Kashif J. Piracha, MD, is a board-certified physician with over 14 years of experience treating patients in acute care hospitals and rehabilitation facilities.
Diabetes and chronic kidney disease (CKD) are common conditions affecting 11% and 17% of adults in the United States, respectively. Although each can occur on its own, they can also occur together as comorbid (coexisting) conditions.
On the one hand, diabetes can give rise to CKD due to the long-term damage it can inflict on blood vessels throughout the body, including those of the kidneys.
On the other, there is increasing evidence that CKD can cause diabetes due to the buildup of waste from the malfunctioning kidneys, which, in turn, affects insulin production. How the body produces or responds to insulin (a hormone that allows cells to take in sugar for energy) is key to the development of diabetes.
This article takes a closer look at the connection between diabetes and chronic kidney disease, including how one increases the risk of the other. It also explores treatment options and things you can do to prevent this all-too-common comorbidity.
For the purposes of this article, “male” refers to people born with penises and “females” refers to people born with vaginas irrespective of which gender or genders they identify with or if they identify with no gender at all.
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Both diabetes and CKD are chronic illnesses, meaning that they are persistent and typically progressive. Over time, they can cause damage to multiple organs, leading to such comorbid conditions as hypertension (high blood pressure), hyperlipidemia (high cholesterol), and cardiovascular (heart) disease.
Diabetes and CKD can also give rise to each other, particularly when the diseases are advanced or poorly controlled.
Diabetes is a group of diseases that causes high blood sugar (glucose). When blood sugar levels are high—referred to as hyperglycemia—they reduce levels of a chemical in the blood called nitric oxide.
The persistent depletion of nitric oxide, which the body uses to regulate blood pressure, can cause vessels to lose their elasticity and narrow over time. This causes hypertension, a common condition in people with diabetes.
High blood pressure is a problem because it increases the force of blood through vessels, which can severely damage artery walls. High blood sugar can also directly damage the lining of blood vessels by exposing them to persistent inflammation and oxidative stress.
When this occurs in the kidneys, millions of tiny filtering units called nephrons can be irreversibly damaged. This prevents the kidneys from filtering waste out of your blood, leading to CKD.
CKD caused by diabetes is aptly referred to as diabetic kidney disease. CKD can result from both type 1 diabetes, an autoimmune form of diabetes, and type 2 diabetes, the type largely linked to lifestyle factors such as diet and obesity.
One in three adults with diabetes has CKD, according to the Centers for Disease Prevention (CDC). Every 24 hours in the United States, 170 adults with diabetes begin treatment for kidney failure. Kidney failure, in which the kidney can no longer remove waste or excess fluid from the blood, tends to occur 20–30 years after the onset of diabetes.
CKD is characterized by the progressive loss of kidney function. Many things, including kidney injury, can cause CKD, but the three most common causes are hypertension, heart disease, and diabetes.
Recent research suggests that people with non-diabetic kidney disease run an increased risk of type 2 diabetes due to the buildup of a waste product called urea in the blood.
Urea is a natural byproduct of metabolism that the kidneys can usually remove from the body in urine. However, when kidney function is impaired, urea can start to accumulate. High urea levels can directly affect beta cells in the pancreas, which are responsible for making, storing, and secreting insulin into the bloodstream.
Insulin is the hormone tasked with regulating blood sugar in the body, and the depletion of this hormone can contribute to the onset of diabetes in people with CKD.
It is unclear if high blood urea can do this on its own or simply increases the risk in those already vulnerable to type 2 diabetes. Either way, the link between non-diabetic kidney disease and diabetes remains exceptionally high.
A 2020 study in the Clinical Kidney Journal reported that among 832 adults living with type 2 diabetes, nearly half (49.6%) had non-diabetic kidney disease.
The association between diabetes and chronic kidney disease is well established. Even so, having diabetes doesn't automatically mean that you will get CKD, and having CKD doesn't automatically mean you will get diabetes. With that said, the risk of comorbidity increases if the diseases are poorly controlled.
