Hide Notes 

Slide 1: 24 Focus Diabetes2009 g Sprin health for more ation visit inform Life.com Remedy As seen in COMPLICATIONS 101 Kidney Confidential Kidney disease is a chronic complication that often goes undiagnosed BY KALIA DONER EACH YEAR, 48,000 AMERICANS with diabetes are diagnosed with kidney failure—the last stage of kidney complications before dialysis or transplant. And 180,00 people in the U.S. are living with kidney failure as a result of diabetes. But surprisingly, most people at risk don’t know they are irting with kidney disease. Among African Americans, one group at increased risk, awareness of the condition is scanty at best. A National Kidney Disease Education Program survey found that although 90 percent of people they talked to had heard about kidney disease, only 18 percent thought their personal risk for getting it was higher than average, even though 44 percent of those polled had at least one of the major risk factors. Ignorance of kidney disease is a problem across the board. “When I talk to people in the general public about chronic kidney disease (CKD), they usually think of dialysis or kidney transplant, but they don’t understand that kidney disease encompasses early stages and that in those stages most people feel well,” says Joseph Vassalotti, M.D., chief medical of cer of the National Kidney Foundation (NKF) and a member of the clinical faculty in the division of nephrology at Mount Sinai Medical Center in New York City. The beginning of the disease is the time to intervene; that’s when it is possible to prevent complications and the progression or loss of kidney function. Early detection requires testing of the urine and blood in patients with risk conditions such as diabetes and high blood pressure. “Symptoms appear late,” explains Dr. Vassalotti. “Then you see things WORLD KIDNEY DAY Take advantage of free screenings; early detection can help you avoid serious problems On March 13, the National Kidney Foundation is sponsoring World Kidney Day, as part of National Kidney Month. The NKF’s goal is to educate people who are at risk about the importance of early detection and the critical role the kidneys play in maintaining overall health. The Foundation hopes that the 26 million Americans with chronic kidney disease (many undiagnosed) will participate in KEEP—the Kidney Early Evaluation Program—and come in for a screening test so they can find out if they need to see a doctor about their kidney health. KEEP offers free screening to anyone 18 years and older with high blood pressure, diabetes or a family history of kidney disease. “We know we can do a lot to increase treatment and prevention of kidney disease,” says NKF president Bryan Becker, M.D., “by raising awareness of risks and helping people catch potential problems as early as possible.” To find a free screening in your neighborhood, call the foundation at 800-622-9010 or go online to kidney.org. DIABETES FOCUS ❘ RemedyLife.com Masterfile
Slide 2: 26 like ankle swelling, fatigue, sleep disorders, restless legs or early-morning nausea—and [even then they may be overlooked because] they are not speci c to kidney disease.” Kidneys are the master chemists of our bodies. These organs act as reprocessing devises that lter waste out of around 200 quarts of blood a day, sending about two quarts of uid into the bladder as urine. The waste in the blood is a natural by-product of protein metabolism—the body breaks down proteins to remove what it needs from food, and waste is sent into your KIDNEY CLOSE UP circulatory system. If your kidneys do not remove these wastes, they build up in the blood and damage your body. But expelling the bad stuff isn’t all the kidneys do: They also balance sodium, phosphorus and potassium levels and play important roles in the regulation of blood pressure, red blood cell production and bone health. When this delicate, essential balancing act goes awry because of damage to the ltering system from high glucose levels, a cascade of events begins that characterizes diabetic kidney disease. WHAT HAPPENS? Diabetic kidney disease takes many years to develop. Like type 2 diabetes, it can go undetected for a considerable length of time. Therefore, it’s not surprising that people recently diagnosed with diabetes often discover they also are suffering from kidney problems. To check for early signs of kidney damage, the urine is tested for the presence of a protein called albumin. A low level of the protein signals what is called microalbuminuria, a sign of compromised kidney function. It means the kidneys’ blood vessels are leaking albumin, even though the kidneys’ ltering process may be normal. As the disease progresses, albumin levels in the urine increase, and you may develop heavy proteinuria or macroalbuminuria. Another way to test for kidney disease is to nd out your estimated glomerular ltration rate (GFR). It is the best indicator of kidney function, or how well your kidneys are working. In a GFR test, a liquid is injected into the bloodstream and urine is collected over time to monitor the elimination of that substance. Alternatively, GFR can be estimated without an examination of the urine; instead, a blood test can measure the presence of creatinine, which builds up when the kidneys are not working well. “People with albumin in the urine, diabetes and/or high blood pressure should have a GRF test