What Is The Outlook
- If you have microalbuminuria , this may clear away, especially with treatment.
- If you have proteinuria , over time the disease tends to become worse and progress to end-stage kidney failure. However, the length of time this takes can vary and it may take years. If your kidneys do begin to fail you should be referred to a kidney specialist.
- Once the kidney function goes below a certain level then you will need kidney dialysis or a kidney transplant.
- A main concern is the increased risk of developing cardiovascular diseases. Cardiovascular diseases, such as heart attack and stroke, are the main causes of death in people with diabetic kidney disease. The treatments outlined above will reduce the risk of these occurring.
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What Is Chronic Kidney Disease
Your kidneys are important because they keep the rest of your body in balance. They:
- Remove waste products from the body
- Balance the bodys fluids
- Help keep blood pressure under control
- Keep bones healthy
- Help make red blood cells.
When you have kidney disease, it means that the kidneys have been damaged. Kidneys can get damaged from a disease like diabetes. Once your kidneys are damaged, they cannot filter your blood nor do other jobs as well as they should.
Strategy For Glycemic Control And Other Risk Factors
The primary goal of optimizing glycemic control to reduce the development of microvascular and macrovascular complications is universal. The medication regimen is based on the comfort of the patient and physician and should be individualized, especially as renal function changes.
For those who need insulin, MDI with an average of 4 daily injections is common. The closest approximation of physiologic insulin secretion can be achieved with an insulin pump delivering a continuous subcutaneous infusion. A single type of insulin is used in the pump such as a rapid-acting analog that serves as the basal, bolus and correction insulin. Insulin pumps require vigilance on the part of the patient and their use should be overseen by endocrinologists and experienced diabetes educators.
Continuous Glucose Monitoring Systems are available that can continually measure glucose levels. A small plastic catheter is inserted subcutaneously and measures glucose every 5 min. Patients can view this in real-time and detect upward and downward trends in glucose. The added benefit is that alarms for high and low readings can be set.
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Standard Test For Blood Sugar Control Not Accurate In Diabetic Dialysis Patients
- Wake Forest University Baptist Medical Center
- The standard test for measuring blood sugar control in people with diabetes is not accurate in those. The hemoglobin A1c test underestimates true glucose control in hemodialysis patients and could give false comfort to patients and physicians. Hemodialysis, in which blood is passed through an artificial kidney machine for cleansing, is used in cases of kidney failure.
The standard test for measuring blood sugar control in people with diabetes is not accurate in those on kidney hemodialysis, according to new research at Wake Forest University Baptist Medical Center.
Wake Forest investigators reported in Kidney International that the hemoglobin A1c test underestimates true glucose control in hemodialysis patients and could give false comfort to patients and physicians. Hemodialysis, in which blood is passed through an artificial kidney machine for cleansing, is used in cases of kidney failure.
“These results suggest that the nearly 200,000 diabetic hemodialysis patients in the United States who use this test may not be receiving optimal care for their blood sugar,” said Barry I. Freedman, M.D., senior author and a professor of internal medicine and nephrology.
HbA1c measures the percentage of hemoglobin that has reacted with glucose. This measure, also known as glycosylated hemoglobin, reflects blood sugar control over the previous 30-120 days.
What Is The Treatment For Diabetic Kidney Disease
Treatments that may be advised are discussed below. Treatments aim to:
- Prevent or delay the disease progressing to kidney failure. In particular, if you have early diabetic kidney disease it does not always progress to the proteinuria phase of the disease.
- Reduce the risk of developing cardiovascular diseases such as heart disease and stroke.
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Glycemic Goal To Attain A1c ~70 %
Glycemic control is essential to delay or possibly prevent nephropathy. In general, the recommended target A1c for diabetes control by the ADA has been less than or around 7 % . The ADA advises both higher or stricter A1c goals for certain populations . AACE suggests a goal A1c of 6.5 % in healthy patients who are at low risk for hypoglycemia but also acknowledges the goals need to be individualized . The 2007 Kidney Disease Outcomes Quality Initiative guidelines for Diabetes and CKD endorse a target A1c of < 7.0 % but their updated 2012 guidelines instead recommend an A1c of ~7.0 % .
