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Preventing Diabetes from Progressing Into Kidney Disease

Since one of the big risk factors for diabetes-based End-Stage Renal Disease (ESRD) is hypertension, drugs used to lower blood pressure (antihypertensive drugs) can slow the progression of kidney disease significantly. One drug, an angiotensin-converting enzyme (ACE) inhibitor, has proven effective in preventing progression to stages IV and V.1 Calcium channel blockers, another class of antihypertensive drugs, also show promise.

Some, but not all, calcium channel blockers may be able to decrease proteinuria (loss of protein into the urine) and damage to kidney tissue. Researchers are investigating whether combinations of calcium channel blockers and ACE inhibitors might be more effective than either treatment used alone. Patients with even mild hypertension or persistent microalbuminuria (presence of albumin, a component of protein, in the urine) should consult a physician about the use of antihypertensive medicines.

A diet containing reduced amounts of protein may benefit people with kidney disease of diabetes. In people with diabetes, excessive consumption of protein may be harmful. Experts recommend that most patients with stage III or stage IV nephropathy consume moderate amounts of protein.

If you have diabetes:

  • Have your doctor measure your glycohemoglobin regularly. The HbA1c test averages your level of blood sugar for the previous 1-3 months.

  • Follow your doctor's advice regarding insulin injections, medicines, diet, exercise, and monitoring your blood sugar.

  • Have your blood pressure checked several times a year. If blood pressure is high, follow your doctor's plan for keeping it near normal levels.

  • Ask your doctor whether you might benefit from receiving an ACE inhibitor.

  • Have your urine checked yearly for microalbumin and protein. If there is protein in your urine, have your blood checked for elevated amounts of waste products such as creatinine.

  • Ask your doctor whether you should reduce the amount of protein in your diet.

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