Diabetes is associated with serious and potentially life-threatening complications. One of these is chronic kidney disease or CKD. Estimates indicate that CKD affects over 850 million people, with diabetes and hypertension responsible for two-thirds of cases.
CKD occurs when the kidneys become damaged and cannot filter blood as well as they should. High blood glucose levels are one cause of damage to blood vessels and the kidneys themselves. Moreover, many people with diabetes also develop high blood pressure, which can damage the kidneys. As a result, excess fluid and waste from blood remains in the body, increasing the risk of other complications such as heart disease and stroke.
In its advanced stages, CKD can lead to kidney failure, requiring dialysis or a transplant. Meanwhile, cardiovascular complications that result from CKD can lead to early death before kidney failure occurs.
Blood glucose control is one of the aspects of preventing kidney disease in diabetes. In people with diabetes, you will also have other comorbidities, particularly hypertension and dyslipidaemia, that also impact kidney disease development,” Professor Antonio Ceriello, Research Consultant at IRCCS and Adjunct Professor of Internal Medicine, Italy.
A progressive and silent condition
Kidney disease is a progressive and silent condition that requires a pre-emptive and proactive approach to detect its early signs. Research from the IDF Diabetes Atlas Report: CKD and Diabetes found that seven in ten people with diabetes were diagnosed with CKD due to an existing complication. This finding indicates that healthcare providers and people living with diabetes cannot rely on signs or symptoms to detect CKD. A simple and widely available test can enable early diagnosis and assess an individual’s progression risk.
Various risk factors can contribute to the development of CKD in people with diabetes, but the most important are high blood glucose, obesity, hypertension and blood lipid imbalances. Accordingly, good diabetes management — which requires access to regular treatment, care and support — can improve these factors.
Furthermore, evidence-based guidelines recommend screening people with diabetes for kidney-related complications once a year. This frequency should increase to three months if a person with diabetes presents with CKD in one of its five stages, particularly those most advanced.
Waiting for signs or symptoms of kidney disease is not the right way of raising the problem in people with diabetes. You need to be proactive in screening for early signs. With simple tests, you can not only diagnose kidney disease early but also stratify the risk of progression,” Professor Roberto Pecoits-Filho, nephrologist and Professor of Medicine (Brazil).
Advocating for renewed action to tackle diabetes and kidney disease
In response to the growing prevalence of diabetes and CKD, the International Diabetes Federation (IDF) and the International Society of Nephrology (ISN) developed a policy brief, Renewing the fight: a call to action for diabetes and chronic kidney disease, with recommendations targeted at policymakers for preventing, managing and treating the two conditions effectively.
The policy brief contains nine recommendations, including multi-stakeholder collaboration to develop policies to prevent and treat diabetes and CKD; the implementation of interventions to facilitate diabetes and CKD screening; and providing universal health coverage (UHC) that covers CKD screening, treatment and care.
Policy initiatives and future outlooks
The growing global burden of diabetes and its complications has garnered international commitments and initiatives. The World Health Organization (WHO) has set goals to reduce premature mortality from non-communicable diseases (NCDs), including diabetes, by 25% by 2025. Sustainable Development Goal 3.4 targets preventing and treating NCDs, including diabetes, to reduce early death from NCDs by one-third. In April 2021, the WHO launched the Global Diabetes Compact, a global initiative aimed at reducing the risk of diabetes and ensuring equitable access to comprehensive treatment and care for all people with the condition.
We will only be able to address kidney disease in people with diabetes by developing a multisectoral approach to prevent and treat both conditions,” IDF-ISN policy brief “Renewing the fight: a call to action for diabetes and chronic kidney disease
Despite its prevalence and impact, CKD is not featured as an indicator for any NCD target at the UN or WHO level. Targeted interventions to tackle CKD are needed as it is a complex and multifaceted condition that requires specialised care and management. By prioritising kidney disease in diabetes and allocating resources accordingly, we can improve outcomes and quality of life for people affected by these conditions.
For more insights on diabetes and chronic kidney disease, tune in to the IDF D-Talk podcast where Professors Antonio Ceriello and Roberto Pecoits-Filho join host Phylissa Deroze to examine the links between diabetes and CKD and the benefits of a multisectoral approach to prevent and treat both conditions.
Renewing the fight: a call to action for diabetes and chronic kidney disease
To mark the launch of their joint policy brief, IDF and ISN hosted an online event to explore the key messages and recommendations included in the brief and share experiences from diabetes advocates about what living with these conditions means and how better policy can improve lives.
