Nutritional Recommendations For Diabetic Patients With Ckd
As diabetic patients experience progressive loss of renal function, nutritional issues become more complex. On one hand, in addition to the existing limitations associated with DM, specific restrictions are needed for patients with CKD, including restriction of protein, phosphorus, and potassium. On the other hand, patients with worsening uremic syndrome have a higher risk of protein-calorie malnutrition that needs to be identified and addressed by the medical team. Thus, nutritional monitoring is of utmost importance in this patient population. Standardized protocols should be avoided, and individualized care and monitoring of patients should be implemented.
Initially, patients should be evaluated based on their standard intake and clinical laboratory results. Then, a nutritional counseling plan should be designed based on nutritional guidelines that aid in the development of appropriate diets for patients, always considering individual needs.
For the population of diabetic patients with CKD in the non-dialytic phase, the composition of macronutrients in the nutritional plan is described in Table
Table 1 Dietary plan macronutrient composition for DKD in the non-dialysis stage.
One method that can be used to control blood glucose in these patients is carbohydrate counting, in which grams of this macronutrient obtained from meals are recorded throughout the day. This method is efficient in food control and the use of insulin, and its orientation should be individualized.
How Do Health Problems From Diabetes Begin
If your diabetes is not well controlled, the sugar level in your blood goes up. This is called hyperglycemia . High blood sugar can cause damage to very small blood vessels in your body. Imagine what happens to sugar when it is left unwrapped overnight. It gets sticky. Now imagine how sugar sticks to your small blood vessels and makes it hard for blood to get to your organs. Damage to blood vessels occurs most often in the eyes, heart, nerves, feet, and kidneys. Lets look at how this damage happens.
What Are The Symptoms Of High Blood Pressure And Kidney Disease
Most people with high blood pressure do not have symptoms. In rare cases, high blood pressure can cause headaches.
Early CKD also may not have symptoms. As kidney disease gets worse, some people may have swelling, called edema. Edema happens when the kidneys cannot get rid of extra fluid and salt. Edema can occur in the legs, feet, ankles, orless oftenin the hands or face.
Symptoms of advanced kidney disease can include
- loss of appetite, nausea, or vomiting
- drowsiness, feeling tired, or sleep problems
- headaches or trouble concentrating
- chest pain or shortness of breath
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How Do I Know If I Have Kidney Damage
Most people with early kidney damage do not have symptoms. The best way to find early kidney damage is to have a urine test once a year. This test checks for very small amounts of protein in the urine called albuminuria. It helps show kidney damage at an early stage in people with diabetes. Not everyone with kidney disease gets kidney failure. With the right treatment, you can prevent kidney disease from getting worse.
What Happens To The Kidneys In Diabetes
The main function of the kidneys is to filter waste products and excess water from the bloodstream so that they can be excreted in the form of urine. This is carried out by a system of tubes and blood vessels known as nephrons. Inside the nephrons are tiny blood vessels called capillaries and tiny urine-collecting tubes. One of the major structures in the nephron is a group of blood vessels known as the glomerulus, which acts as a filter.
Having high blood glucose levels can interfere with the function of the glomerulus. The filtering function of the kidneys doesnt work properly and proteins start to leak from the blood into the urine.
High blood glucose levels can also cause scarring of the glomerulus . As the scarring gets worse, the kidneys stop being able to filter waste products from the blood.
When enough glomeruli have been damaged, kidney failure results.
People who have diabetic nephropathy also often have high blood pressure. High blood pressure can further contribute to kidney damage.
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How Are The Kidneys Kept Working As Long As Possible
The kidney doctor, called a nephrologist, will plan your treatment with you, your family and your dietitian. Two things to keep in mind for keeping your kidneys healthy are controlling high blood pressure in conjunction with an ACE inhibitor and following your renal diabetic diet. Restricting protein in your diet also might be helpful. You and your dietitian can plan your diet together.
How Do Diabetes And High Blood Pressure Cause Ckd
High blood sugar levels and high blood pressure can damage blood vessels throughout the body, including the ones in the kidneys. Those blood vessels can then become less efficient at filtering blood, and are not able to deliver oxygen and nutrients to kidney tissue.
This reduced blood supply to the kidneys can then further damage their filtering system, and damaged kidneys can cause a buildup of waste and fluid that increases blood pressure even more.
Diabetes, high blood pressure, and CKD can often go undetected for years, silently causing damage throughout the body, so its important to know your risk and see your doctor regularly to be screened for these conditions. Getting proper treatment is key, and managing one condition can help you better manage the others. If you have CKD, the best way to slow or prevent kidney damage is to reach your blood sugar and blood pressure goals.
