Mayo Clinic nephrologist Ivan Porter II has explained how diabetes damages the kidneys and raises the risk of chronic kidney disease (CKD). He stressed the need for blood sugar control and regular kidney function checks to prevent complications.
Global estimates show that up to 40% of people with diabetes develop CKD. The condition harms the kidneys’ ability to filter waste from the blood and keep the body’s fluids and salts in balance. It can progress without obvious symptoms, leading to some patients having advanced damage before they are diagnosed. In severe cases, kidney failure may require dialysis or a transplant to sustain life.
How Diabetes Harms Kidneys
Both type 1 and type 2 diabetes can cause CKD, though type 2 is responsible for more cases because it is more common. Diabetes interferes with insulin production or use. Insulin, a hormone made by the pancreas, helps the body turn glucose into energy and control blood sugar levels.
According to Dr. Porter, long-term exposure to high blood glucose damages blood vessels, including the tiny vessels in the kidneys that filter blood. “High levels of circulating glucose in the blood are poisonous to nerves and blood vessels, and the kidneys are a big ball of blood vessels,” Dr. Porter explained.
High glucose levels also cause chemical changes that lead to protein leaking into the urine. This activates processes that promote scarring and fibrosis in kidney tissue, which progressively lowers kidney function.
Preventing and Managing the Condition
The relationship between diabetes and CKD is also bidirectional. While uncontrolled blood sugar can damage the kidneys, failing kidney function can increase insulin resistance and worsen type 2 diabetes. The risk of kidney complications generally increases with how long a person has had diabetes and poor blood sugar control.
CKD has five stages, classified by the estimated glomerular filtration rate (eGFR). Stage 1 has an eGFR of 90 or higher with other signs of damage, like protein in the urine. Stage 2 ranges from 60 to 89. Stage 3 is split into 3a (45 to 59) and 3b (30 to 44), showing reduced function. Stage 4 has an eGFR of 15 to 29, indicating severe impairment. Stage 5, below 15, means kidney failure and may require dialysis or a transplant.
Dr. Porter emphasized managing diabetes and monitoring kidney function. This includes taking medication, a balanced diet, exercise, and accounting for factors like illness and stress that affect blood sugar. For those at risk of type 2 diabetes, a healthy weight, physical activity, and managing cholesterol can reduce risk. Limiting alcohol is also advised.
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