How One Doctor Helps Diabetes Patients Avoid Kidney Dialysis
One man's biking regimen and weight loss helped improve his blood pressure and blood glucose.Istockphoto
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."
Next Page: Three ways to prevent kidney failure
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Ian de Boer, MD, helped one of his diabetes patients avoid kidney dialysis.(IAN H. DE BOER, MD)
The patient cut sodium in his diet, started a biking regimen, and lost weight, which helped improve his blood pressure and blood glucose. He monitored his blood sugar more carefully than before, and he worked closely with his other physicians to maintain tighter control. Plus, he was very diligent about taking his medications.
Three years have passed and Dr. de Boer's patient is doing quite well. The man's blood pressure is under control and he improved his blood sugar levels. While his GFR did not improve, it remains stable. And that's good news, because he has not progressed to dialysis.
Three things you can do to prevent kidney failure
If tests reveal a problem, your doctor will recommend ways to slow the decline in kidney function and prevent kidney failure, which include the following.
- Controlling your blood sugar. The United Kingdom Prospective Diabetes Study found that intensive blood glucose management reduces the risk of kidney damage in type 2 patients.
- Controlling your blood pressure. Studies show that treating hypertension slows the progression of kidney disease. The target for people with diabetes is 130/80.
- Taking blood pressure medicines. To manage hypertension in people with diabetes, the American Diabetes Association advises doctors to prescribe angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), drugs that lower blood pressure and may have a protective effect on the kidneys of diabetics.
Zachary T. Bloomgarden, MD, an endocrinologist at Mount Sinai School of Medicine in New York City who specializes in diabetes, prescribes these drugs to most of his patients, particularly those with hypertension, cardiovascular disease, or risk factors for heart disease, such as high cholesterol. He also prescribes these drugs to patients with increased levels of albumin in urine and creatinine in the blood.