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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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Where Can I Get More Information
The National Kidney Foundation has free booklets that provide more information about diabetes and kidney disease. Call the national toll-free number 855.653.2273 and ask for free booklets. You can see these and other titles at www.kidney.org/store.
If you would like more information, please contact us.
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The Connection Between Diabetes Kidney Disease And High Blood Pressure
It’s a triple health threat faced by tens of millions of Americans. But few think about it until they’re forced to.
Even then, the interplay between diabetes, high blood pressure and kidney disease can be a challenge for people to grasp. But doctors say having an understanding is key for anybody who wants to reduce their risk or already has the conditions, or who helps a family member with them.
It’s especially important for people who could benefit from new medications but face barriers slowing their use.
More than 34 million people, or 10.5% of the U.S. population, have diabetes, according to the Centers for Disease Control and Prevention. Most cases are Type 2, or adult-onset. When someone has diabetes, they can’t make or use insulin as well as they should. That causes blood sugar to rise, which leads to various complications throughout the body.
Dr. Vivek Bhalla, an associate professor of medicine and nephrology at Stanford University School of Medicine in California, summed it up: “Diabetes can affect small blood vessels. And that can result in hypertension. And that can also result in kidney disease.”
It can be a vicious cycle, said Bhalla, past chair of the American Heart Association’s Council on the Kidney in Cardiovascular Disease.
Much of that cycle goes on invisibly, Bhalla said.
A new generation of diabetes drugs could radically improve that.
Rangaswami said that highlights the need for doctors to better communicate with one another.
Good Control Of Your Blood Glucose Level
Good control of your blood sugar level will help to delay the progression of the kidney disease and to reduce your risk of developing associated cardiovascular diseases, such as heart disease and stroke. Ideally, the aim is to maintain your HbA1c to less than 48 mmol/mol but this may not always be possible to achieve and the target level of HbA1c should be agreed on an individual basis between you and your doctor.
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How Can I Reduce My Risk Of Kidney Disease
There are lots of things you can do to reduce your risk of developing kidney disease:
- Keep your blood sugar levels within your target range
- Get support to stop smoking
- Eat healthily and keep active
- Go to all your medical appointments.
We have lots of information and support to help you have you tried our Learning Zone? Thousands of people with diabetes are using it to help them manage their diabetes. You can also download a copy of our ‘Diabetes and kidney disease’ leaflet free of charge from our online shop.
Protein Or Blood In The Urine
Urinalysis or urine testing is used to look for abnormalities such as an excess amount of protein, blood, pus, bacteria or sugar. A urine test can help to detect a variety of kidney and urinary tract disorders, including chronic kidney disease, diabetes, bladder infections and kidney stones. A trace of one type of protein, albumin in urine is an early sign of chronic kidney disease. Persistent amounts of albumin and other proteins in the urine indicate kidney damage. The presence of albumin is also a risk factor for cardiovascular events and death.
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Diabetes And Chronic Kidney Disease
If you have diabetes, ask your doctor about kidney disease.
Chronic kidney disease often develops slowly and with few symptoms. Many people dont realize they have CKD until its advanced and they need dialysis or a kidney transplant to survive.
If you have diabetes, get your kidneys checked regularly, which is done by your doctor with simple blood and urine tests. Regular testing is your best chance for identifying CKD early if you do develop it. Early treatment is most effective and can help prevent additional health problems.
CKD is common in people with diabetes. Approximately 1 in 3 adults with diabetes has CKD. Both type 1 and type 2 diabetes can cause kidney disease.
- Kidney diseases are the 9th leading cause of death in the United States.
- Approximately 1 in 3 adults with diabetes has CKD.
- Every 24 hours, 170 people with diabetes begin treatment for kidney failure.
Beware Chronically High Blood Sugars
If you consider what we know about how persistently high blood sugar levels can damage nerves and blood vessels throughout your eyes, kidneys, fingers, toes, etc., then it isnt hard to see why it can interfere with pregnancy, too.
The health of your uterus is just as affected by those long-term high blood sugar levels.
High blood sugars also contribute to congenital conditions that can develop in the first trimester.
When you become pregnant, during the first trimester the cells of that fetus are dividing and forming first into heart cells, arm and leg buds, ears and eyes, the mouth palate, and external genitalia, Smith explains.
The next trimester includes the forming of the brain, spinal cord, and more.
This is why women with diabetes are told their pregnancy faces a higher risk of birth defects because persistently high blood sugar levels can interfere with the healthy development of every part of that fetuss development, Smith says.
