Question: What are the kidney complications of diabetes and how are they treated?
Answer: Hyperglycemia, or elevated blood sugar, in patients with diabetes – both type 1 and type 2 – can cause kidney injury by damaging the filters in the kidney. This is first seen by looking at the urine for protein. So tests checking for protein in the urine are one of the first screening tests that are done to try to identify early kidney injury. This should be done on a yearly basis, with either the primary care physician or the endocrinologist, and if identified can be treated effectively with medications such as ACE inhibitors or angiotensin receptor blockers. This can slow the progression of kidney diseases significantly and oftentimes might eliminate the need for any kind of renal replacement therapies. And when I speak of renal replacement therapies, what I'm speaking of is dialysis and kidney transplantation for those patients who ultimately do have kidney failure related to their diabetes.
Dialysis is one possibility. It involves either hemodialysis or peritoneal dialysis. Hemodialysis is done in the dialysis clinics three times a week for approximately 3-4 hours each treatment. Peritoneal dialysis involves a catheter in the abdomen and frequent volume or fluid exchanges that clear the waste products and can be done at home.
More preferably to these two options for the type 1 and type 2 diabetic patient, is kidney transplantation. Kidney transplantation provides a greater quality of life and also a greater quantity of life. Patients generally live twice as long via kidney transplant than staying on dialysis. Again, there are complications that are associated with kidney transplantation, but these complications are greatly mitigated by the fact that the protection on the heart and on the vessels is significantly better with kidney transplantation versus dialysis.