Diabetes and Kidney Disease

On World diabetes Day

Indian healthcare’s Dangerous Duo

By Dr S.J.Acharya

As per the International Diabetes Federation, worldwide more than 285 million people now live with diabetes. With every sixth diabetic an Indian, India is truly the world’s Diabetes Capital with 50.8 million diabetics. China follows with 43.2 million and the US with 26.8 million. Sedentary lifestyles, delays in early detection and lack of proper treatment are all contributing to the life-threatening rise in diabetic cases.

Diabetes is a condition where the body either does not produce enough insulin or does not respond properly to insulin – a hormone produced in the pancreas. When insulin is no longer produced or it is ineffective, the glucose cannot enter the cells and keeps circulating with increased levels in the blood. This is where the problems begin.

High level of sugar is poisonous for cells . That is why we find high incidence of cataract , blindness, heart disease , leg problems , kidney problems and problems related to nerves in diabetic patients . All these could be avoided if blood sugar is kept under reasonable control .

Blood pressure tends to be high in diabetics due to stiffening of blood vessels – a result of high level of fat in blood in diabetics . Blood pressure further damages heart , eyes and kidneys . So a diabetic must have a better control of blood pressure .

Smoking and tobacco chewing add salt to the injury . Diabetic smokers are prone for gangrene of legs . In the world , every twenty minutes a diabetic faces amputation of a limb due to gangrene.

Kidneys bear brunt of diabetic assault . Kidneys are damaged easily with high blood sugar and blood pressure . Kidneys are rich in blood supply . The kidneys comprises of millions of tiny filters or nephrons. In turn, the nephrons have even smaller vessels within them. The kidneys constantly remove wastes and toxins from the bloodstream. When glucose levels in the bloodstream are consistently too high, the nephrons (filters) are slowly destroyed. The kidneys can no longer filter the blood, and wastes that would be excreted keep circulating in the bloodstream. Gradually, this gives rise to Chronic Kidney Disease.
Unlike heart attacks which manifest with chest pain , kidneys bear the assault silently for years . And by the time a physician detects kidney problem , its too late and irreversible .

The manifestation of diabetic kidney disease are swelling of face and feet , weakness , nausea , vomiting , itching , bony pains , menstrual disturbance , loss of sexual urge , inability to concentrate etc . Anemia , high blood pressure and eye problems are invariably associated .
Laboratory tests reveal protein in urine , rise in urea and low haemoglobin

Diabetics should undergo periodic or annual screenings to check kidney functions and detect kidney disease in time.

Although chronic kidney disease is not reversible, a treatment regimen and medical intervention is necessary so toxins do not build up within the body. Along with strict glucose control, taking medications to control blood pressure and eating a low-protein diet to reduce stress on the damaged kidneys.

In severe cases of chronic kidney disease , dialysis may be required to flush out toxins and clean the patient’s blood. Dialysis is a three- or four-hour process that needs to be repeated every few days. There are two types of dialysis:
• Haemodialysis: A machine filters the patient’s blood thrice a week. The procedure takes three to four hours and must be done at a dialysis centre.
• Peritoneal dialysis: This can be performed independently at home. Here the blood is not filtered directly, but via the abdomen using fluids instead. Some patients find this more convenient.


Another treatment of chronic kidney disease is kidney transplantation . But finding a suitable family member for kidney donation is difficult in diabetics because most of the family members turn out to be diabetic and hence not suitable for kidney donation . Also presence of other complications like heart disease often makes a diabetic patient unfit to undergo transplant surgery . However kidney transplantation in selected patients is the most appropriate treatment for diabetic kidney disease .


The urine of diabetics has high sugar content, which encourages growth of bacteria, leading to kidney infections. Diabetics must take special care and treat infections promptly.

Finally, people with diabetes and CKD must have a carefully controlled diet, drawn up in consultation with their doctor. So rather than following a troublesome list of do’s and don’ts, it makes perfect sense to control your diet now and exercise daily to prevent diabetes and diabetic kidney disease in the future.



(Dr S.J.Acharya is eminent kidney and transplant physician in Central India and also founder secretary of Central India Kidney Foundation )