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Diabetic Kidney Disease and Dialysis

By Jonas Wilson, Ing. Med.

Diabetic kidney disease (DKD) occurs due to the long-term damage caused by diabetes to the kidneys. In severe cases, this leads to kidney failure that requires dialysis, which is the clinical purification of blood to artificially substitute for normal kidney function.

It is expensive and requires many lifestyle changes like dietary alterations, but a relatively normal life in terms of work and recreation can still be led provided they do not interfere with treatment.

One cannot live without the kidneys, because they play important roles, such as maintaining pH homeostasis and balancing blood electrolytes in addition to removing waste products and regulating blood pressure.

While the etiology of DKD is not fully understood, several factors have been implicated in the pathogenesis. These include hyperglycemia, glycation end products, and the activation of pro-inflammatory cytokines, like transforming growth factor B (TGF-B).

These slowly cause damage to the kidneys overtime, which can be asymptomatic for many years before the appearance of clinical signs and symptoms.

Additional environmental and familial and/or genetic factors may also play a role in developing DKD. These include smoking, high blood pressure, high cholesterol and having roots from ethnic groups, such as African Americans, Hispanics, and native American Indians.

Signs and Symptoms

Regular tests for kidney function are imperative, because the early stages of DKD are asymptomatic and early damage caused by diabetes may be reversed. Signs of failing kidneys are many.

Some of the first signs of progressive kidney insufficiency include albuminuria, increasing blood pressure, and edema (i.e., the excess accumulation of fluid in bodily tissues or cavities), most notably in the ankles and legs.

Other signs and symptoms are high blood urea nitrogen and serum creatinine as well as frequent trips to the toilet at night and morning sickness, vomiting, and nausea.

Dialysis

In the United States, approximately 44% of patients requiring dialysis are diabetics. In chronic or end-stage renal disease (ESRD), a patient will require dialysis for the rest of their lives and, where applicable, might be placed on a waiting list for a new kidney.

Dialysis becomes necessary when a patient develops loss of kidney function by 85 to 90 percent and glomerular filtration rate (GFR) drops below 15 ml/min.

Dialysis attempts to replace kidney function by removing waste and excess fluids as well as maintaining blood pressure and levels of electrolytes. Dialysis is usually done in a hospital at a dialysis unit or at home.

There are two main types of dialysis, namely, hemodialysis and peritoneal dialysis. Hemodialysis requires access into a blood vessel, usually the arm or leg and blood is passed through a hemodialyzer to remove waste, chemicals, and excess fluid.

One session of dialysis lasts for about four hours and about three sessions are required per week. Peritoneal dialysis does not remove blood from the body.

Instead, a catheter is placed into the peritoneal cavity, which is then filled with a dialysate solution that draws extra fluid and waste products out of the blood and into the solution that is later removed.

Reviewed by Susha Cheriyedath, MSc

Further Reading

Last Updated: Sep 23, 2016

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