Diabetes serves as a primary risk factor for chronic kidney disease, a progressive condition that impairs the filtration of blood and frequently requires dialysis in advanced stages.
As World Diabetes Day approaches on November 14, nephrologists and health organizations emphasize the critical need for early screening and continuous vascular management to prevent irreversible organ damage.
The pathophysiological link between diabetes and renal failure centers on sustained hyperglycemia, or chronically elevated blood glucose levels. Over time, persistent high sugar damages the small blood vessels within the kidneys, which gradually diminishes the organ’s glomerular filtration rate. Hypertension also contributes to this process, creating a dual mechanism of injury.
Data from the 2024 Brazilian Dialysis Census conducted by the Brazilian Society of Nephrology reveals that roughly 29 percent of patients undergoing dialysis nationwide have diabetes. Diabetic kidney disease affects between 20 percent and 40 percent of all individuals living with the condition, matching hypertension as a cause for renal failure in patients in dialysis in the country.
“É fundamental que pessoas com diabetes acompanhem regularmente a saúde dos rins, mesmo quando não apresentam sintomas. A doença renal pode evoluir silenciosamente, e o diagnóstico precoce permite adotar medidas para retardar sua progressão,” said Bruno Zawadzki, vice-president of medical services at DaVita.
Key terms in kidney function and treatment
- Glomerular Filtration Rate (GFR): A laboratory measurement derived from blood creatinine levels that estimates how efficiently your kidneys filter waste products from the bloodstream.
- Albuminuria: The abnormal presence of albumin in the urine, serving as an early indicator of damaged renal filtration.
- SGLT2 Inhibitors: A pharmacological drug class that clinical trials show can contribute to slowing the progression of kidney disease and reducing the risk of cardiovascular events.
Kidney disease progresses without early symptoms
Chronic kidney disease typically remains asymptomatic during its initial stages, allowing microvascular damage to accumulate undetected. Routine diagnostic evaluations for diabetic patients must include serum creatinine tests to estimate glomerular filtration rates alongside urinary albumin-to-creatinine ratio assessments.
Manuela Lordelo, a nephrologist, explained that patients rarely notice physical manifestations until they lose much of their renal capacity. Clinical symptoms such as swelling in the legs and ankles, foamy urine, elevated blood pressure, and frequent fatigue generally emerge as the disease progresses.
Preventative management requires glycemic and blood pressure regulation, coupled with lifestyle modifications like balanced nutrition, regular physical activity, and smoking cessation. Specialists also caution against the indiscriminate use of anti-inflammatories, which can harm renal function.
Advanced therapies and multidisciplinary dialysis care
When the disease reaches advanced stages and the kidneys no longer perform their functions adequately, dialysis may be necessary. Hemodialysis and peritoneal dialysis are treatment modalities that can be indicated to replace part of the renal functions, helping to remove waste and excess fluids from the body.
Therapeutic innovations have expanded protective strategies for patients managing both type 2 diabetes and chronic kidney disease. Among these advances are SGLT2 inhibitors, finerenone, and GLP-1 receptor agonists, such as semaglutide.
The FLOW clinical trial demonstrated that semaglutide reduced the relative risk of a composite outcome of renal disease events and cardiovascular death by 24 percent in people with type 2 diabetes and chronic kidney disease.
“Mais do que tratar a doença renal em estágios avançados, o desafio é atuar antes que ela progrida, garantindo diagnóstico, acompanhamento e assistência especializada,” Zawadzki said.
| Therapeutic Intervention | Primary Pharmacological Class | Documented Clinical Benefit |
|---|---|---|
| Semaglutide | GLP-1 Receptor Agonist | Reduced relative risk of renal events and cardiovascular death by 24% in FLOW trial |
| SGLT2 Inhibitors | Sodium-Glucose Cotransporter-2 Inhibitor | Contributes to slowing the progression of kidney disease |
| Finerenone | Finerenone | Contributes to slowing the progression of kidney disease |
Seek medical advice for renal changes
Early diagnostic referral is essential for any patient exhibiting changes in renal function.
References
- Sociedade Brasileira de Nefrologia. Censo Brasileiro de Diálise 2024.
- FLOW Clinical Trial.
