Written by Dr Jonathan Kwan for Doctify
It was variably reported that between 25% to 40% of diabetic patients (both Type 1 and Type 2) will develop diabetic kidney complication. This could be very mild with only a small amount of protein loss in the urine to very severe with progressive reduction in the filtration and waste product excretion functions of the kidneys leading to the need for dialysis treatment or kidney transplantation. It is predicted that by 2035, there will be some 5 million population suffering from diabetes in the UK. The health burden in managing patients with chronic diabetic kidney disease is likely to be high; so prevention and retarding deterioration in patients with established disease are the correct strategies going forwards. Currently, just under 20% of all patients (~4,500) needing life-maintaining dialysis have diabetes as the primary cause of their kidney condition. Every year there will be some 1800 new diabetic patients joining this list. Prevention in diabetic kidney disease will bring both personal benefits to the patient and reduce the Nation’s health expenditure in the medical management of these unfortunate patients.
The presence of small amount of protein in the urine (microalbuminuria), in the absence of urine infection, is usually the first tell-tail sign of potential progressive diabetic damage to the kidneys. Most registered diabetic patients would normally go through an annual medical review, at the GP or Hospital Diabetic Clinics, which include urine testing to detect early presence of microalbuminuria. The presence of microalbuminuria should target healthcare providers to optimise care to these patients to halt or slow down their progressive disease. These will include the following:
1. Life style modification
Reduce body weight if obese, stop smoking, avoid excess alcohol, cut down salt to help with reduction of fluid retention and blood pressure control, adopt a more ambulatory live style with more exercise.
2. Optimise sugar control
Optimise sugar control working with your diabetic doctors and nurses aiming to maintain HbA1c, the 3 month time-averaged sugar control marker, of below 7% (or IFCC 53 mmol/mol – the new unit we now use).
3. Optimise blood pressure control
Optimise your blood pressure control with an aim to maintain BP < 140/80 mmHg, without undue dizziness. Your doctor may advice on an even lower reading in certain clinical situations.
4. Blood pressure meds: Use classes of blood pressure tablets which reduce systemic blood pressure as well as pressure inside the kidneys, ACEI’s, ARB’s and DRI (your doctor will advise the appropriate agent).
5. Statins
Treat high cholesterol level with statin if tolerated.
6. Aspirin
Low dose aspirin or other anti-platelet drugs where indicated.
These measures are the good practice management approaches of any diabetic patients even before they develop markers of kidney dysfunction; they also protect other organs in the diabetic patients too.
In summary, good sugar control, good blood pressure control with the appropriate medications, and good cholesterol control will reap benefits not only in preventing kidney damage, it will also reduce diabetic eye, heart, brain and nerve diseases.
