Diabetes and CKD What is the Connection

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Diabetes and CKD What is the Connection?
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Discussion topics

• Number of people in U.S. with diabetes
• Diabetes and related problems
• Diabetes and Chronic Kidney Disease (CKD)
• Stages of CKD
• What you can do to help yourself

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You are not alone

• 20.8 million people in U.S. have diabetes
• that is 7 of the population
• Majority are Type 2
• Diabetes to increase 165 between 2000 and 2050
• There is a 1.8 times greater risk among African
  Americans

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Possible complications of diabetes
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Diabetes and CKD

• Diabetes is the leading cause of CKD in U.S.
• Early kidney disease has no symptoms
• When not diagnosed it can progress to kidney
  failure with little or no warning

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Control your diabetes

• High blood sugar levels can lead to many health
  problems including kidney disease
• 30 of people with Type 1 diabetes develop CKD
• 10-40 of people with Type 2 diabetes develop CKD

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What is the kidney

• The kidneys weigh about a pound each
• Located in the retroperitoneal space
• About the size of an adult fist
• Shaped like a kidney bean
• Attached to blood stream through renal arteries
• Each renal lobe is made of tiny blood vessels

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Kidney functions

• Remove waste
• Remove excess fluid
• Secrete Erythropoetin to make red blood cells
• Regulate bone metabolism
• Regulate blood pressure
• Maintain electrolyte and acid balance

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How does diabetes cause CKD?

• Damages small blood vessels in kidneys and other
  organs
• Proteins begin to leak into the urine
• Ability to filter waste decreases
• Waste products begin to build up
• Kidneys may fail
• May need dialysis or transplant to live

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Signs of kidney damage

• Damage to kidneys may or may not involve kidney
  failure. Some signs of damage
• Blood in urine
• Protein in urine (Proteinuria)
• Abnormal blood or other urine tests
• Abnormal imaging tests
• Abnormal kidney biopsy

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CKD symptoms

• Decreased appetite
• Nausea, vomiting
• Weight gain/loss
• Change in bowel habits
• Decreased sensation in hands and feet (neuropathy)

• Tired
• Decreased concentration
• Frail appearance
• Decreased sexual functioning
• Bronze or discolored skin

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NKF definition of CKD

• The National Kidney Foundation defines CKD as
  kidney damage for 3 or more months based on
  findings of abnormal structure (Imaging studies)
  or abnormal function (blood or urine tests)
• OR
• GFR lt 60 mL per minute for 3 or more months with
  or without evidence of Kidney damage

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Detecting CKD

• Detect CKD with 2 simple tests
• Urine test for detecting proteinuria
• Blood test for estimating glomerular filtration
  rate (eGFR)

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Stages of Chronic Kidney Disease
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Stage 5 CKD or ESRD

• Stage 5 CKD is more commonly called ESRD or
  End Stage Renal Disease.
• Treatment required
• Some form of dialysis to maintain life
• Medications
• Diet modification

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Delayed CKD detection can lead to serious
consequences

• Lack of treatment for early complications
• Diabetes - High
  blood pressure
• Cardiovascular disease - Malnutrition
• Late referral to nephrologist/cardiovascular
  specialist or dietitian
• Lack of patient education for prevention or
  treatment options
• Lack of access placement prior to the start of
  dialysis

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CKD risk factors

• Diabetes
• Hypertension
• Smoking
• High Cholesterol
• Family history of CKD
• Age
• Gender

• Racial /ethnic background
• African American
• Native American
• Asian American
• Pacific Islander
• Hispanic

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CKD risk factors continued

• Exposure to Nephrotoxic drugs
• Contrast Dye
• NSAIDS
• Ibuprofen
• Advil
• Motrin
• Naproxen

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USRDS 2004
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USRDS 2004
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(No Transcript)
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Why CKD prevention is important with diabetes
hypertension

• More than 90 of Medicare patients with CKD also
  have diabetes, hypertension, or both
• Approximately 83,000 Medicare beneficiaries with
  diabetes in Missouri (Fee-for-Service 4/06-3/07)
• Diabetes and hypertension both cause CKD and make
  complications worse

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When to get tested

• Type 1 Diabetes 5 years after diagnosis, then
  annually
• Type 2 Diabetes at diagnosis, then annually
• Hypertension at diagnosis and initiation of
  therapy, then every 3 years if eGFR and
  microalbumin tests are normal
• Family history of kidney disease every 3 years,
  as long as tests are normal
• These testing intervals are recommendations
  physician opinion may differ
• 
  
  KDOQI Guideline 1

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Help prevent or delay CKD

• Control Blood Sugar - Goal of A1C lt 6.5
• Eat at about the same time every day
• Eat a meal or snack every 3-4 hours and do not
  skip meals
• Eat the same amount of carbohydrates in meals or
  snacks each day
• Check blood sugar as instructed
• Take your medicine and /or insulin as directed
• Keep your doctor appointments take your blood
  sugar record with you

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Control blood pressure

• Monitor your own blood pressure
• Try to keep it at 125/70 or lower
• Take medication as directed
• Limit salt and sodium intake

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Watch your weight

• Achieve and maintain desirable body weight
  (target BMI to normal range of 18.5-24.9 kg/m2)

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If you smoke

• STOP

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Take an active role in your health care

• Monitor your own blood pressure and blood sugar
• Know what your levels should be
• See your doctor regularly
• Ask if you are on an ACE or an ARB for your BP
• Ask if you had a urine test for protein
• Know your eGFR
• If you have CKD, know what stage

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CKD Stage 3

• Limit protein and phosphorous intake
• High protein levels increase the workload of the
  kidney

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CKD Stage 4 or 5

• Limit phosphorus intake in your diet
• High levels of phosphorus can cause damage
  without any symptoms

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Foods high in phosphorus

• Milk and dairy products
• Cola drinks and Dr. Pepper
• Chocolate
• Nuts and butters
• Pancakes, waffles and biscuits
• Dried beans
• Processed meats like hot dogs, sausage, bologna
• Whole grain foods

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Take better care of yourself

• Changes in diet, fluid intake and medications can
  be confusing and challenging.
• These changes can help you feel better and slow
  kidney disease
• Go to your doctor and ask questions
• Take your medications as instructed
• Report any changes

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It takes a team
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Now is the time to ask

• Questions

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Information Resources

• National Kidney Foundation - www.kidney.org
• Missouri Kidney Program - http//som.missouri.edu/
  mokp
• Heartland Kidney Network - www.network12.org
• American Assoc. of Kidney Patients - www.aakp.org
• Renal Support Network - www.ikidney.com