A new study published in The New England Journal of Medicine found that the rate of chronic kidney disease in the U.S. has markedly increased in recent years, along with increased rates of diabetes.

According to the Center for Disease Control and Prevention (CDC), chronic kidney disease (CKD) is common in people with diabetes. Approximately 1 in 3 adults with diabetes has CKD, and any type (including type 1 and type 2 diabetes) can spur kidney disease.

Less than 10% of patients with early-stage kidney disease are aware they have Chronic Kidney Disease (CKD)—knowledge is crucial because early intervention is pivotal in reducing the disease’s progression. So it may not come as a surprise that the prevalence of kidney failure requiring dialysis or transplant more than doubled to nearly 800,000 persons in the U.S. between 2000 and 2019, with diabetes as the leading cause.

The scientists in this research study sought to determine the rate of new-onset CKD, specifically in people with diabetes, and if rates are increasing in various cohorts. Knowing this information could be vital for identifying high-risk populations, as well as determining the effectiveness of interventions.

Researchers tracked 654,549 adults with various types of diabetes from 2015 through 2020 using electronic health records to assess the link between the diseases and chronic kidney disease. It’s important to note that the subjects with diabetes were identified according to blood glucose levels, use of glucose-lowering medications, or administrative codes—meaning that this study did not discern between type 1 and type 2 diabetes, though causation and treatment methods for the types differ.

The study found new onset CKD rates increased by 60% in the Hawaiian and Pacific Islander population, 40% in the Black population, 33% in the American Indian/Alaska Native population, and 25% in the Hispanic population, compared to white persons with diabetes. Although high CKD incidence in diabetics is still occurring, the rate actually declined from 8% per year in 2015 to 6.4% per year in 2020 in the overall diabetic population.

So, how have diabetes and kidney disease been historically linked?

Diabetes mellitus remains the leading cause of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) in the U.S., contributing to hypertension and/or proteinuria (loss of protein into the urine) from the kidneys, which causes inflammation and scarring within the kidneys, says Ashte Collins, M.D., internal medicine, nephrology and associate professor of Medicine at The George Washington University. He adds that “diabetic persons are twice as likely as non-diabetics to develop CKD. Moving forward, rates of diabetes are expected to continually rise as sedentary lifestyle, obesity, and changes in the nutritional content of Western diets rise in prevalence.” Though, it is important to note that many factors contribute to diabetes, including autoimmune diseases and genetics.

What do the study’s findings mean for people with diabetes?

If a person has diabetes, the new study suggests that a target is on their back with respect to the risk of developing diabetic kidney disease, says Collins. “Lack of awareness of a diabetes diagnosis often spells doom for patients, since 1 in 5 patients with diabetes are unaware that they even have diabetes and are therefore at greater risk of developing CKD.”

What can people with diabetes do to prevent chronic kidney disease?

According to Collins, the first step to prevent chronic kidney disease is to undergo screening for it, especially if a person knows that they are at risk. So, he explains, regular doctor’s visits can help detect early warning signs of CKD, such as proteinuria.

In addition to screening, Collins says that tight blood sugar control has been demonstrated in multiple studies to decrease the risk of developing CKD and slowing its progression. He adds that “tight blood pressure control in diabetics, in some studies, has been shown to be just as if not more effective in preventing CKD as blood sugar control.”

How can I lower my risk for CKD?

For starters, lessen the load on your kidneys. Most people consuming a Western diet eat far more protein than their kidneys were designed to handle, so lowering one’s protein intake to less than 1.2 g per kg of body weight daily may help reduce the load on the kidneys. Most animal protein generates more acid than plant protein, so a switch to a plant-based diet could be protective in most adults, says Collins. He also notes that “a person’s kidneys stop growing larger around the time that person stops growing taller, so limiting the amount of work the kidneys must do over a lifetime after they stop growing is critical.”

And lastly, Collins says that avoidance of smoking and sugar-sweetened beverages can go a long way to lowering the rate of CKD, not to mention lowering your risk for countless other medical issues.

The bottom line

The increase in kidney disease and diagnoses of diabetes shows a correlation between the two conditions. But, a diabetes diagnosis of any kind does not guarantee you’ll end up with CKD. There are steps you can take to lower your risk of developing issues with your kidneys, and plenty of preventative measures you can take. Speak with a healthcare professional to find out more about what you can do to be your healthiest self.

Prevention