The Burden of Kidney Failure
Each year in the United States, more than 100,000 people are diagnosed with
kidney failure, a serious condition in which the kidneys fail to rid the body of
wastes.1 Kidney failure is the final stage of chronic kidney disease (CKD).
Diabetes is the most common cause of kidney failure, accounting for nearly 44
percent of new cases.1 Even when diabetes is controlled, the disease can lead to
CKD and kidney failure. Most people with diabetes do not develop CKD that is
severe enough to progress to kidney failure. Nearly 24 million people in the
United States have diabetes, 2 and nearly 180,000 people are living with kidney
failure as a result of diabetes.1
People with kidney failure undergo either dialysis, an artificial blood-cleaning
process, or transplantation to receive a healthy kidney from a donor. Most U.S.
citizens who develop kidney failure are eligible for federally funded care. In
2005, care for patients with kidney failure cost the United States nearly $32
billion.1
Diagnosis of CKD
Effects of High Blood Pressure
Preventing and Slowing Kidney Disease
Dialysis and Transplantation
The Course of Kidney Disease
Diabetic kidney disease takes many years to develop. In some people, the
filtering function of the kidneys is actually higher than normal in the first
few years of their diabetes.
Over several years, people who are developing kidney disease will have small
amounts of the blood protein albumin begin to leak into their urine. This first
stage of CKD is called microalbuminuria. The kidney’s filtration function
usually remains normal during this period.
As the disease progresses, more albumin leaks into the urine. This stage may be
called macroalbuminuria or proteinuria. As the amount of albumin in the urine
increases, the kidneys’ filtering function usually begins to drop. The body
retains various wastes as filtration falls. As kidney damage develops, blood
pressure often rises as well.
Points to Remember
Diagnosis of CKD
People with diabetes should be screened regularly for kidney disease. The two
key markers for kidney disease are eGFR and urine albumin.
eGFR. eGFR stands for estimated glomerular filtration rate. Each kidney contains
about 1 million tiny filters made up of blood vessels. These filters are called
glomeruli. Kidney function can be checked by estimating how much blood the
glomeruli filter in a minute. The calculation of eGFR is based on the amount of
creatinine, a waste product, found in a blood sample. As the level of creatinine
goes up, the eGFR goes down.
Kidney disease is present when eGFR is less than 60 milliliters per minute.
The American Diabetes Association (ADA) and the National Institutes of Health
(NIH) recommend that eGFR be calculated from serum creatinine at least once a
year in all people with diabetes.
Urine albumin. Urine albumin is measured by comparing the amount of albumin to
the amount of creatinine in a single urine sample. When the kidneys are healthy,
the urine will contain large amounts of creatinine but almost no albumin. Even a
small increase in the ratio of albumin to creatinine is a sign of kidney damage.
Kidney disease is present when urine contains more than 30 milligrams of albumin
per gram of creatinine, with or without decreased eGFR.
The ADA and the NIH recommend annual assessment of urine albumin excretion to
assess kidney damage in all people with type 2 diabetes and people who have had
type 1 diabetes for 5 years or more.
Dialysis and Transplantation
When people with diabetes experience kidney failure, they must undergo either
dialysis or a kidney transplant. As recently as the 1970s, medical experts
commonly excluded people with diabetes from dialysis and transplantation, in
part because the experts felt damage caused by diabetes would offset benefits of
the treatments. Today, because of better control of diabetes and improved rates
of survival following treatment, doctors do not hesitate to offer dialysis and
kidney transplantation to people with diabetes.
Points to Remember
Diabetes is the leading cause of chronic kidney disease (CKD) and kidney failure
in the United States.
People with diabetes should be screened regularly for kidney disease. The two
key markers for kidney disease are estimated glomerular filtration rate (eGFR)
and urine albumin.
Drugs used to lower blood pressure can slow the progression of kidney disease
significantly. Two types of drugs, angiotensin-converting enzyme (ACE)
inhibitors and angiotensin receptor blockers (ARBs), have proven effective in
slowing the progression of kidney disease.
In people with diabetes, excessive consumption of protein may be harmful.
Intensive management of blood glucose has shown great promise for people with
diabetes, especially for those in the early stages of CKD.