The ACCORD study showed higher risk of hypoglycemia and mortality in patients with type 2 diabetes treated with intensive glucose control , without any risk reduction on CVD. The increased mortality could not be attributed to hypoglycemia . In the ADVANCE trial, more intensive glycemic control showed no reduction in CVD. However, the intensive group had a 21 % reduction in nephropathy . The VADT study also showed no benefit on CVD risk with stricter glucose control .
The data clearly show that lowering A1c leads to benefit in regards to nephropathy. Benefits in A1c reduction are also seen on rates of retinopathy and neuropathy. However, the effect of lowering A1c is much less in regards to macrovascular disease. Thus, it is reasonable that a target A1c ~7.0 % offers an optimal risk to benefit ratio rather than a target that is considerably lower.
The Effects Of Kidney Disease
Over time, high blood sugar levels can damage tiny blood vessels in your kidneys, which means they cannot filter your blood properly.
As a result, tiny particles of protein spill into the urine this is called microalbuminuria. As kidney disease progresses, larger amounts of protein spill into the urine this condition is called proteinuria.
As kidney disease progresses, waste products start to build up in your blood because your body can’t get rid of them. If left untreated, your kidneys will eventually fail and dialysis or a kidney transplant will be required.
Diabetes can also affect the nerves that tell you when your bladder is full. The pressure from a full bladder can damage the kidneys. If urine remains in the bladder for a long time, it can increase your risk of developing a urinary tract infection, which can spread to the bladder.
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Medical Therapy In Diabetic Nephropathy
Medical therapy for diabetes is continually changing as new therapies become available for use and new updates are available that add to our knowledge of the safety profile of available medications. Please refer to Table for adjustments in dosing for diabetes medications used in CKD.
Table 1 Dose adjustment for insulin compounds and medications for diabetes in CKD
S To Improve Kidney Health
Check out these tips for maintaining or improving your kidney health:
- Meet your blood sugar targets. For most people with diabetes, blood sugar levels should be 4 to 7 mmol/L two hours before a meal and 5 to 10 mmol/L two hours after the start of a meal.
- Control your blood pressure. For most people with diabetes, blood pressure should be less than 130/80 mm Hg.
- Maintain healthy lifestyle habits. These include: eating healthy foods, and limiting intake of salt and sodium exercising regularly maintaining a healthy weight, or losing weight if needed and quitting smoking.
- Take your medication as prescribed. Your healthcare team will prescribe medicine based on your specific needs. This may include medications to help you meet your blood sugar and blood pressure goals, as well as to slow the progression of kidney disease.
- Have your kidney function tested. Most people with diabetes should have their kidney function assessed annually through blood or urine tests.
This article was sponsored by Janssen Inc.
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Low Blood Sugar In Chronic Kidney Disease
If you have chronic kidney disease, you are at the risk of low blood sugar and the risk is higher when you are on dialysis. Some studies indicate that low blood sugar may account for some portion of excess heart-related deaths seen in CKD patients. In view of this, finding out low blood sugar and getting prompt treatment is very important to assist your whole treatment. Headache, tiredness, weakness, sweating, feeling hunger, confusion, blurry or double vision and rapid or pounding heartbeat all can remind you to measure your blood sugar to make sure whether your blood glucose is lower than the normal. If so, prompt treatment is needed urgently. Eating rich-nutrition foods and taking diabetes medicines following with the guideline of doctors can help increase patients blood sugar effectively. In addition, treatments that can help improve patients kidney function is also needed. Only if their kidney function is increased, their condition can be reversed and patients overall health can be better.Continue reading > >
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Prevention & Treatment Of Kidney Disease
Kidney disease is closely linked to high blood sugar, high blood pressure and smoking. The best way to prevent or delay kidney damage is to:
- keep your blood sugar and blood pressure at target
- avoid smoking
- take your medications as prescribed
- have your blood cholesterol checked annually and keep it at target
- follow a healthy meal plan
- exercise regularly
- talk to your doctor about getting screened
If you’ve already been diagnosed with kidney damage or kidney disease, you may need to limit certain foods to prevent waste products building up in your body. Your health-care team may suggest you limit protein foods or foods high in potassium, phosphate or sodium. Controlling your blood pressure is also very important. You should see a registered dietitian for diet advice that is right for you.
