When it comes to potential complications of diabetes, chronic kidney disease (CKD) probably isn’t first or even second on the list of what people fear the most. Unlike losing your eyesight or developing a sore on your foot that won’t heal and leads to infection and amputation, it’s difficult to imagine ahead of time what it feels like to have kidneys that can’t adequately filter waste products from your blood.
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But CKD can be detrimental to quality of life in people who develop it, especially if your condition progresses rapidly. Not only does it typically require modifying your diet in ways that might seem strange, it can cause deep fatigue, loss of appetite and — in its later stages — requires either regular dialysis treatments or a kidney transplant. It’s also enormously expensive to the healthcare system as a whole, if not on an individual level.
So a new study on the progression of CKD in people with diabetes should raise some alarm bells, since it shows that in many people, the condition progresses rapidly in the months following their diagnosis.
Common complication of type 2
The new study, published in the Clinical Kidney Journal, notes that since CKD is a fairly common complication of type 2 diabetes, the growing number of people with type 2 means that CKD is also expected to rise — with enormous implications in terms of resources to treat the disease and cost to the healthcare system. For these reasons, it’s important to understand how quickly CKD tends to progress in people with diabetes, and what factors can influence how it progresses.
The study looked at thousands of newly recognized CKD cases in the United States from January 2008 to September 2018, among people who already had type 2 diabetes. Their disease progression was assessed through two measures of kidney function: estimated glomerular filtration rate (eGFR) and urine albumin:creatinine ratio (UACR). Data from 88,766 people was included in the study.
Over a median follow-up period of two years, the data showed worsening CKD in 10% to 17% of the participants, depending on exactly how it was evaluated. This result was based on about one third of all participants showing worse numbers for their eGFR or UACR.
Slowing kidney disease progression
The researchers concluded that their results showed a relatively high percentage of CKD cases getting worse over a short period of time — perhaps a greater number than most of them had anticipated. This means, they write, that it’s essential to adopt better steps than we now have to identify which people with type 2 diabetes and CKD are likely to experience rapid progression of their CKD.
While this study highlights the problem posed by CKD progression in people with diabetes, it doesn’t identify any new ways to identify who is likely to experience rapid CKD progression. More studies are needed in this area, the researchers write, along with studies to identify what kinds of interventions are effective at helping to slow the progression of CKD.
Since type 2 diabetes is the most common cause of CKD, it’s possible that interventions related to blood glucose control — or other factors like blood pressure — could have a meaningful impact on progression of CKD. But since there are so many complicated health considerations in this population, it’s important to make sure that any attempts to improve blood glucose control don’t cause additional complications — such as an increased risk of hypoglycemia (low blood glucose).
There are several promising options for treating CKD in people with diabetes, including some whose benefits have been recently identified. Just last year, the type 2 diabetes drug Farxiga (dapagliflozin) was found in a study to have an “overwhelming” benefit for treating CKD, and the popular type 2 drug metformin was also found to have a protective effect on cardiovascular health in people with CKD.
For more information about diabetes and CKD, check out “Ten Things to Know About Kidney Disease.”.
Want to learn more about keeping your kidneys healthy with diabetes? Read “Managing Diabetic Kidney Disease,” “Protecting Your Kidneys,” and “Kidney Disease: Your Seven-Step Plan for Prevention.”
