How One Doctor Helps Diabetes Patients Avoid Kidney Dialysis

Although people with type 2 diabetes are at greater risk of kidney problems, kidney failure is not inevitable. Controlling diabetes by lowering blood sugar, dieting, exercising, or taking medication—particularly blood-pressure-lowering medication, if you need it—can help prevent kidney problems.

Seeing a kidney specialist (known as a nephrologist) sooner rather than later is helpful for some people with type 2 diabetes, according to Ian H. de Boer, MD, an assistant professor of medicine in the division of nephrology at the University of Washington School of Medicine in Seattle.

There are specific interventions, such as limiting salt in the diet, that can help prevent the progression of kidney disease in people who have the early signs.

Prevented or delaying kidney problems
Dr. de Boer often sees type 2 diabetes patients after signs of kidney trouble have surfaced. They may have very large amounts of protein in their urine (a marker of kidney disease), which is evidence of moderately impaired kidney function or difficult-to-control hypertension.

One particular patient, a man in his mid-50s, had all of the above. At 30 ml/min, his glomerular filtration rate, or GFR—a measure of kidney function—suggested he already had moderate to severe damage. He had a large amount of protein in his urine, poorly controlled hypertension, and poorly controlled blood sugar.

"His disease was clearly progressive by his recent history," Dr. de Boer explains. "When he learned that he was heading toward dialysis in the next year or less, that was a bit of a shock to him, and it actually motivated him to make a lot of changes."