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Patients with Prediabetes at Risk for Early Kidney Damage

Research study finds high levels of glucose could be affecting kidneys even prior to diabetes diagnosis.

There are more than 180,000 people diagnosed with kidney failure in the United States. Kidney failure is a serious condition when kidneys fail to eliminate the body’s waste and is the final stage of chronic kidney failure. There are many causes of kidney failure such as high blood pressure, glomerulonephritis, urologic diseases, or cystic disease. Among those causes, diabetes is the most common cause of kidney failure accounting for almost 44% of new patient cases. Even with tight controls over blood glucose, patients with diabetes can still progress to kidney failure. The number of diabetes patients in the United States is approaching 30 million and in 2005 nearly 180,000 people are living with kidney failure due to diabetes.

Patients with kidney failure are required to either go through dialysis, which artificially filters their blood, or they must receive a kidney transplant. Patients with kidney failure are qualified for federally funded care, which in 2005 cost the United States nearly $32 billion.

The course of a diabetic kidney takes many years to develop as the kidney’s filtering function declines. Small amounts of blood protein albumin begins to leak into a patient’s urine as they develop kidney disease. As the severity of the disease progresses, the greater the leak in albumin. As the amount of albumin in the urine increases, the kidney’s filtering function will usually begin to drop. Kidney disease rarely develops during the first 10 years of beginning a diabetic. Kidney failure usually begins to occur in patients with diabetes after 15 to 25 years of diabetes.

Though there is abundant evidence of kidney failure developing in patients with diabetes, there haven’t been studies looking at patients who have prediabetes. The recently published prospective cohort study looked at 1,261 persons without diabetes mellitus from the general population age 50 to 62. The study defined prediabetes as a fasting blood glucose level of 100 to 125 mg/dL and/or an HbA1c level of 5.7% to 6.4%. The study participants were assessed at study baseline and followed for a median of 5.6 years. The study found that prediabetes is a risk factor in development of glomerular hyperfiltration and albuminuria. The study suggests that prediabetes could be targeted for early treatment to prevent chronic kidney disease.

There are many options to slowing down the progression of kidney disease. Maintaining a low blood pressure is a great way to protect your kidneys as hypertension is the second leading cause of kidney failure. Patients can be on an ACE inhibitor, which does not only lower blood pressure but also provides renal protection. ACE inhibitors have been found to lower proteinuria and slowed deterioration of the glomeruli in both patients with and without diabetes. Another way to prevent kidney disease is to have a moderate protein diet. Patients with diabetes are recommended to avoid high-protein diets as it may be harmful to the kidneys. Aside from managing your blood pressure and a low-protein diet, intensive management of blood glucose is highly recommended for patients. There are several studies that found great benefits for controlling blood glucose. The National Institute of Diabetes and Digestive and Kidney Disease researchers found a 50% decrease in development and progression of early diabetic kidney disease in patients who followed an intensive regimen for controlling their blood glucose. Another study by the United Kingdom Prospective Diabetes Study spanning from 1976 to 1997 found conclusive evidence that people with improved glucose control reduced their risk of kidney disease by a third. These studies have clearly shown that controlling blood glucose is greatly beneficial to patients in preventing early stages of kidney disease as well as many other complications.

Practice Pearls:

  • Diabetes is the number one cause of kidney failure accounting for almost 44% of new cases of kidney failure. The second most common cause is hypertension.
  • A new prospective cohort study suggests that patients who have prediabetes are at higher risk of developing chronic kidney disease. Prediabetes patients should be targeted for intervention to prevent future complications.
  • It is recommended that patients control their blood pressure, maintain a low-protein diet, and most importantly maintain their blood glucose to slow or prevent the progression of kidney disease.

 

Melsom, Toralf, et al. “Prediabetes and Risk of Glomerular Hyperfiltration and Albuminuria in the General Nondiabetic Population: A Prospective Cohort Study.” American Journal of Kidney Diseases (2015).

National Institute of Diabetes and Digestive and Kidney Diseases. “Kidney Disease of Diabetes”. www.niddk.nih.gov.


Researched and prepared by Jimmy Tran, Doctor of Pharmacy Candidate LECOM College of Pharmacy, reviewed by Dave Joffe, BSPharm, CDE