If you have diabetes, it’s important to check your kidney function

Diabetes and chronic kidney disease often go hand in hand

The National Kidney Foundation estimates that 37 million adults in the U.S. have chronic kidney disease (CKD).¹ This chronic condition refers to the gradual decline of kidney function, which can ultimately lead to needing dialysis (a treatment that takes over kidney function) or kidney transplant.

While there are many factors that can cause CKD, diabetes is the number one culprit. In the U.S., as many as 1 in 3 adults with diabetes has CKD.¹ Yet nearly half of Americans don’t know that having diabetes can increase the chance of developing kidney disease or kidney failure.²

“Too few diabetes patients have any idea how well their kidneys are functioning,” said Jay Belcher, a registered pharmacist with Express Scripts^® Pharmacy.

“This is particularly problematic,” Belcher said, “because CKD is a ‘silent’ or asymptomatic disease until it progresses to a point where it’s difficult to slow down or stop. If you’re diabetic, it’s important to take a proactive approach with your doctor to monitor your kidney (renal) function before you develop symptoms.”

What is chronic kidney disease?

Your kidneys play a few roles in your body. They:

• Filter out waste and excess fluid from your blood.
• Help control your blood pressure.
• Make hormones that your body needs to stay healthy.

When you have chronic kidney disease, your kidneys don’t function properly, causing waste and fluid to gradually build up in the blood. Over time, this buildup can lead to complications such as high blood pressure, anemia, weak bones, nerve damage, and poor nutrition.

CKD initially starts out with few to no symptoms, which is why as many as 90% of Americans with CKD don’t know they have it.³ It’s not until the disease becomes advanced that they start to experience symptoms such as low energy, trouble concentrating, puffy eyes, itchy skin, swollen feet or ankles, and frequent urination at night.

The connection between chronic kidney disease and diabetes

CKD is common in people with diabetes because the kidneys have to work harder to filter out excess sugar from the blood. Over time, the excess sugar can damage blood vessels and tiny filters called nephrons in the kidneys so they don’t work as well. Many people with diabetes also develop high blood pressure, which can also damage the kidneys.

Testing for chronic kidney disease

While there are a number of different tests doctors can use to assess kidney function, the estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) tests are the current gold standard in diabetes patients.

If you have diabetes, it’s important to get your kidneys checked regularly by your doctor through simple blood and urine tests. Doing so increases the likelihood of identifying CKD early, when treatment is the most effective.

The American Diabetes Association (ADA) recommends annual screenings in patients without established CKD starting at the time of type 2 diabetes diagnosis or 5 years after a type 1 diabetes diagnosis (as CKD is uncommon during the first 5 years of type 1 diabetes). The ADA recommends quarterly screenings for diabetes patients with established CKD.

Strategies to prevent or slow down the progression of chronic kidney disease

The Centers for Disease Control and Prevention recommends several strategies for keeping your kidneys healthy if you have diabetes. Always talk to your doctor first before making any lifestyle changes or taking any new medications.

• Take diabetes medication as directed to keep your blood sugar in the target range as much as possible.
• Get your A1C tested at least twice a year (or as often as your doctor tells you to) with the goal of keeping your A1C level below 7%.
• Check your blood pressure regularly and talk with your doctor about blood pressure-lowering medications if it’s higher than 140/90.
• Keep your cholesterol in check.
• Eat foods lower in sodium to control blood pressure. Stick to a low protein and high fruits and vegetables diet (the more protein you eat, the more your kidneys need to work to filter out protein waste).
• Get 150 minutes a week of physical activity.

Medications to slow down the progression of chronic kidney disease

There are several different medications that can be prescribed to slow the progression of advanced stage CKD. ACE inhibitors or angiotensin receptor blockers (ARBs) are the preferred first line treatment for people with both diabetes and hypertension.

Those with diabetes who have been diagnosed with CKD may benefit from glucose-lowering therapies. Talk with your doctor about what medications may be best for you.

How chronic kidney disease affects diabetes treatment

Once CKD reaches a certain level, some medications, which rely upon the kidneys for elimination from the body, may not be able to be used, explained Belcher. Work with your doctor and pharmacist to determine which medication is best for you.

Our pharmacists are here to help

Preventing or slowing down the progression of CKD starts with better blood sugar management. If your health benefits include Express Scripts^® Pharmacy, you get 24/7 access to specially trained pharmacists who understand the complexities of diabetes and CKD. They can provide personalized care and guidance all from the comfort of your own home.

1 National Kidney Foundation: Kidney Disease: The Basics (accessed April 25, 2023): kidney.org/news/newsroom/fsindex.
2 National Kidney Foundation: New Harris Poll Shows Many Americans Don’t Know About Kidney Disease Risk (November 14, 2019): kidney.org/news/new-harris-poll-shows-many-americans-don%E2%80%99t-know-about-kidney-disease-risk.
3 Centers for Disease Control and Prevention: Chronic Kidney Disease in the United States, 2021 (accessed April 25, 2023): cdc.gov/kidneydisease/publications-resources/ckd-national-facts.html.