In advanced or “end-stage” kidney disease, dialysis may be needed to do the job of the kidneys.
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Metabolic Effects Of Glucose
Significant increases in the plasma levels of -hydroxybutyrate and acetoacetate are more likely to occur after haemodialysis with a glucose-free dialysate than with a glucose-containing dialysate.18 This finding suggests that when a glucose-free dialysate is used, the body tries to maintain an adequate blood glucose concentration by changing to a more catabolic state of gluconeogenesis and glycogenolysis. Such a mechanism explains why levels of lactate and pyruvatesubstances important for gluconeogenesisare decreased under such circumstances.
Frequently recurring episodes of hypoglycaemia in diabetic patients result in decreased neurohumoral responses to low blood glucose levels and diminished clinical manifestations of hypoglycaemia.24 A single episode of hypoglycaemia can cause a generalized reduction of the neuroendocrine and symptomatic response to subsequent episodes even in nondiabetic individuals.25 In animals, long-term maintenance of hypoglycaemia increases the capacity of brain cells for glucose uptake, and a similar mechanism could explain the asymptomatic nature of hypoglycaemia in some patients with diabetes.26 Frequent recurrence of hypoglycaemic episodesdespite their asymptomatic naturemight increase the risk of progressive cognitive impairment in patients with diabetes.2729
Fatigue And Muscle Cramps Can Be A Symptom Of Kidney Failure
One of the differences between kidney failure and other diseases is that renal failure does not point to the site of the problem. In fact, very few people complain of kidney pain.
And although some persons with early renal problems get up to urinate during the night more frequently, there are many other causes that relate to this symptom. So, how can you tell if you have kidneys disease?
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Continuous Renal Replacement Therapy
The side effects of CRRT havent been as extensively studied as those caused by other types. One from 2015 found that the most common side effects of CRRT included:
- low calcium levels, called hypocalcemia
- high calcium levels, called hypercalcemia
- high phosphorus levels, called hyperphosphatemia
- low blood pressure
Many of the side effects of dialysis, including low blood pressure and other heart conditions, happen because of nutrient imbalances during treatment. A registered dietitian can provide appropriate dietary recommendations, including what to eat and what to avoid.
Other things you can do at home to minimize the risk of dialysis side effects include:
- checking your access site frequently, which can help to minimize infection risk
- getting enough exercise, such as low to moderate aerobic exercise, which can help reduce weight gain
- drinking water or liquids according to your healthcare providers instructions, which can reduce dehydration
- having more frequent dialysis sessions, which has shown may reduce the risk of low blood pressure and weight gain
- enjoying your favorite activities, which can up your mood throughout treatment
When to call your doctor
Although dialysis side effects are incredibly common, its important to keep your care team in the loop about anything you may be experiencing. Seek medical care right away if you experience any of the following symptoms during or after dialysis treatment:
- difficulty breathing
For People With Type 1 Diabetes
Microalbuminuria or proteinuria is rarely present at the time when the diabetes is first diagnosed. By five years after the diagnosis of diabetes, about 1 in 7 people will have developed microalbuminuria.
After 30 years, about 4 in 10 people will have developed microalbuminuria. Some people with microalbuminuria progress to proteinuria and kidney failure.
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More Information And Support About Kidney Disease
Talk with your diabetes team. They should be able to answer most of your questions. And were here to provide support and information when you need it too.
