Protect Your Kidneys In Diabetes: Tips For Kidney Health

Our kidneys are one of the most important organs in the body that help maintain health by filtering our blood and removing waste products and extra water in the form of urine. Any damage to them can cause these waste products to accumulate in the body along with the extra water. This can cause an increase in weight, shortness of breath, and loss of sleep as well as long-term complications.

Diabetes can put one at risk of damage to the kidneys. Taking care of our kidneys early can protect them and prevent us from succumbing to the complications of diabetes.

Here, we take a look at the impact of diabetes on kidneys, the signs of recognising kidney damage, and tips on how to protect your kidneys in diabetes.

Effects of diabetes on kidneys

Our kidneys contain small filters called nephrons, which act as a sieve, separating waste materials from our blood so they can be flushed out as urine. Each nephron contains a tiny bundle of blood vessels called glomeruli, which allow only water, small waste products, and extra minerals to go through while preventing the loss of bigger and more important blood components, such as proteins. This selective filtration process helps maintain the proper balance of substances in the body.

In diabetes, persistently high glucose levels in the blood can lead to certain changes in the kidneys. It damages the filtration barrier of the small blood vessels or glomeruli, which causes the escape of important proteins from the blood into the urine.

This is normally seen in patients with diabetes for a long time (>ten years). It may start with small amounts of protein detected in the urine (micro-albuminuria). If not corrected in time with appropriate treatment, it may lead to the loss of larger amounts of protein escaping in the urine (macro-albuminuria).

Ultimately, it can lead to complete loss of the kidneys’ filtering function and the need for regular dialysis to remove the waste products from the blood. A kidney transplant is needed in severe or chronic cases where dialysis can no longer support kidney function.

Cues and signs of kidney damage

In the beginning, there are often no symptoms and only laboratory tests may help identify damage to the kidneys.

However, as the damage progresses, various symptoms may manifest.

Warning signs of kidney damage in diabetes include, among others:

• Increase in weight due to retention of extra fluid in the body
• Swelling in the feet and ankles
• Itching
• Loss of sleep
• Feeling weak
• Loss of appetite

Additionally, certain laboratory tests can help detect kidney damage:

• Urine albumin-creatinine ratio (uACR): This test helps find out if there is any protein in the urine. It measures the levels of albumin (a type of protein) and creatinine (a waste product) in the urine. Albumin is normally present in the blood, but its presence in the urine can indicate a kidney problem.
• Estimated glomerular filtration rate (eGFR): This test helps to find out if the kidneys are functioning normally. It measures how much blood can the kidneys filter in one minute.

The presence of albumin in the urine and/or a reduction in the eGFR is the basis for a clinical diagnosis of kidney disease in diabetes.

In patients with type 2 diabetes, the onset is unknown and therefore, it is likely that some amount of albumin may already be present at the time of diagnosis. Routine testing of these laboratory parameters may help in identifying and preventing the progression of kidney damage in diabetes.

Risk factors for kidney damage in diabetes

High blood pressure and uncontrolled glucose levels are the two major risk factors for kidney damage in diabetes.

Additionally, the greater the duration of diabetes, the more the likelihood of the development of kidney damage. Other risk factors that can have an impact on kidney damage in diabetes include:

• Obesity
• Family history of diabetes
• Smoking
• High cholesterol levels

Kidney damage in diabetes is often associated with other complications such as heart disease and damage to the eyes.

Following the advice of medical professionals and ensuring control of blood pressure, blood glucose levels, and diet can help protect our kidneys from damage and prevent the related complications of diabetes.

Low glucose levels and kidney disease – is there a connection?

Various research studies have shown that the presence of diabetes along with kidney damage, especially over a long period, can increase the risk of low glucose levels (also called hypoglycemia).

A normal healthy body maintains glucose levels through various mechanisms, including glucose storage in the liver and kidneys. However, in diabetes with kidney damage, this storage is less / depleted.

Also, kidney damage can have additional effects that can further increase the risk of low blood glucose levels, such as nutritional deficiencies, risk of infections and heart diseases, and reduced clearance of insulin (a hormone that regulates blood glucose levels) from the body. Limited drug options for use in such a situation further aggravate the problem.

Low blood glucose levels may manifest as unintelligible speech, confusion, or even as serious conditions such as abnormal heartbeat or seizures. It is known to affect the prognosis and longevity adversely.

Tips to protect your kidneys in diabetes

Simple routine steps can go a long way in protecting our kidneys from diabetes. These include:

• A healthy diet: This includes an adequate quantity of non-starchy vegetables such as cauliflower and eggplant, fruits such as apples and berries, lean meats, plant-based proteins, nuts, whole grains, and fibre. Reducing the intake of processed / refined food and foods with added sugars can further help normalise glucose levels. Working with a dietician to decide on the most appropriate diet can not only help you enjoy your meals but also be adherent to them.
• Moderate physical activity, such as walking for at least 30 mins a day for five days a week, provides benefits that help in better utilisation of insulin and being friendly to the health of the kidneys, the heart, and the mind.
• Smoking cessation: Tobacco use is detrimental to kidney and heart health. Cessation of smoking can help prevent the development of kidney and heart diseases.
• Reduced salt intake: Reducing salt can help reduce blood pressure and the risk of heart disease associated with kidney damage.
• A regular check of laboratory parameters such as HbA1c (glycated haemoglobin), UACR, or eGFR on a 3 or 6-monthly period or as directed by the doctor helps identify the damage early and take appropriate steps to protect the kidneys.
• Maintaining blood glucose levels in control by regular self-monitoring of glucose levels at home and adhering to medications prescribed by the doctor can help keep diabetes in control and prevent endangering the kidneys.
• Keeping blood pressure under control through medication and lifestyle interventions as directed by the doctor can protect against heart disease associated with kidney damage.

Conclusion

Kidneys play a very important role in our body. So, protecting your kidneys in diabetes and preserving their function is key to preventing the long-term complications of diabetes.

This requires recognition of lifestyle interventions such as diet, exercise, smoking cessation, regular risk assessments, and adherence to treatment options prescribed for maintaining glycaemic control and blood pressure control.

Being aware and educated on the impact of diabetes on kidneys can help in being prepared to manage them effectively, and on time.

Disclaimer: This material is for informational purposes only. It does not replace the advice or counsel of a doctor or health care professional.