Other risk factors can contribute to the onset of CKD in people with diabetes, some of which are modifiable (meaning you can change them) and others which are not.
Common risk factors for diabetic kidney disease include:
Type 2 diabetes is the leading cause of end-stage kidney disease, for which dialysis or kidney transplant are the only treatment options. Diabetic kidney disease is also linked to an increased risk of death overall, particularly from heart disease.
The link between non-diabetic kidney disease and type 2 diabetes is far less clear. In some cases, they may develop independently of each other. Even so, there are certain factors that can speed the progression of CKD and potentially contribute to the onset of diabetes.
Common modifiable and non-modifiable risk factors for CKD progression include:
Latinx and Black people in the United States experience up to a twofold increased risk of CKD progression compared to White people. Though genetics play a part (as seen with the APOL1 gene, which increases the risk of CKD progression in Black people), higher poverty rates and poorer access to healthcare limit their ability to manage CKD effectively and avoid progression.
Although there is no cure for either diabetes or chronic kidney disease, both can be managed with lifestyle changes and medications to slow their progression and prevent long-term complications.
The primary aim of both type 1 and type 2 diabetes is to maintain your blood sugar within the normal range to avoid disease progression and complications. The treatment plan can vary by the type and stage of diabetes you are living with, but it typically involves:
The treatment of chronic kidney disease varies by cause. If diabetes is the cause, the focus would be on maintaining glycemic control and treating disease complications (such as high blood pressure or high cholesterol).
The treatment plan for CKD also varies by the stage of the disease and how functional your kidneys are. Options include:
Diabetes and chronic kidney disease are not always avoidable. Type 1 diabetes, for example, is caused by a malfunctioning immune system, and, even with type 2 diabetes, genetic factors may predispose you to the disease. The same applies to CKD, for which there are risk factors you can't change (like race or family history).
That said, there are effective ways to reduce your risk of diabetes and CKD, many of which overlap.
Lose excess weight.
Be more physically active.
Follow a healthy eating plan.
Avoid sugary and highly processed foods.
Stop smoking.
Lose excess weight.
Be more physically active.
Follow a healthy eating plan.
Avoid sugary and highly processed foods.
Manage your diabetes.
Manage your blood pressure.
Diabetes and chronic kidney disease (CKD) are closely linked. On the one hand, uncontrolled diabetes can cause CKD by damaging blood vessels and tiny filters called nephrons in the kidneys. On the other, CKD may contribute to the onset of diabetes due to the buildup of waste products that suppress insulin production.
Eating a healthy diet, avoiding sugary foods, exercising regularly, and maintaining an ideal weight can go a long way toward preventing diabetes and CKD, individually and together.
One of the challenges of diabetes and chronic kidney disease is that both can be "silent" until the diseases are advanced and cause serious symptoms. This is especially true with CKD, in which two of every five people with severe kidney disease are unaware of their condition.
To this end, it is important to recognize the early signs of diabetes (including frequent urination, fatigue, increased thirst, blurred vision, tingling hands or feet, slowed healing, and unintended weight loss) and the early signs of kidney disease (including decreased urination, nausea, fatigue, loss of appetite, foamy urine, and ammonia-smelling breath),
The earlier you are diagnosed and treated, the better able you will be to slow disease progression and avoid potentially serious complications.
Symptoms of diabetic kidney disease, also known as diabetic nephropathy or diabetic renal disease, include:
Kidney damage caused by diabetes cannot be reversed. By the time symptoms appear, the damage to the filters of the kidneys (called nephrons) has already been done. Even so, by gaining control of your blood sugar, you can slow the progression of diabetes and retain the function of your kidneys for longer.
Diabetic kidney disease generally takes 20 years or more to develop, with symptoms typically appearing during adulthood. Even so, studies suggest that in children with type 1 diabetes—the autoimmune form of diabetes—kidney impairment may start as early as 18 months following the onset of the disease (though symptoms may not be apparent for years).
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Dennis Sifris, MD, is an HIV specialist and Medical Director of LifeSense Disease Management. James Myhre is an American journalist and HIV educator.
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