Diabetes: Remember to Protect Your Kidneys!

It is estimated that nearly 600 million people worldwide suffer from kidney disease. Today, the first cause of these diseases is diabetes, very often associated with overweight and high blood pressure. Discover these little-known links as well as the means of prevention and medical advances for dialysis patients.

More than 5% of the world's population suffers from chronic renal failure . Without early diagnosis, millions die prematurely from this disease or its cardiovascular complications . However, these disorders can be detected and their evolution stopped or slowed down.

The classic causes of chronic kidney disease are inflammatory kidney disease , urinary tract infections and  obstructions , and genetic diseases such as polycystic kidney disease . But today, we see in all countries that diabetes and high blood pressure have become the most common causes. In France, approximately 30% of chronic dialysis patients , and 40% of patients undergoing dialysis, are diabetic. And, the number of diabetics requiring dialysis or kidney transplantation is expected to double over the next decade.

What is nephropathy? 

Nephropathy is a  kidney condition that manifests as kidney failure. It is characterized by the elimination of albumin in the urine, the decrease in the rate of glomerular filtration and arterial hypertension.

It is often associated with the presence of protein and blood in the urine. But, it is also possible to have no symptoms.

However, the first consequence of this little-known chronic kidney disease is the progressive loss of kidney function leading to dialysis or a kidney transplant to save the patient's life. The second consequence is a risk of premature death from cardiovascular complications .

How does diabetes affect the kidneys? 

The chronic hyperglycemia of diabetics damages the kidneys . Indeed, the excess sugars in the blood gradually damage the  small blood vessels of the kidneys which no longer manage to perform their filter function correctly. Renal  permeability occurs, which can pass proteins in the urine ( albumins ). Eventually, if the nephropathy is not treated and the diabetes is not stabilized, the kidney filters can be so damaged by excess sugar that the kidneys stop working.

In addition, diabetes can also damage the nerves controlling the urinary system , causing difficulty in urinating and pressure in the bladder, which can then cause damage to the kidneys. 

Finally, bacteria love sugar. Diabetics therefore have a favorable ground for the proliferation of bacteria and therefore  kidney infections . 

Screening and diagnosis of nephropathy 

About 30% of diabetics have impaired renal function.  Any diabetic patient should in fact be screened at least once a year . This examination consists of a urinary assessment to detect the presence of albumins and  blood to check the creatinine dosage . 

Most forms of kidney disease are  treatable , and their progression can be halted, especially if treatment is started early.

What treatments for kidney failure?

Unfortunately,  damage to the kidneys caused by nephropathy is irreversible . But, at each stage of diabetic kidney disease, an effective and simple treatment can  stabilize or even reverse the evolution . Microalbuminuria and even proteinuria may regress, kidney function may stabilize or even improve with careful blood sugar and blood pressure control.

To do this, your diabetologist will be able to adapt your treatment and/or prescribe you antihypertensive medication such as an enzyme-converting enzyme inhibitor to lower the blood pressure in the kidneys and help preserve their function.

You may also be advised to consult a dietician to learn how to control your protein and certain mineral intake (calcium, phosphorus, sodium, potassium) in order to lighten the work of your kidneys. 

The 7 key prevention measures

More than 80% of patients do not know enough about the  renal risks of diabetes , nor the objectives and means of treatment, the two pillars of which are glycemic balance and blood pressure control. 

• Control of high blood pressure which helps slow the loss of kidney function
• Reduction of proteinuria by drugs blocking the renin-angiotensin system
• Reduction of salt intake which promotes the control of high blood pressure
• Control of hyperglycemia and hypercholesterolemia
• Smoking cessation
• Increase in physical activity
• Control of excess weight

Sometimes, however, the nephropathy continues to progress. And, when kidney function is less than 15%, dialysis is needed to replace the impaired kidney function and clean the blood .

Towards more comfort for dialysis patients

When the disease requires dialysis, new techniques are available to patients. Indeed, even if the technologies of chronic dialysis are not recent, some innovations today allow greater comfort  :

• Real-time dialysis dose measurement

It is now possible to indicate the quantity of purification delivered , including for the devices used by the autonomous hemodialysis patient in self-dialysis or at home. This makes it possible to check that the dose of dialysis prescribed by the doctor is reached and thus to avoid (by modifying if necessary the blood flow in the device or the duration of the session) being insufficiently purified of its waste, which would lead to a loss of appetite leading to malnutrition - a very important factor in mortality in dialysis patients.

• Dialysis machines for daily hemodialysis

Daily hemodialysis (6 sessions per week from 2h to 2h30) is often preferred by patients to conventional hemodialysis (3 sessions per week lasting 4h to 4h30), on the one hand because they feel much better ( absence symptoms during the sessions, no recovery time necessary after the session, practically free diet between sessions), on the other hand because a daily hemodialysis regimen is sometimes easier to fit in than a conventional regimen in a social or professional life. However, this scheme doubles the time and cost of transport to the treatment unit, but also the time for preparing the machine before the session and disinfection after the session. This is why several dialysis devices are being developed to reduce this time as much as possible and allow the patient to undergo dialysis at home .

• Expert system in peritoneal dialysis

A telemedicine system ( Diatelic ) avoids the risk of weight drift in peritoneal dialysis . All the patient has to do is collect their peritoneal dialysis data on the computer every day (instead of doing so in their dialysis notebook). These data are transmitted to an expert system which evaluates the evolution of the patient's parameters and in particular of his weight. In the event of a deviation, the system sends an alert message to the doctor in charge , who will then contact the patient to inform him of the changes to be made in the terms of his treatment. The goal is to no longer wait for a monthly appointment to react and thus avoid numerous hospitalizations.