checked to understand how well is the kidney functioning. Depending on the eGFR, there are 5 stages to a kidney disease, as given by
Symptoms of Diabetic Kidney Disease
In the early stages, diabetic kidney disease (DKD) may have no symptoms. However, as the disease is left unmanaged, the following symptoms may develop:
- Swelling: Swelling, particularly in the feet, ankles, and legs, can be a sign of DKD. This can occur due to fluid buildup in the body caused by decreased kidney function.
- Fatigue: Fatigue and weakness can be a result of the buildup of waste products in the blood, which can cause anemia and decreased energy levels.
- Anemia: The kidney plays an important role in the production of red blood cells. A glycoprotein hormone called erythropoietin (EPO) produced in the kidney is an important regulator of RBC production. A damaged kidney often leads to EPO deficiency, leading to low RBC and anemic.
- Low Vit D: Kidney is also responsible for the production of the active form of vitamin D, through a process called hydroxylation. The Vit D formed under the skin through sunlight is in its inert (inactive) form and has to be activated by both the liver and kidney. Impaired kidney function, hence leads to low vitamin D levels and low bone density.
- High blood pressure: High blood pressure is a common complication of DKD and can be a symptom of the disease.
- Foamy or bubbly urine: The presence of excess protein in the urine can cause it to appear foamy or bubbly.
- Decreased urine output: A decrease in urine output can occur as a result of decreased kidney function.
- Nausea and vomiting: Nausea and vomiting can occur as a result of the buildup of waste products in the blood.
It’s important to note that these symptoms can also be caused by other conditions and that not everyone with DKD will experience the same symptoms or experience symptoms to the same degree.
Diagnosis of Diabetic Kidney Disease
Diagnosing diabetic kidney disease (DKD) typically involves a combination of tests and exams. Some of the common tests used to diagnose DKD include:
- Urinalysis: A urinalysis can detect the presence of excess protein or glucose in the urine, which can be a sign of kidney damage.
- Blood tests: Blood tests can measure the levels of creatinine and blood urea nitrogen (BUN), which are waste products that are normally filtered out of the blood by the kidneys. Elevated levels of these waste products can indicate a decline in kidney function.
- Glomerular filtration rate (GFR) test: A GFR test measures the amount of waste products that are filtered by the kidneys into the urine over a certain period of time. A GFR test is the most reliable measure of kidney function.
- Kidney biopsy: In some cases, a kidney biopsy may be recommended to obtain a small sample of kidney tissue for analysis. A kidney biopsy can provide important information about the extent and type of kidney damage.
In addition to these tests, a doctor may also perform a physical exam, take a medical history, and review the results of other tests, such as blood pressure readings, to make a diagnosis of DKD.
Also Read: Creatinine & Kidney Health
Medical Management of DKD
While it is not possible to completely reverse DKD, there are a number of medications that can help to slow down the progression of the disease.
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs): These medications help to lower blood pressure and reduce the workload on the kidneys. They can also help to slow down the progression of DKD and reduce the risk of cardiovascular disease.
- Blood glucose control medications: Controlling blood sugar levels can help to slow down the progression of DKD. A combination of lifestyle changes, such as exercise and a healthy diet, and medications, such as metformin, can help to control blood sugar levels.
- Blood pressure control medications: High blood pressure is a common complication of DKD, and controlling blood pressure can help to reduce the risk of further kidney damage. A combination of lifestyle changes, such as reducing salt intake, and medications, such as diuretics and calcium channel blockers, can help to control blood pressure.
- Phosphorus-binding agents: Elevated levels of phosphorus in the blood can cause bone and mineral problems, as well as cardiovascular disease. Phosphorus-binding agents, such as sevelamer and lanthanum, can help to lower phosphorus levels in the blood.
- Sodium-glucose cotransporter 2 (SGLT2) inhibitors: These medications help to lower blood sugar levels by blocking the reabsorption of glucose in the kidneys. SGLT2 inhibitors have been shown to have a protective effect on the kidneys and have been approved for use in people with type 2 diabetes and kidney disease.
It’s important to note that the choice of medication and the approach to managing DKD will depend on the individual patient’s health status, other medical conditions, and the stage of the disease. A healthcare provider can provide more information about the best approach for each individual patient. It goes without saying that one should not self-medicate or regulate/change the medicine dosages without the advice of a qualified medical doctor.
