Reviewed by: HU Medical Review Board | Last reviewed: March 2021. | Last updated: January 2023
Diabetes is the leading cause of kidney disease. About 1 in 3 people with diabetes has kidney disease. Understanding the connection between diabetes and this common complication can help you take steps to protect your health.1
What is kidney disease?
Kidney disease means your kidneys are damaged and cannot filter or clean your blood like normal. This may happen quickly with an injury or illness, or over time with a disease like diabetes. When kidney disease happens over time, it is also known as chronic kidney disease.1
There are 5 stages of kidney disease. Stage 1 is mild, while stage 5 is near or complete kidney failure. The later stages are known as end-stage renal disease (ESRD). Your doctor can determine the stage based on a blood test that measures how quickly your kidneys filter waste from your body. This test is known as the estimated glomerular filtration rate (eGFR).2
The diabetes connection
Diabetes is a disease where your blood sugar (glucose) is too high. This may be because your body cannot make insulin (type 1 diabetes) or your body does not make or use insulin the way it should (type 2 diabetes). Insulin is a hormone in your body that helps sugar in your blood get used for energy. If there is a problem with the insulin, sugar in your blood builds up, causing increased blood sugar (hyperglycemia).3
Sugar crystals in the blood are sharp and can damage the vessels in your body when there is too much sugar. Your kidneys are full of tiny blood vessels (glomeruli) that help clean your blood. These tiny blood vessels may get damaged when blood sugar is high in diabetes. The blood vessels cannot be fixed and, if left untreated, may lead to kidney failure.3
Your kidneys play an important role in regulating your blood pressure. High blood pressure (hypertension) increases the risk for kidney disease.1
You cannot feel if your kidneys have been damaged due to diabetes. The earliest sign of diabetic kidney disease is an increased amount of protein (albumin) in the urine. As your kidneys fail, other signs or symptoms may occur:3
- High blood pressure
- Ankle and leg swelling
- Urinating more often at night
- High levels of blood urea nitrogen (BUN) and creatinine in blood. These measure the amount of waste in your blood. These may be called kidney function blood tests.
- Muscle cramps (especially in your legs)
- Nausea and vomiting
- Pale, itchy skin
Kidney disease is diagnosed when you have abnormal kidney function blood tests. The disease may also be diagnosed when there is protein in your urine and your blood pressure is high.1
The focus on treatment is the prevention of complications or worsening of the disease. Some methods include:1
- Controlling blood glucose
- Controlling blood pressure
- Avoiding drugs that cause or worsen kidney damage
- Adopting a diet that limits sodium and potassium
Dialysis may be a treatment used when prevention techniques fail. Dialysis helps to remove toxins, wastes, and fluid from your body when your kidneys are not working properly. Your doctor will tell you more about which type of dialysis may be best for you. There are 2 types of dialysis:4-6
- Hemodialysis (HD) uses a machine to clean and filter your blood. This is the most common type of dialysis used for those with ESRD. Before starting this treatment, you will need minor surgery to create a point of access, where the blood will leave and return to your body.Before every treatment, the dialysis technician will place 2 needles in the access point. Your blood flows from your body to the dialysis machine, where it is cleaned. The blood is then returned to your body using the other needle. This type of treatment can be done at home, dialysis center, or hospital. It takes about 3 to 4 hours per treatment, and people typically need 3 to 4 treatments per week.
- Peritoneal dialysis (PD) is a treatment that uses the lining of your belly (abdomen), called the peritoneum. Dialysate, a sugar-containing fluid, is poured into your belly, where it helps to pull fluid and waste out of your body. The fluid sits in your belly for a certain amount of time, then it is drained. Before starting this treatment, you will need minor surgery to place a soft, flexible tube called a catheter into your belly or chest.
A kidney transplant is a surgery that removes your diseased kidney and replaces it with a healthy one. The healthy kidney can be from a living donor (usually someone you know) or a donor who has died.4,7
Talk to your doctor about different drugs that may help with the symptoms of kidney disease. These treatments do not cure kidney disease. Kidney disease will eventually get worse over time.4
Can I prevent kidney disease if I have diabetes?
Keeping your blood sugar under control is the best way to prevent kidney disease if you have diabetes. Manage your blood pressure as best as you can with help from your doctor.1,3
Talk to your doctor about additional things you can do that can help prevent kidney disease.