It is common knowledge that diabetes is a significant risk factor for chronic kidney disease (CKD) and kidney failure. So, it may not be a surprise, that diabetes and high blood pressure are the leading causes of kidney failure.[i] Moreover, diabetes is the most common cause of kidney failure in the U.S.[ii]
What most of us are probably not aware of is that the rate of kidney failure cases due to diabetes has skyrocketed in the last 30 years.
In 1985, almost 21,000 people were reported having End-Stage Renal Disease (ESRD, which is total and permanent kidney failure). Back then, this figure represented 29% of all new cases. In 2012, approximately 240,000 diabetes patients were on renal replacement therapy, which accounted for 44% of all new ESRD cases.[iii]
Most recently, a 2017 study of the Global Burden of Disease (GBD) listed diabetes-related kidney failure as a "stand-alone" category, contributing to half a million deaths.[iv]
It is important to note that the only treatment for ESRD is dialysis or a kidney transplant.
The National Kidney Foundation (NKF) provides specifics on the two areas in which diabetes harms your kidneys:
- High sugar levels can clog tiny but crucial blood vessels in the filtering units of the kidneys. The lack of blood flow damages the kidneys and forces an essential protein called albumin out of the filters and into the urine (where it should not be).
- Diabetes can also damage the nerves in your bladder, thus cutting off the brain’s ability to tell when your bladder is full. The overdue pressure from a constantly full bladder leads to kidney disease. Furthermore, if urine stays in your bladder for too long, you can develop a urinary tract infection.[v]
For the 100 million-plus Americans who have diabetes or pre-diabetes,[vi] I hope that I have sounded a major panic alarm. I include the pre-diabetic patients in this discussion for three main reasons.
First, while kidney damage caused by diabetes occurs slowly (in some cases many years), the GBD study also attributes the 1.5 million deaths from type 2 diabetes and diabetes-related kidney failures to the rise in obesity rates. Patients who have had diabetes for more than two years should be especially concerned if they have weight management issues and should take the necessary steps to improve their weight through a proper diet and exercise routine. There are no early warning signs of diabetic kidney disease, so they should schedule a urine test at least once a year. A urine test will show early-stage kidney damage in patients with diabetes so that you can take the necessary treatment steps to prevent ESRD (again, this is kidney failure).
Second, of the projected 84 million Americans with pre-diabetes, a staggering number of these cases remain undiagnosed. I can make a pretty educated guess that high percentages in this category are struggling with obesity or at the very least weight management issues. If patients with pre-diabetes and diabetes (especially those newly diagnosed) can commit to a weight loss program, they can protect their kidney health as well as possibly reverse their diabetic condition.
Third, the health quality of the Western diet continues to decline, as does the affordability and accessibility to healthier, more natural, and unprocessed, unpackaged diet choices. I would also wager that this trend has a lot to do for the rise in diabetes-related kidney failures in recent years. I would go one step further in arguing for research to see if our broken food system accelerates the process of kidney damage from diabetes. For those of us in diabetic or pre-diabetic categories, I would not wait for the results of such a study and would also start making critical changes now.
To prevent or slow kidney damage, most people with diabetes know they have to control their blood sugar, and blood pressure levels. Your doctor may have already prescribed ACE inhibitors or ARBs – even if your blood pressure is normal.