Diet for DKD
Diet plays an important role in managing diabetic kidney disease (DKD). Here are some dietary considerations for people with DKD:
- Protein intake: People with DKD should monitor their protein intake and aim to eat a moderate amount of high-quality protein. High-quality protein sources include fish, poultry, lean meats, eggs, and dairy products. Too much protein can put additional stress on the kidneys and contribute to the progression of DKD.
- Phosphorus intake: The kidney plays an important role in removing extra phosphorous from the blood. Impaired kidney function can lead to elevated levels of phosphorus in the blood. This can cause bone and mineral problems, as well as cardiovascular disease. Limiting foods that are high in phosphorus, such as dairy products, nuts, and legumes can help to control phosphorus levels. Phosphorus-binding agents, such as sevelamer and lanthanum, can also be used to lower phosphorus levels in the blood.
- Potassium: People with diabetic kidney disease (DKD) may need to limit their potassium intake. Extra potassium is removed from the blood by the kidneys. Damaged kidney function leads to high levels of potassium in the blood, which can be harmful to the heart. Foods such as bananas, tomatoes, oranges and potatoes are all rich in potassium. A healthcare provider can provide specific recommendations for potassium intake based on the individual’s kidney function and other health conditions.
- Chromium: Chromium is a mineral that is involved in insulin sensitivity and glucose metabolism. Some research suggests that chromium supplementation may help to improve glucose control and reduce the risk of complications in people with diabetes. However, more research is needed to determine the role of chromium in the management of DKD.
- Leaching of vegetables: Leaching refers to the process of removing nutrients from vegetables when they are cooked in water. Boiling vegetables can lead to the loss of some vitamins and minerals, including potassium. Steaming or microwaving vegetables is a better option for retaining their nutritional value.
- Sodium intake: High levels of sodium in the diet can contribute to high blood pressure, which is a common complication of DKD. Limiting salt and salty foods can help to control blood pressure and reduce the risk of complications.
- Fat intake: A diet that is high in fat can increase the risk of cardiovascular disease, which is a common complication of DKD. Limiting fat and choosing healthy sources of fat, such as avocados, nuts, and olive oil, can help to reduce the risk of complications.
- Carbohydrate intake: People with DKD should aim to control their carbohydrate intake and choose complex carbohydrates, such as whole grains, fruits, and vegetables, over simple carbohydrates, such as sugar and white flour.
- Hydration: Staying hydrated is important for people with DKD, but they may need to limit their fluid intake, depending on the stage of the disease. It’s important to talk to your doctor about the best approach for each individual and the amount of water that is required.
Other lifestyle changes like
- Maintaining a healthy diet: People with DKD need to monitor their protein intake, limit their intake of phosphorus-rich foods, and maintain a healthy diet that is low in salt and fat.
- Exercising regularly: Regular exercise can help to control blood sugar levels, maintain a healthy weight, and reduce the risk of cardiovascular disease.
- Quitting smoking: Smoking can increase the risk of complications from DKD, including cardiovascular disease. Quitting smoking can help to reduce this risk.
- Managing stress: Stress can lead to spikes in blood sugar levels and contribute to the development of complications from DKD. Practicing stress management techniques, such as deep breathing and meditation, can help to reduce stress and maintain good health.
- Monitoring blood pressure: High blood pressure is a common complication of DKD and can contribute to the progression of the disease. Regular monitoring of blood pressure and taking medications as prescribed can help to control blood pressure and reduce the risk of complications.
- Monitoring blood glucose levels: Regular monitoring of blood glucose levels and taking medications as prescribed can help to control blood sugar levels and prevent complications from DKD.
Is CKD different from DKD?
Chronic kidney disease (CKD) is a general term that refers to a gradual loss of kidney function over time. It can be caused by a variety of factors, including diabetes, high blood pressure, glomerulonephritis (a type of kidney disease that causes inflammation), and other conditions.
DKD, on the other hand, specifically refers to kidney damage or disease that is caused by diabetes. High blood sugar levels over time can damage the blood vessels in the kidneys, leading to a gradual loss of function.
It’s possible for a person with diabetes to have both CKD and DKD, as diabetes is a common cause of CKD. In such cases, the person’s healthcare provider will typically focus on managing underlying diabetes to help prevent or slow the progression of kidney disease.
Also Read: World Kidney Day – Lifestyle Changes
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