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If you have type 1 or 2 diabetes, you’re at higher risk for kidney disease. About a third of adults  with diabetes have this condition, which slowly damages your kidneys. If it gets worse, you could lose most of your kidney function. Diabetes is the No. 1 cause of kidney failure.

If you have diabetes and don’t yet have kidney damage, you and your doctor may be able to stop it before it starts. You can't reverse it once you have it. But there are ways to slow it down.

Regular visits to your doctor are key. Your doctor needs to keep a close eye on how well your kidneys are working and adjust your medications if your kidney function drops. You also need to take your medications faithfully to keep your blood sugar and blood pressure at near-normal levels. Doctors call this “tight control.”

“This is a very long-term disease," says Chi-yuan Hsu, MD, professor of medicine and chief of the Division of Nephrology at the University of California, San Francisco. But, he says, doctors now have medications that work better to slow kidney damage than those of the past.   

“I tell people that medicine is like the ocean,” he says. “Every day you look at the ocean, and nothing much happens. It’s very boring. But over 10 to 20 years, the coastline is very powerfully shaped by the ocean. That’s true for medicine, too. It’s a very powerful, potent tool.”

Even if you’re in a late stage of disease and headed for kidney failure, there are still steps you can take to get the best possible outcome, Hsu says.

Diabetes and Kidney Damage

When the high blood sugar of diabetes is not controlled well, it damages your kidneys. “It’s just not normal for the kidneys to be bathed in higher-than-normal blood sugar levels,” Hsu explains.

Your kidneys filter waste and extra fluid from your body through clusters of tiny blood vessels. Over time, high blood sugar damages these blood vessels and it gets harder for them to do their work.

Damage makes the vessels leaky, and a protein called albumin gets into your urine instead of staying in your blood, where it helps keep muscles and tissues healthy.

“Albumin in the urine, called albuminuria, is classically the first sign of diabetic kidney disease,” Hsu says.

Doctors can use blood and urine tests to see whether you have kidney damage and how far along it is. If you’ve had type 1 diabetes for 5 years or more, your doctor should test your kidney function yearly. For type 2 diabetes, they should test you when you’re diagnosed, and then at least once a year after that.

Catching damage early means your doctor can start treatment to slow it down.

Slowing Kidney Disease

If you don’t have kidney disease, you and your doctor should focus on controlling your blood sugar levels. “That’s because research has shown that tight glucose control can in most cases prevent albuminuria,” Hsu says.

Tight blood sugar control means your level on an HbA1c blood test is 7% or less. To get to that goal, you may need a combination of medications.

If you have high blood pressure, which can also cause kidney damage, your doctor will prescribe medication to bring it below 140/90.

Even if your blood pressure isn’t high, your doctor may want you to take ACE inhibitors or ARBs. These blood pressure medications can delay kidney damage in people with diabetes.

Your doctor may also suggest a newer kind of drug called an SGLT2 inhibitor. These work well to both slow the progression of kidney disease and improve heart health, says S. Ananth Karumanchi, MD, director of the Division of Nephrology at Cedars-Sinai in Los Angeles. So it's best to start them early.

When used along with ACE inhibitors or ARBs, SGLT2 inhibitors may reduce your risk for kidney failure by 50%, he says.

Your doctor will decide which drugs to add to your treatment and when to start them based on:

  • How well your kidneys are working
  • How much albumin you have in your urine
  • Oher risk factors that can speed up damage

Treatments for Kidney Failure

Sometimes kidney disease advances even when you see your doctor regularly, take all your medications, and stick to a healthy lifestyle, Hsu says. At that point, your doctor may say you’ll need dialysis or a kidney transplant in the future.

But here’s where you can take action that could help you live longer, with a better quality of life and fewer complications.

“People should be listed for transplant before they start dialysis,” says Hsu, who notes that wait times for a kidney from the national transplant waiting list can be years long.

As soon as your kidney function drops below a certain level, you’re eligible to start your wait and begin moving up the list. You can contact a transplant center for an evaluation. And you don’t even need a doctor to refer you.

You also can ask family and friends if they’re willing to donate a kidney. They’ll need to undergo a long process to see if they’re good match for you. But if one of them is, you may be able to avoid the waitlist.

If you get on the kidney transplant waitlist early or find a living donor, you also may be able to skip dialysis. That means you’ll avoid all its risks, costs, and hassle. This is called pre-emptive transplant, but it’s not an option most people know about -- only 2.5% of all transplants in the United States are pre-emptive.

Still, going straight to transplant is the best choice for your health and quality of life. Talk to your doctor or contact a transplant center to learn more about your options.

© 2022 WebMD, LLC. All rights reserved.

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Photo Credit: Charles Wollertz / Getty Images

SOURCES:

Chi-yuan Hsu, MD, professor of medicine; chief of the Division of Nephrology, University of California, San Francisco.

S. Ananth Karumanchi, MD, director, Division of Nephrology, Cedars-Sinai, Los Angeles, CA.

National Institute of Diabetes and Digestive and Kidney Disease: “Diabetic Kidney Disease.”

Johns Hopkins Medicine: “Preserving Kidney Function When You Have Diabetes.”

National Kidney Foundation: “Diabetes and Chronic Kidney Disease,” “Preventing Diabetic Kidney Disease: 10 Answers to Questions,” “Diabetes and Kidney Disease (Stages 1-4),” “Albuminuria,” “Preemptive Kidney Transplants: Why Aren't They More Popular?”

American Diabetes Association: “Kidney Disease (Nephropathy).”

Medline Plus: “Hemoglobin A1C (HbA1c) Test.”