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Diabetes & End
Stage Renal Disease (ESRD)
Diabetes is a pandemic. Researchers
from the World Health Organization (WHO) report that in 1995 there were 135 million people with diabetes; by 2025 at least 300 million will have it.
The WHO reports
that diabesity mirrors the growing phenomenon of globesity. With obesity comes increased risk for many diseases, most of all
Type 2 diabetes, coronary artery disease, hypertension & arthritis. And diabetes & hypertension increase risk for kidney disease.
In 2000, care
for patients with kidney failure cost the U.S. nearly $20 billion. The U.S. Renal Data System researchers forecast that by
2010 the cost in just the U.S. for ongoing ESRD programs will top $28.3 billion.
Researchers at the Center
for Biomedical Engineering report that as of July, 2001, over 1.1 million patients worldwide were on dialysis treatment; they
anticipate the number will double by 2010. In the U.S., the total annual cost per patient is about $66,000. The worldwide
cost of treating ESRD will surpass $1 trillion for the first decade of the 21st century.
There's a pattern. According to the American Diabetes Associations’
statistics from 2001, there are more than 18.2 million Americans with diabetes, but nearly 1/3
are unaware that they have the disease.
The National Kidney & Urologic Diseases Information
Clearinghouse estimates that each year, nearly 100,000 Americans are newly diagnosed with
kidney failure. More than 100,000 currently have ESRD due to diabetes.
According to the U.S. Health
& Human Services Agency for Healthcare Research & Quality, an estimated 650,000 Americans will have kidney failure
by 2010 & will require renal replacement therapy, either ongoing renal dialysis or a kidney transplant. Without one of
these therapies, ESRD is fatal.
According to the ADA, diabetes is the leading cause of ESRD, which develops slowly, over years & is often silent. The kidney’s
tiny nephrons, which act as filters to remove wastes, chemicals & excess water from the blood, become damaged by chronic
high blood sugars.
According to the National Kidney Foundation, new evidence suggests
that the incidence of irreversible kidney failure may be about the same for both Type 1
and Type 2.
Approximately 43% of new cases of ESRD are attributed to diabetes, double in the past 20 years.
In 2000, 41,046 people with diabetes initiated treatment for end-stage renal disease & 129,183 people with diabetes underwent dialysis or kidney transplantation.
Although diet, exercise & medications help control blood glucose, diabetes often leads to nephropathy & kidney failure.
American minorities are more likely to suffer from diabetes & kidney failure. The incidence of reported ESRD in people with diabetes is more than 4 times as high in African Americans, 4 to 6 times as high in Mexican Americans & 6 times as high in Native
Americans than in the general population of diabetes patients.
About 95 % of people with diabetes have Type 2 diabetes. Type 2s are either insulin resistant or produce insufficient insulin & 80% or more are overweight.
The American Obesity Association
notes that obesity may be a direct or indirect factor in the initiation or progression of renal disease.
Between 1993 & 1997, more than 100,000 people in the United
States were treated for kidney failure caused by Type 2 diabetes.
People with Type 2 diabetes aren't diagnosed, on average, for
5 to 6 years after getting the disease & by that time damage has often occurred - damage to the tiny capillaries in the
eyes, the nerves in the foot & the vulnerable nephrons in the kidneys.
Keep Your Kidneys Healthy
Having diabetes doesn't mean you’ll automatically have kidney failure, but your risk is greater. There are some things
you can do.
Pamela Ofstein, eDiets’ Director of Nutritional Services,
specializes in renal nutrition. She says half the patients she sees in her private practice have diabetes & controlling
hypertension & maintaining strict blood glucose control are the most important factors in lowering your risk for kidney
Getting to a healthy weight is important. Depending upon your insurance coverage, consult with
a registered dietitian for chronic kidney disease may be covered, or may be reimbursable.
RD consults for renal
disease are covered by Medicare, so speak with your physician for a referral.
Why are your kidneys so important?
The National Organization for Renal Disease describes the kidneys as our “internal
filters,” cleaning our system of wastes thru urine produced in the million nephrons in each of our 2 kidneys.
Kidneys are also responsible
for hormone and electrolyte balance. As they filter out waste, they also regulate sodium and potassium, and release hormones
necessary for red blood cell production, to maintain calcium levels and regulate blood pressure.
lose their ability to filter out wastes, a person must have the blood mechanically filtered, or get a kidney transplant. The
process of dialysis is time consuming and may be uncomfortable; also, the patient must follow a strict diet and medication
regime. Transplant means permanent treatment with anti-rejection drugs.
I’m not trying to scare you,
but kidney failure is nothing to be taken lightly. There are other causes of kidney failure besides diabetes: trauma, genetics,
and environmental toxicity such as poison could also damage the kidneys. But, diabetes is the number one cause of renal failure,
so take charge to reduce your risk:
Intensive blood glucose control slows the progression of kidney
disease. Work with your certified diabetes educator and physician to maintain normal blood glucose, by testing often and administering
insulin based on diet and exercise.
Have your doctor measure your A1C level at least twice a year.
The test provides a weighted average of your blood glucose level for the previous three months. The ADA says aim for A1C of
7 percent or less.
Have your urine albumin excretion (protein in urine, a sign
of kidney damage) checked at least once yearly.
Check your blood pressure regularly. Hypertension is a double-edged
sword. It contributes to kidney disease, and it’s caused by kidney disease. The American Diabetes Association and the
National Heart, Lung, and Blood Institute recommend that people with diabetes and kidney disease keep their blood pressure
Obesity increases risk for hypertension and Type 2 diabetes:
Losing weight helps lower blood pressure and increases insulin sensitivity.
Ask your doctor whether you might benefit from taking an ACE
inhibitor or ARB.
Ofstein says people with kidney disease should consume the recommended
dietary allowance (RDA) for protein, and avoid high-protein diets. It’s extremely important to reduce your dietary sodium
and phosphorus if you have renal disease. A reduced-protein diet with advanced kidney disease may help delay progression.
However, people on dialysis have different needs and requirements,
and may need more protein. Dialyzed patients will work with a registered dietitian to achieve the optimal balance depending
upon their type of treatment.
Ofstein says, “Take ownership of your body, and remember
what you are putting into it.” I like it. It’s up to you to control what you can control. You can control your
diet and your lifestyle, and stay as healthy as possible.