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Over Time High Blood Pressure Harms Renal Blood Vessels
The nephrons in the kidneys are supplied with a dense network of blood vessels, and high volumes of blood flow through them. Over time, uncontrolled high blood pressure can cause arteries around the kidneys to narrow, weaken or harden. These damaged arteries are not able to deliver enough blood to the kidney tissue.
- Damaged kidney arteries do not filter blood well. Kidneys have small, finger-like nephrons that filter your blood. Each nephron receives its blood supply through tiny hair-like capillaries, the smallest of all blood vessels. When the arteries become damaged, the nephrons do not receive the essential oxygen and nutrients and the kidneys lose their ability to filter blood and regulate the fluid, hormones, acids and salts in the body.
- Damaged kidneys fail to regulate blood pressure. Healthy kidneys produce a hormone called aldosterone to help the body regulate blood pressure. Kidney damage and uncontrolled high blood pressure each contribute to a negative spiral. As more arteries become blocked and stop functioning, the kidneys eventually fail.
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What Kidney Problems Can Happen
When blood sugar is high, it can damage the blood vessels in the kidneys, leading to kidney disease. This is sometimes called diabetic nephropathy .
Kidney disease is more likely in people who havent controlled their blood sugar levels over a long period of time. Kidney disease can get worse if someone also has high blood pressure or uses tobacco.
If doctors find kidney disease early, the damage can sometimes be reversed with treatment.
If the kidney disease gets worse, a person may need dialysis or a kidney transplant. The good news is that these days kidney disease is less likely to end up as kidney failure because of earlier detection and better treatment than in the past.
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What Are The Kidneys
The kidneys are bean-shaped organs that are located near the middle of the back, just below the rib cage with one on each side of the spine.
Of the many roles they perform, one of the most important is the removal of waste products from the blood , which come from food and the normal breakdown of active tissues, such as muscles.
Other key functions of the kidneys include the secretion of three important hormones:
- Erythropoietin which is released in response to hypoxia to stimulate the production of red blood cells in the bone marrow.
- Calcitriol the active form of vitamin D, which helps maintain calcium for bones and for normal chemical balance in the body
- Renin an enzyme involved in the regulation of blood pressure
Inhibition Of The Sympathetic Nervous System
The role of sympathetic over-activity in intradialytic hypertension has not been firmly established. It is clear that patients with renal disease have evidence of sympathetic nerve activity, which normalizes after nephrectomy. Whether patients who have undergone bilateral nephrectomy develop intradialytic hypertension is unknown but this certainly cannot be routinely advocated to control BP. Adrenergic blockers such as alpha- and beta-blockers should be considered as therapeutic options to control BP. In particular, carvedilol and labetolol with combined alpha and beta-adrenergic blockade should be considered as they are not significantly removed by hemodialysis.
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The Impacts Of Emotional Stress
You also have to consider the emotional stress youre going through at the time, and the weeks afterwards, Smith says. If youre sad and depressed, if youve changed your normal routine around exercise and food, these can all have a sudden impact on your diabetes.
Regardless of whether you were trying to get pregnant or not, experiencing a miscarriage or abortion can be a stressful event in your life.
Dont underestimate the impact of stress on your blood sugar. Higher stress levels increases cortisol levels, which means your liver is releasing more glucose, meaning youll need more insulin.
Even the most subtle stress can call for an increase in your background insulin needs.
Both experiences can come with feelings of failure, shame, fear, worry and guilt. If youre struggling with these emotions, reach out for help from friends, family, your healthcare team, or professional counselors.
If you find yourself having trouble working through your emotions, reach out for help from friends, family, your healthcare team, or a therapist or counselor. Your doctor can give you a referral to a therapist or counselor.
Can A Patient With Diabetes Have A Kidney Transplant
Yes. Once you get a new kidney, you may need a higher dose of insulin. Your appetite will improve so your new kidney will break down insulin better than your injured one. You will use steroids to keep your body from rejecting your new kidney. If your new kidney fails, dialysis treatment can be started while you wait for another kidney. To learn more about kidney transplant .
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What Are Kidneys And What Do They Do
The kidneys are two bean-shaped organs, each about the size of a fist. Theyre located just below the rib cage against the back muscles, on the left and right sides of the body.
Kidneys have two very important functions: they help the body pass waste as urine, and they help filter blood before sending it back to the heart. They also:
- Help maintain the balance of minerals and electrolytes in the body, such as calcium, sodium, and potassium
- Play an essential role in the production of red blood cells
- Help maintain the delicate acid-base balance of the blood