Answer: First of all, if you are a diabetic with kidney disease, you should know you are not alone. Approximately 25 percent of patients with adult-onset (type II) diabetes will develop kidney disease within 20 years of their diagnosis. Men with type II diabetes are up to five times more likely to have kidney involvement than women.

If you have chronic kidney disease (CKD) and diabetes, your kidneys have most likely already been affected by your diabetes to some degree. However, most patients with diabetic kidney disease do not end up needing dialysis. Fortunately, there are a few things CKD patients can do with the assistance of their doctors to help protect their kidneys from the dangers of diabetes. This includes tight blood sugar (glucose) control, excellent blood pressure management, and dietary changes. Through regular follow-up visits with your doctor, often accompanied by blood tests and measurement of the amount of protein loss in your urine, you can see the benefits your behavior is having on your kidneys.

The importance of keeping your blood sugar under strict control cannot be overstated. Large studies have shown that in juvenile (type I) and type II diabetics, keeping blood sugars well-regulated can slow the progression of kidney disease. Your doctor performs a blood test called a hemoglobin A1C every few months to monitor your diabetes control. The goal at this time for patients with CKD and diabetes is to achieve an A1C value of less than or equal to 6.5, which can be quite difficult for many diabetics to reach. A combination of a strict diet and a sophisticated medication regimen is usually required to reach this goal.

A number of studies have also shown the amazing benefits of well-controlled blood pressure on kidney disease progression in diabetics. More specifically, the use of certain blood pressure agents known as ACE (angiotensin converting enzyme)-inhibitors or ARBs (angiotensin receptor blockers) can reduce both protein loss in the urine and an actual decline in kidney function. Again, attaining the goal blood pressure for patients with CKD (<125/75 for patients with greater than 1g of protein loss in the urine and <130/80 for the remainder of diabetic kidney patients) can be a challenging proposition, but one well worth the effort.

Finally, there is some evidence that points to the benefits of restricting the amount of protein in your diet. This has been hotly debated among kidney specialists for many years. The “Ask the Doctor” article featured in the March/April 2005 issue of this magazine by Dr. Keith Norris provides an outstanding review of this issue.

Answer provided by Ronald Goldin, MD. Dr. Goldin is a nephrologist in the Fort Lauderdale/Plantation area of South Florida. He completed his fellowship at the University of Florida in Gainesville and is a contributing author to the Handbook of Nephrology and Hypertension. He specializes in hypertension, dialysis and diabetic kidney disease.

The American Association of Kidney Patients presents Ask the Doctor, an opportunity for readers to submit kidney related health questions to healthcare professionals who specialize in an area of concern. The answers are not to be construed as a diagnosis and therefore, alterations in current healthcare should not occur until the patient’s physician is consulted.

This article originally appeared in the September/October 2005 issue of Kidney Beginnings: The Magazine, Vol. 4, No. 3.