What You Can Do to Help Prevent Progression of Kidney Disease in Type 2 Diabetes

This article is for people who have type 2 diabetes (T2D), or their care partners, as well as others who want to learn more about kidney disease that could happen with T2D. The goal is to educate patients on the importance of engaging with their doctor and healthcare team about ways they can help delay or prevent progression of kidney disease.

You will learn about:

• What chronic kidney disease (CKD) is

• How T2D can cause CKD

• How kidney disease is recognized

• Treatment of kidney disease with T2D

• Ways to help prevent the progression of kidney disease

• Questions to ask your doctor

Chronic kidney disease (CKD) happens when damage to your kidneys keeps them from functioning properly and they can't remove waste and extra water from your body. These can then build up and cause damage to your organs.

T2D is the leading cause of CKD. Kidney damage caused by T2D usually happens over many years. But you can take steps to protect your kidneys and prevent or delay damage.

Other names for CKD in diabetes are diabetic kidney disease and diabetic nephropathy.

In T2D, high blood glucose (sugar) damages the blood vessels in your body. When vessels in the kidneys are damaged, they can't filter blood properly and extra water, salt, and waste aren't removed. As a result, you can get protein in your urine and waste materials in your blood.

T2D also damages nerves and can make it difficult to empty your bladder. Pressure from a full bladder can further damage your kidneys. If urine stays in your bladder for too long, you may develop an infection.

And, many people with T2D have high blood pressure, which can also damage your kidneys.

Anyone with T2D can get CKD. Having T2D for a longer time may increase your chances of kidney damage.

If you have T2D, you are also more likely to develop CKD if you have:

• High blood glucose

• High blood pressure

• High blood cholesterol

• Poor diet

• Heart disease

• History of smoking

• Family history of diabetes or kidney disease

Most people with T2D don't show symptoms of CKD, so it's important to get tested by your doctor every year. A urine test checks for protein (albumin) and a blood test can see how well your kidneys are working to remove waste from your body.

Other tests your doctor may recommend include an X-ray, ultrasound, or blood tests for kidney function.

Some people with CKD and T2D may have symptoms such as:

• Ankle swelling

• Weight gain

• Nausea

• Loss of appetite

• Using the bathroom (urinating) more frequently at night

• Increased blood pressure

Kidney damage from T2D can get worse over time. About 10% to 40% of people with T2D will eventually have kidney failure, also called end-stage renal disease. This is the last stage of CKD.

Kidney failure means that your kidneys are working at less than 15% of their normal function. This also means they have stopped working well enough for you to survive without dialysis or a kidney transplant.

You can take steps to help prevent or delay kidney damage from CKD.

The best way is to keep your blood glucose and blood pressure under control by checking your levels regularly, taking your medicines as directed to help reach your goals, and keeping a healthy lifestyle.

You should follow the diabetic diet recommended by your doctor. Your doctor may also recommend a low-protein diet to reduce the amount of work your kidneys have to do. It may also be valuable to see a dietician or nutritionist to help you with your meal plan.

Your doctor may prescribe you medicines to help:

• Manage high blood glucose: canagliflozin, dapagliflozin, and empagliflozin

• Control high blood pressure: irbersartan and losartan

• Lower high cholesterol: "statins," which can also lower protein in your urine

Taking your medicines as directed to meet your goals for blood glucose, blood pressure, and blood cholesterol can help slow or prevent kidney damage.

The oral medicine Invokana^® may be prescribed by your doctor to help manage your high blood glucose and help protect your kidneys. Invokana^® contains canagliflozin, a medicine taken along with a proper diet and exercise program to control high blood glucose. In people with T2D and CKD, canagliflozin can also help prevent progression of CKD.

Canagliflozin works by helping your kidneys remove extra glucose from your body. It is taken as a pill, usually once a day -- your doctor will prescribe the best dose for you.

People who take canagliflozin may have side effects such as an increased chance of getting yeast infections (in women) and urinary tract infections (UTIs), or using the bathroom (urinating) more frequently.

You should talk to your doctor or pharmacist about the proper way to take this medicine and any side effects you may have.

Maintaining a healthy lifestyle can help slow or prevent kidney damage. Ways to help keep your kidneys healthy include:

• Quit smoking

• Follow a diabetes meal plan, and limit salt, potassium, and protein (if recommended)

• Stay physically active

• Maintain a healthy weight

• Get enough sleep -- 7 to 8 hours each night

• Get treatment for a bladder infection or UTI right away

• Develop coping strategies to help reduce stress

See your doctor regularly so they can review your treatment and run tests to check your kidneys and T2D.

Questions to ask your doctor:

• What can I do to help control my T2D and keep my kidneys healthy?

• Do I have kidney damage?

• What medicines are available and what are their side effects?

• What type of diet should I be eating?

• What changes should I make to my lifestyle?

• What should I do if I feel stressed?

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