As a patient with type 2 diabetes, it is crucial to understand the relationship between your condition and chronic kidney disease (CKD). Despite the importance of managing both conditions, many patients with type 2 diabetes are unaware of their risk for CKD.
Weight loss is often promoted as the primary solution for managing type 2 diabetes, but while it offers significant health benefits, it is important to understand that weight loss alone does not address all the risks associated with type 2 diabetes, particularly the development of CKD. Type 2 diabetes can cause inflammation and scarring that progressively damages the kidneys, heart, and blood vessels, increasing the risk of cardiovascular events before CKD is diagnosed or treated.
Approximately one in three people with type 2 diabetes develop CKD, and most are unaware of their risk until it’s too late and they require dialysis. To address this, the American Diabetes Association (ADA) has updated its standards of care to emphasize proactive CKD screening for patients with type 2 diabetes. Early detection is essential to prevent further complications and delay disease progression.
In this Q&A, Robert Perkins, Vice President of US Medical Affairs/Renal at Bayer, explains how type 2 diabetes leads to CKD, the significance of the ADA’s updated screening guidelines, and the impact of new therapies on managing diabetes and kidney disease. He also addresses common misconceptions and provides valuable advice for patients to effectively manage both conditions.
Can you start by explaining the relationship between type 2 diabetes and chronic kidney disease?
Type 2 diabetes is the leading cause in this country, at least, for both chronic kidney disease and end-stage kidney disease, which means complete kidney failure requiring dialysis or transplant. The second leading cause is high blood pressure, but diabetes exceeds that by at least 10 percent in this country. It’s a major problem.
The reasons why patients with type 2 diabetes get kidney disease are several-fold. High blood sugar chronically damages the filtering part of the kidney, leading to damage that progresses over years, ultimately requiring dialysis or transplantation. What’s less commonly recognized is that long before patients are symptomatic or impacted by their kidney disease, they are at very high risk for cardiovascular events like strokes, heart attacks, and heart failure. So, that’s an important piece of the diabetes-kidney disease connection.
Can you discuss how type 2 diabetes and chronic kidney disease can affect patients even if they are actively managing their weight and exercising regularly?
We live in an exciting time with many new therapies for patients with diabetes and kidney disease from diabetes. Particularly, the class of drugs called GLP-1 receptor agonists are well-proven to help patients lose weight and control their diabetes, offering cardiovascular and kidney benefits. However, many patients who benefit from these therapies already have established kidney disease when they start, and there’s little evidence to suggest these therapies reverse the existing damage. It’s important to understand that, while these new therapies are beneficial, patients still need long-term management to prevent further risks.
The American Diabetes Association recently updated its guidelines to emphasize proactive screenings for patients with type 2 diabetes. How do these guidelines change the approach to managing type 2 diabetes and chronic kidney disease?
You bring up a really important point about screening. Unfortunately, we have done a terrible job in this country of getting patients at risk screened. For kidney disease in patients with diabetes, the recommendation is straightforward: an annual test for abnormal amounts of protein in the urine and an annual blood test to check kidney function (estimated GFR test). Despite this, we see only 40-60 percent of patients with diabetes getting screened in any given healthcare system, with much lower rates in underserved communities. It’s crucial for anyone with diabetes to ask their doctor if they’ve checked for kidney problems due to diabetes.
Are there any other types of questions or things that patients should be looking for when they visit their doctors?
Unfortunately, diabetes often isn’t the only issue impacting both heart and kidney health. High blood pressure is often a companion to diabetes and can negatively affect kidney and heart health. Patients should also pay attention to blood pressure management. Additionally, Black Americans, who often face disparities in healthcare access, tend to have worse long-term kidney and heart outcomes. Patients should regularly see their healthcare provider, and ask about their kidney and heart health, blood pressure, cholesterol levels, and lifestyle recommendations for diet and exercise.
Are there any other specific tests or monitoring methods that patients should be aware of?
Focusing on the kidneys, patients should know about the UACR test (urine albumin-to-creatinine ratio) to check for protein in the urine and the estimated GFR test to measure kidney function. Patients should know these numbers and ask their doctor about them. It’s the fault of our healthcare system that we don’t do a better job ensuring every patient with diabetes gets these tests.
Are there any common myths or misunderstandings about the relationship between type 2 diabetes and chronic kidney disease that our audience should know about?
A common statement I heard when I practiced as a kidney doctor was, “I wish somebody had told me about my risks.” Often, patients only learn about their kidney disease when their function is critically low. It’s crucial for patients to ask their doctor about their kidney health and whether they have chronic kidney disease or protein in their urine. Early detection and proactive management are key because we now have many effective therapies that didn’t exist 10-15 years ago.
While weight loss and exercise alone may not always prevent kidney disease in those with diabetes, are there any lifestyle factors that can help reduce the risk?
Besides weight loss and exercise, good nutrition is important. There’s no special restrictive diet unless kidney disease is very advanced. Another factor is awareness of certain over-the-counter medications that can be toxic to the kidneys if taken long-term.
For those in the early stages of kidney disease, what can they do to manage their condition?
Early detection and identification are critical. Good blood pressure control, good diabetic control, and avoiding harmful medications are essential. Early intervention with effective therapies can prevent further kidney function loss. Although kidney disease progression isn’t always predictable, early management can make a significant difference.
Are there ways that pharmaceutical companies and healthcare providers can work together to reduce these risks? Are there any treatment options on the horizon?
There are multiple new therapies available now, working in complementary ways to reduce the risks of kidney disease progression and cardiovascular events. These include SGLT-2 inhibitors, non-steroidal MRAs, and soon GLP-1 receptor agonists. For patients with diabetes and chronic kidney disease, managing both conditions is possible with these therapies, which also offer heart protection.
What should the process look like for those who have noticed that their type 2 diabetes has led to chronic kidney disease? How can they proactively manage both conditions?
Managing these complications isn’t difficult. Using the available therapies—SGLT-2 inhibitors, GLP-1 receptor agonists, and others—alongside traditional diabetes management methods, patients can protect their kidneys and heart. These therapies can be used in combination safely and effectively.
Anything else you’d like to add?
I’d just add that Black Americans, while representing a small portion of the population, disproportionately suffer from end-stage kidney disease. Encouraging participation in clinical trials is crucial for developing effective therapies. Associations like the American Association of Kidney Patients help explain the importance of these trials to the community. Increasing trial participation will help address this disproportionate risk and develop better treatments.