If you have more questions, or just want someone to listen, give our helpline a call. Youll be able to talk things through with highly trained advisors who have counselling skills and an extensive knowledge of diabetes.
The National Kidney Federation have kidney disease leaflets and can put you in touch with a local group. Kidney Care UK also offers resources and support including a telephone counselling service that you may find useful.
Kidney Research UK are dedicated to research into kidney disease. Weve been working together to identify the most important areas of future research, so that we can ultimately stop kidney disease in people with diabetes.
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You May Need Dialysis If Diabetes Damages Your Kidneys
Although kidney damage can sometimes be prevented or delayed, some people with diabetes may need dialysis if their kidneys fail. Diane Bonfrisco, 61, of Fair Lawn, N.J., had already suffered through complications with her feet and legs when suddenly she experienced symptoms of dehydration, dizziness, and abdominal pain and her skin turned yellow. “After numerous tests at the hospital, it was clearly stated that her kidneys were not working anymore,” says her 37-year-old daughter Christine. Diane has been on kidney dialysis for three and a half years now. Because her kidneys aren’t functioning, she takes medicine to prevent potassium and phosphorus from building up in her blood, which could cause other health problems. And she can only consume 32 ounces of liquidthe equivalent of four glasses of watereach day, her daughter notes. An accumulation of fluid between dialysis sessions could raise her blood pressure and make her heart work harder than it already does.Continue reading > >
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How Can I Tell If I Have Diabetic Kidney Disease
Most people with diabetic kidney disease do not have symptoms. The only way to know if you have diabetic kidney disease is to get your kidneys checked.
Health care professionals use blood and urine tests to check for diabetic kidney disease. Your health care professional will check your urine for albumin and will also do a blood test to see how well your kidneys are filtering your blood.
You should get tested every year for kidney disease if you
- have had type 1 diabetes for more than 5 years
What Are The Specific Types Of Feline Kidney Disease
There are many types of kidney disease in cats. Some are congenital and some are developmental.
Your veterinarian will be able to tell you which type your cat has.
While I cant get into every specific type of renal disease, here are some types you may encounter.
- Renal agenesis is the failure of kidney formation: sometimes kidneys dont form at all.
- Renal dysplasia: means abnormal kidney development.
- If one or both kidneys are displaced, your cat may be diagnosed with renal ectopia.
- And then there is polycystic kidney disease which comes with the formation of cysts throughout the kidney tissue.
Kidneys are complex.
That means there are a lot of things that could go wrong.
Structural issues, blood vessel problems, responses to outside influences, all the way down to the cells that make up the kidneystheres so much to know about these small but important organs.
While listing all of the exact diseases and congenital problems are beyond the scope of this article, I found a comprehensive list right here.
This informative video can also help shed some light on kidney failure in cats:
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Medical Therapy In Dialysis And Post
There are a few oral agents that can be used safely in patients on dialysis, particularly if the diabetes is fairly mild. Most others, however, will need insulin for glycemic control.
Patients receiving hemodialysis can have different clearance rates of insulin that may be affected by the timing of dialysis. We have done continuous glucose monitoring on patients undergoing HD and found that patients glycemic responses during HD are quite idiosyncratic and their insulin regimens need to be individualized to avoid both hyper-and hypoglycemia during and after HD. Patients who are on peritoneal dialysis have exposure to large amounts of glucose in the dialysate that can lead to uncontrolled hyperglycemia. In patients receiving PD continuously, a standard basal/bolus insulin regimen is best. However, with overnight PD using a cycler, coverage of the increased glucose load may best be accomplished using a fixed mixture insulin combination, such as 70/30 or 75/25 insulins, given at the onset of PD. The nephrologist prescribing the PD will often change the glucose concentration of the dialysate because of the need for more or less fluid removal and such changes need to be discussed with the endocrinologist so that the insulin doses may be appropriately changed.