Pharmacists play a significant role in the comprehensive management of this condition through education, intervention and monitoring.
The main function of the kidneys is to maintain the balance of minerals and water in the body and to function as a filtering system to remove excess fluid and waste. The nephrons in the kidneys are supplied by a dense network of blood vessels. A large volume of blood flows through these vessels, carrying nutrients and oxygen to the kidneys.
Diabetic kidney disease usually develops slowly and with few symptoms. Many people don’t realize they have kidney disease until it is advanced and they need dialysis or a kidney transplant to survive.1
Kidney disease is one of the leading causes of death in the United States. Approximately 1 in 3 adults with diabetes have chronic kidney disease. Every 24 hours, 170 diabetics start treatment for kidney failure.1 Black, Hispanic, and Indigenous individuals develop diabetes, kidney disease, and kidney failure at a higher rate than white individuals.two
Each kidney is made up of millions of tiny filters called nephrons. Over time, the high blood sugar caused by diabetes can damage the blood vessels in the kidneys, making them not work as well as they should.1 Many individuals with diabetes also develop high blood pressure (BPH), which can damage the kidneys.1 Over time, uncontrolled BPH can cause the arteries around the kidneys to harden, narrow, or weaken. These damaged arteries are unable to supply enough blood and oxygen to the kidney tissue.3
The chances of developing kidney disease with type 1 or type 2 diabetes increase if patients are not active, are overweight, do not follow a proper diet, eat high sodium, smoke, have a family history of kidney disease, and/or have heart disease.two
In the early stages of diabetic kidney disease, there are usually no noticeable signs or symptoms. In later stages, signs and symptoms may include protein in the urine; swelling of ankles, eyes, feet or hands; increased need to urinate; and worsening blood pressure control. Further deterioration can result in confusion or difficulty concentrating, fatigue, loss of appetite, nausea and vomiting, persistent itching, reduced need for diabetes medication or insulin, and shortness of breath.4
Kidney damage caused by diabetes can get worse over time. Kidney damage can cause permanent scarring. If not treated, kidney failure can occur. Kidney failure means that the kidneys are functioning at less than 15% of normal kidney function. However, most individuals with diabetes and kidney disease do not end up with kidney failure.5
Complications of diabetic kidney disease can develop gradually over months or years and can include the following6🇧🇷
🇧🇷Anemia: reduced number of red blood cells
• Bone and mineral disorders: inability of the kidneys to maintain the balance of calcium and phosphorus in the blood
🇧🇷Cardiovascular disease: damage to the heart and blood vessels, which can lead to a stroke
🇧🇷Diabetic retinopathy: damaged blood vessels in the light-sensitive tissue of the eyes
•Edema: fluid retention can lead to BPH, fluid in the lungs or pulmonary edema, as well as swelling in the arms and legs
🇧🇷End stage kidney disease: may require dialysis or kidney transplant
🇧🇷erectile dysfunction: damage to blood vessels and nerves
🇧🇷Festering sores on the feet: can result in amputation due to blood vessel and nerve damage
• Hyperkalemia: high levels of potassium in the blood due to a fluid imbalance
• Pregnancy complications: for both mother and child
To reduce the risk of developing diabetic kidney disease, some suggestions for patients include the following7🇧🇷
🇧🇷Do not smoke. Smoking can damage the kidneys and make existing kidney damage worse.
🇧🇷Follow directions on OTC medications. Follow directions on packages of over-the-counter pain relievers such as aspirin and nonsteroidal anti-inflammatory drugs. For patients with diabetic kidney disease, taking these types of pain relievers can cause even more kidney damage.
•Get enough sleep. Consistently get 7 to 8 hours of good sleep every night. Patients who are not sleeping well should try to improve their sleeping habits. Providers can help by offering sleep aids.
•Keep all appointments for diabetes management. This helps patients monitor how well they are managing their diabetes and screens for diabetic kidney disease and other complications.
• Limit alcohol consumption. Alcohol can raise blood pressure and add empty calories, which can increase weight.
•Maintain a healthy weight. Work to maintain a healthy weight by being physically active most days of the week. If weight loss is necessary, consult a physician about weight loss strategies such as consuming fewer calories and increasing daily physical activity.
• Manage BPH or other medical conditions. These can increase your risk of kidney disease. Controlling the conditions can delay or prevent the development of kidney disease.
• Treat diabetes. With effective diabetes treatment, diabetic kidney disease can be prevented. With proper treatment, blood glucose numbers will remain at or near targets.
Role of Pharmacists
Pharmacists play a significant role in the comprehensive care of diabetic kidney disease through education, intervention and monitoring. Pharmacists can advise patients on appropriate and cost-effective medications while preventing drug-induced injuries. As part of a healthcare team, pharmacists can contribute to a smooth transition of care and help patients slow the progression of their disease.
1. Diabetes and chronic kidney disease. CDC. Updated May 7, 2021. Accessed October 9, 2022. https://www.cdc.gov/diabetes/managing/diabetes-kid-ney-disease.html
2. Diabetic kidney disease. National Institute of Diabetes and Digestive and Kidney Diseases. Updated February 2017. Accessed October 9, 2022. https://www.niddk.nih.gov/health-information/diabetes/overview/prevent-ing-problems/diabetic-kidney-disease
3. How high blood pressure can lead to kidney damage or failure. American Heart Association. Updated March 4, 2022. Accessed October 9, 2022. https://www.heart.org/en/health-topics/high-blood-pressure/health-threats-from-high-blood-pressure/ how-high-blood pressure can lead to kidney damage or failure
4. 10 Signs You Might Have Kidney Disease. National Kidney Foundation. December 17, 2020. Accessed October 9, 2022. https://www.kidney.org/news/ekidney/august14/10_Signs_You_May_Have_Kidney_Disease
5. What is chronic kidney disease? National Institute of Diabetes and Digestive and Kidney Diseases. Updated June 2017. Accessed October 9, 2022. https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/what-is-chronic-kidney- disease
6. Symptoms: chronic kidney disease. National Health Service. Updated 29th August 2019. Accessed 9th October 2022. https://www.nhs.uk/conditions/kidney-disease/symptoms/
7. Prevention of chronic kidney disease. National Institute of Diabetes and Digestive and Kidney Diseases. Updated October 2016. Accessed October 9, 2022. https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/prevention
About the author
Kathleen Kenny, PharmD, RpH, has over 25 years of experience as a community pharmacist. She is a freelance medical writer based in Homosassa, Florida.