It is predicted that by 2025 around five million of the UK population will suffer from diabetes. The health burden for specialists to manage patients with chronic diabetic kidney disease is likely to be high. Therefore prevention and improving deterioration in patients already established with the disease is the correct strategy in going forward.
Currently, just under 20% of all patients needing life-maintaining dialysis have diabetes as the primary cause of their kidney condition. Every year there will be some 1800 new diabetic patients joining this list. Prevention in diabetic kidney disease will bring both personal benefits to the patient and reduce the nation’s health expenditure in the medical management of these unfortunate patients.
The presence of a small amount of protein in the urine (microalbuminuria), in the absence of urine infection, is usually the first tell-tail sign of potential progressive diabetic damage to the kidneys. Most registered diabetic patients would normally go through an annual medical review with their GP, which includes urine testing to detect early presence of microalbuminuria. The presence of protein in the urine should target healthcare providers to optimise care to these patients and to halt, or slow down, their progressive disease.
Patients are able to prevent or halt kidney disease by adhering to the following:
Look after the body by reducing body weight if obese, stop smoking, avoid excess alcohol, cut down on salt to reduce fluid retention and blood pressure control, and try adopting a lifestyle with more exercise.
Watch your sugar intake
Optimise sugar control by working with diabetic doctors and nurses, aiming to maintain HbA1c, the three-month time-averaged sugar control marker, of below 7% (or in IFCC 53 mmol/mol, the new unit of measure.)
Blood pressure control
Optimise your blood pressure control with an aim to maintain BP < 140/80 mmHg, without undue dizziness. Your doctor may be able to advise on an even lower reading in certain clinical situations.
Blood pressure tablets
Use classes of blood pressure tablets that reduce systemic blood pressure, as well as the pressure inside the kidneys, ACEIs, ARBs and DRI. Your doctor will advise the appropriate agent.
Monitor cholesterol levels
Treat high cholesterol levels with statin if tolerated.
Take low dose aspirin or other anti-platelet drugs where indicated.
These measures are the good practice management approaches of any diabetic patients even before they develop markers of kidney dysfunction; they also protect other organs in the diabetic patients too.
Good sugar control, good blood pressure control with the appropriate medications, and good cholesterol control will reap benefits not only in preventing kidney damage, it will also reduce diabetic eye, heart, brain and nerve diseases.