Publication MO-09-11-CKDThis material was prepared by Primaris, the Medicare Quality Improvement Organization for Missouri, under contract with the Centers for Medicare & Medicaid

Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy

Diabetes and CKD What is the Connection?

Discussion topics

Number of people in U.S. with diabetes

Diabetes and related problems

Diabetes and Chronic Kidney Disease (CKD)

Stages of CKD

What you can do to help yourself

You are not alone

20.8 million people in U.S. have diabetes –

that is 7% of the population

– Majority are Type 2

– Diabetes to increase 165% between 2000 and 2050

– There is a 1.8 times greater risk among African Americans

Possible complications of diabetes

StrokeStroke

BlindnessBlindness

Peripheral Vascular Disease

Peripheral Vascular Disease

CKDCKD

High Blood PressureHigh Blood Pressure

Heart diseaseHeart disease

DiabetesDiabetes

Diabetes and CKD

Diabetes is the leading cause of CKD in U.S.

Early kidney disease has no symptoms

– When not diagnosed it can progress to kidney failure with little or no warning

Control your diabetes

High blood sugar levels can lead to many health problems including kidney disease

– 30% of people with Type 1 diabetes develop CKD

– 10-40% of people with Type 2 diabetes develop CKD

What is the kidney

The kidneys weigh about a pound each

Located in the retroperitoneal space

About the size of an adult fist

Shaped like a kidney bean

Attached to blood stream through renal arteries

Each renal lobe is made of tiny blood vessels

Kidney functions

Remove waste

Remove excess fluid

Secrete Erythropoetin to make red blood cells

Regulate bone metabolism

Regulate blood pressure

Maintain electrolyte and acid balance

How does diabetes cause CKD?

Damages small blood vessels in kidneys and other organs

– Proteins begin to leak into the urine

– Ability to filter waste decreases

– Waste products begin to build up

– Kidneys may fail

– May need dialysis or transplant to live

Signs of kidney damage

Damage to kidneys may or may not involve kidney failure. Some signs of damage:

– Blood in urine

– Protein in urine (Proteinuria)

– Abnormal blood or other urine tests

– Abnormal imaging tests

– Abnormal kidney biopsy

CKD symptoms

Decreased appetite

Nausea, vomiting

Weight gain/loss

Change in bowel habits

Decreased sensation in hands and feet (neuropathy)

Tired

Decreased concentration

Frail appearance

Decreased sexual functioning

Bronze or discolored skin

NKF definition of CKD

The National Kidney Foundation defines CKD as kidney damage for 3 or more months based on findings of abnormal structure (Imaging studies) or abnormal function (blood or urine tests)

OR

GFR < 60 mL per minute for 3 or more months with or without evidence of Kidney damage

Detecting CKD

Detect CKD with 2 simple tests:

– Urine test for detecting proteinuria

– Blood test for estimating glomerular filtration rate (eGFR)

Stages of Chronic Kidney Disease

Stage DescriptionGFR*

mL/min/1.73m2

1Slight kidney damage with normal or increased filtration

More than 90

2Mild decrease in kidney function

60-89

3Moderate decrease in kidney function

30-59

4Severe decrease in kidney function

15-29

5Kidney failure requiring dialysis or transplantation

Less than 15

*GFR is glomerular filtration rate, a measurement of the kidney's function.

Stage 5 CKD or ESRD

Stage 5 CKD is more commonly called ESRD or End Stage Renal Disease.

Treatment required

– Some form of dialysis to maintain life

– Medications

– Diet modification

Delayed CKD detection can lead to serious consequences

Lack of treatment for early complications

– Diabetes - High blood pressure

– Cardiovascular disease - Malnutrition

Late referral to nephrologist/cardiovascular specialist or dietitian

Lack of patient education for prevention or treatment options

Lack of access placement prior to the start of dialysis

CKD risk factors

Diabetes

Hypertension

Smoking

High Cholesterol

Family history of CKD

Age

Gender

Racial /ethnic background

– African American

– Native American

– Asian American

– Pacific Islander

– Hispanic

CKD risk factors continued

Exposure to Nephrotoxic drugs

– Contrast Dye

– NSAIDS

– Ibuprofen

– Advil

– Motrin

– Naproxen

USRDS 2004

USRDS 2004

Why CKD prevention is important with diabetes & hypertension

More than 90% of Medicare patients with CKD also have diabetes, hypertension, or both

Approximately 83,000 Medicare beneficiaries with diabetes in Missouri (Fee-for-Service 4/06-3/07)

Diabetes and hypertension both cause CKD and make complications worse

When to get tested

Type 1 Diabetes: 5 years after diagnosis, then annually*

Type 2 Diabetes: at diagnosis, then annually*

Hypertension: at diagnosis and initiation of therapy, then every 3 years if eGFR and microalbumin tests are normal

Family history of kidney disease: every 3 years, as long as tests are normal

These testing intervals are recommendations; physician opinion may differ

*KDOQI Guideline 1

Help prevent or delay CKD

Control Blood Sugar - Goal of A1C < 6.5

– Eat at about the same time every day

– Eat a meal or snack every 3-4 hours and do not skip meals

– Eat the same amount of carbohydrates in meals or snacks each day

– Check blood sugar as instructed

– Take your medicine and /or insulin as directed

– Keep your doctor appointments; take your blood sugar record with you

Control blood pressure

Monitor your own blood pressure

– Try to keep it at 125/70 or lower

Take medication as directed

Limit salt and sodium intake

Watch your weight

Achieve and maintain desirable body weight (target BMI to normal range of 18.5-24.9 kg/m2)

If you smoke

STOP

Take an active role in your health care

Monitor your own blood pressure and blood sugar

Know what your levels should be

See your doctor regularly

– Ask if you are on an ACE or an ARB for your BP

– Ask if you had a urine test for protein

– Know your eGFR

– If you have CKD, know what stage

CKD Stage 3

Limit protein and phosphorous intake

– High protein levels increase the workload of the kidney

CKD Stage 4 or 5

Limit phosphorus intake in your diet

– High levels of phosphorus can cause damage without any symptoms

Foods high in phosphorus

Milk and dairy products

Cola drinks and Dr. Pepper

Chocolate

Nuts and butters

Pancakes, waffles and biscuits

Dried beans

Processed meats like hot dogs, sausage, bologna

Whole grain foods

Take better care of yourself

Changes in diet, fluid intake and medications can be confusing and challenging.

– These changes can help you feel better and slow kidney disease

Go to your doctor and ask questions

Take your medications as instructed

Report any changes

It takes a team

Now is the time to ask

Questions

Information Resources

National Kidney Foundation - www.kidney.org

Missouri Kidney Program - http://som.missouri.edu/mokp

Heartland Kidney Network - www.network12.org

American Assoc. of Kidney Patients - www.aakp.org

Renal Support Network - www.ikidney.com