Q&A: I Have Diabetes; How Do I Keep My Kidneys Healthy?

Q: I am diabetic and my family doctor says I’ve got protein in my urine. I’m worried that I’ll need dialysis. What can I do to keep my kidneys healthy?

A: You’re wise to want to protect your kidneys. Our kidneys have an important role, filtering fluid and waste from the blood, and making hormones that keep our bones and blood healthy.

Kidney failure happens when the intricate filtering mechanisms called glomeruli stop functioning in both kidneys. But the kidneys may not completely shut down for decades. During this time, the kidneys gradually lose their ability to filter the blood and remove water, a condition known as chronic kidney disease or CKD.

Know your kidney score.

There are five different stages of kidney disease, depending upon severity. A blood test that reveals your kidney score – in medical terms, your estimated glomerular filtration rate (eGFR) – will show the stage at which your kidney is functioning. Because it’s vital to treat CKD before the kidneys completely fail, this test is key.

The earlier abnormal kidney function is recognized, the greater the chance that a specialist can help. That is why patients diagnosed with CKD are referred to a nephrologist, who specializes in the medical care of kidneys. By carefully designing a kidney plan, nephrologists can often help to slow the progression of CKD.

Reducing your risk of problems.

What does this mean for you? The extra protein (albumin) in your urine is an early sign that your kidneys are not filtering properly and are "leaking protein." Your diabetes increases your risks for CKD and several related problems, such as anemia, high blood pressure, bone thinning and cardiovascular disease. Most critically, CKD increases your risks of heart attack and stroke.

A nephrologist can assess the cause of your kidney disease and design a plan just for you. This may require specific medications, a special diet, patient education and home blood-pressure monitoring. Patients with CKD need to have their blood pressure controlled both at night and during the day.

When both kidneys fail.

Four treatment options are possible when both kidneys fail: home peritoneal dialysis, in-center hemodialysis, home hemodialysis and kidney transplantation.

A "pre-emptive" kidney transplant can be considered prior to starting dialysis. In this scenario, someone must be willing to donate a kidney to you at the time your kidneys actually fail, but before you begin dialysis.

Kidney transplantation can restore quality of life to the level that patients enjoyed before kidney failure. However, life-long medication is needed to prevent the body from rejecting the kidney.

By Martin J. Schreiber Jr., MD, Chairman, Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic


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