every year,” says Bryan Becker, M.D., president of the NKF and professor of medicine at the University of Wisconsin School of Medicine and Public Health. “And if that test indicates ltration problems, then you need ongoing medical supervision to protect your kidneys from further damage.” In 2002 the NKF published clinical practice guidelines that de ned CKD and classi ed its ve stages based on kidney damage and kidney function tests: Stage 1: Kidney damage with normal GFR (90 or above). Treatment focuses on slowing progression and reducing the risk of heart and blood vessel disease. Early interventions include the use of kidney-protective medication such as an angiotensin converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) to reduce albuminuria. These medicines are generally used to treat high blood pressure, which should be under 130/80 for patients with diabetes and/or CKD. Cholesterol testing and quitting smoking are also part of kidney disease DIABETES FOCUS ❘ RemedyLife.com
Slide 3: COMPLICATIONS 101 27 management. To control low-density lipoprotein (LDL, or bad cholesterol), which is associated with atherosclerosis or hardening of the arteries, your doctor may recommend a low-fat diet and prescribe medication; talk with your doctor about the pros and cons of taking statins when your kidneys are damaged, and discuss other drug options such as brates. Stage 2: Kidney damage with mild decrease in GFR (60 to 89). Treatment is similar to stage 1. Stage 3: Moderate decrease in GFR (30 to 59). When CKD has advanced to this stage, anemia and bone problems become more common, so screening for these conditions is added to ongoing therapy. When anemia is present, the blood does not contain enough red blood cells. Healthy kidneys make the hormone EPO, which stimulates the bones to make red blood cells. But kidney damage may interfere with EPO production, requiring you to take injections of a man-made form of the hormone. Vitamin D is also activated in the kidney, so disorders of vitamin D may call for treatment in stage 3 through stage 5. In addition, certain medications that can cause loss of kidney function should be avoided. For example, people with diabetes and CKD stage 3 to stage 5 should not take metformin for glucose control. Stage 4: Severe reduction in GFR (15 to 29). Continue following the treatment for complications of CKD, and nd out about what to do if you progress to kidney failure. At this stage or earlier, you should consult a kidney specialist, or nephrologist. You may need to begin plans for dialysis, or you should consider asking family or friends to donate a kidney for transplantation. Stage 5: Kidney failure (GFR less than 15). When the kidneys do not work well enough to maintain life, you must go on dialysis or obtain a kidney transplant. However, most people with CKD don’t make it all the way to end stage, when they need to go on dialysis or receive a kidney. Only “a very small number of people with chronic kidney disease end up on dialysis,” says Dr. Becker. “In fact, we know that the majority of people who have progressive chronic kidney disease die before they reach kidney failure or get to dialysis or transplant. The risk of developing cardiovascular and infectious complications is so dire. In many respects, those with kidney failure are the survivors.” For people with diabetes, there are established steps that reduce the risk of developing kidney disease and that treat existing CKD. “These are pretty straightforward, and they are enormously important for anyone with diabetes,” says Dr. Vassalotti. He says to aim for: an A1C of 7 or less blood pressure under 130/80 (the recommended target for anyone with diabetes and/or CKD) In addition to taking kidney-protective and blood pressure medications, you may be put on a low-sodium diet to help control blood pressure. You will probably be given an exercise program as well. To spare the kidneys extra strain, you may also be told to eat moderate amounts of protein, such as lean meats, sh, legumes and low-fat dairy products. The NKF clinical guidelines recommend a daily protein intake of 0.8 grams per kilogram of body weight per day. It’s a good idea to consult with your doctor about a diet tailored to your needs, and a dietitian and/or diabetes educator for help implementing a dietary regime. (Protein requirements are variable. For a 150-pound person with kidney disease, the limit would be about 54 grams per day; for a 120-pound person, the limit would be about 43 grams per day.) DF PREVENTION LIFESTYLE MODIFICATIONS FEELING A BIT HYPER? ER? Jupiter Images High blood pressure, or hypertension, is a major contributor to kidney problems in people with diabetes. And once kidney disease appears, hypertension worsens. That’s why it is so important that anyone with diabetes who has the mildest signs of high blood pressure get prompt treatment to bring it under control. Antihypertensive drugs that lower blood pressure and slow the progression of kidney disease generally fall into two categories: angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs.) Some may do more than lower blood pressure; they may actually protect the tiny filters in the kidney from damage. Still, they might not be enough to lower blood pressure, so your doctor may prescribe diuretics and beta-blockers or calcium channel blockers. RemedyLife.com ❘ DIABETES FOCUS