Kidney function is one of those things that we seldom pay attention to in diabetes, until it’s too late and costly. This is why Dr Paula Diab advocates preventing kidney disease as early as possible.
Recent data published by the International Diabetes Federation (IDF) shows that there has been a dramatic rise in the prevalence of diabetes in South Africa over the last 10 years from 1,2 million to 4,5 million people.
In addition, it estimates that 52,4% of people living with diabetes are undiagnosed and that by 2030, the prevalence would have risen to over 6 million people. Every year diabetes complications claim the lives of about 90 000 people in South Africa and many of these people are under the age of 60.
Amongst these complications, kidney disease is one of the biggest contributing factors, especially in the African population. It is a costly complication and one that is difficult to diagnose and treat therefore it is really important to prevent kidney disease as early as possible.
What is kidney disease?
Kidney disease (diabetic nephropathy) is caused by damage to small blood vessels in the kidneys, leading to the kidneys becoming less efficient or failing altogether.
Kidney disease is much more common in people with diabetes than in those without diabetes. Although other diseases, such as hypertension, may also contribute towards the development thereof. By maintaining near normal levels of blood glucose and blood pressure, you can greatly reduce the risk of kidney disease.
Why is it so difficult to diagnose and treat kidney disease?
Firstly, kidney disease has almost no symptoms until almost all kidney function is lost. What this means is unlike a respiratory infection, for example, where within days of being infected you develop symptoms of a blocked nose, temperature, sore throat; kidney disease begins insidiously in the body without any noticeable symptoms.
When symptoms do start to develop, they are very non-specific. Common indications are fatigue, weakness, nausea, difficulty concentrating or poor appetite. All of these symptoms have multiple other causes which are often far more common and, even more often, are disregarded by healthcare professionals and patients alike as being of no consequence.
The symptoms that generally alert us to specific kidney problems only tend to occur very late in the disease process when very little preventative therapy can be offered. However, they are important to be aware of and include problems, such as a reduced urine output, shortness of breath, dry, itchy skin and puffy feet and face.
Our other indicator of disease is often blood or urine tests. Once again, in kidney disease, these are non-specific, and changes often only tend to occur very late in the disease. Those people who have diabetes or hypertension should make sure that they have regular (twice a year) blood and urine tests to look for changes in kidney function.
End-stage kidney disease is expensive
“Prevention is better than cure” is an old adage used in medicine, but it has never been more relevant than when talking about kidney disease.
Kidney dialysis is an extremely expensive and time-consuming way of treating kidney failure and yet it’s often inevitable if you don’t pay attention to kidney disease early on. It involves multiple visits to hospital every week and leaves people feeling very tired and weak. Although most medical aids will fund dialysis treatment, the amount of money spent on kidney dialysis annually is enough to provide continuous glucose monitoring to each person living with diabetes in South Africa. Imagine how much better we could control diabetes with such technology!
What can be done?
For many reasons, kidney disease has always been one of those forgotten complications of diabetes that we tend to ignore. Possibly because there wasn’t much that could be done to preserve or treat kidney function. Thankfully, much has changed!
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Lifestyle adaptations
Yes, I’m talking about those horrible things like exercise, eating correctly and stopping smoking. It is difficult and involves planning, educating yourself and commitment but it’s still the most effective way of preventing kidney disease. In fact, stopping smoking is probably the single most effective thing you can do to prevent the majority of complications associated with diabetes.
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Avoid excessive over-the-counter medication
Many OTC medicines that we all take on a regular basis can have a negative impact on the kidneys especially if they are taken in excess. Be careful of many herbal preparations and ‘health supplements. Other medications that can be implicated are pain medications, some antibiotics and medications for heartburn or reflux. Please rather get these medications scripted by your doctor who can assess if the benefit of the medication outweighs the risk and ensure you are taking the correct dose.
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Make sure you take your chronic medication regularly
Diabetes medication is unlike any other chronic disease and requires regular updates and alterations. Please don’t be lulled into taking the same medication year after year and allowing your glucose levels to become uncontrolled. Don’t just expect to have a script rewritten every six months with the same medication; regular updates and changes may be necessary.
Check your glucose levels throughout the day and contact your diabetologist regularly to reassess your condition. Blood pressure medication also needs to be taken daily and re-assessed at regular intervals. Newer medications are now available that can be protective to the kidneys and are highly effective at preserving kidney function so talk to your doctor and find out what is best for you.
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See your doctor and healthcare team regularly
When you take your car for a service, you don’t expect the mechanic to repair the dent in the bumper, do the wheel alignment and change the windscreen. These are all specific jobs that all require specialists. The same teacher doesn’t teach all matric subjects and one shop doesn’t necessarily sell all your clothing and grocery needs. Diabetes requires a team approach for the best outcomes to be achieved. Dietitians and diabetes nurse educators play an extremely vital role in complementing and augmenting the services that a doctor can give. Working together as a team also allows for more regular check-ups and preventing diabetes complications from a number of different pathways.
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It’s a good investment
As our kidneys have some of the smallest blood vessels in the body, by ensuring those small vessels are well perfused and healthy, you will also be taking care of other small vessels in the body, such as the eyes, nerves and heart. Taking care of the small vessels also ensures that the larger vessels in the heart, muscles and brain are also kept healthy.
Final say
In conclusion, treating kidney disease is costly. It can be difficult to diagnose and may only be picked up in the late stages of the disease. But, it can certainly be prevented through good lifestyle choices and preventative medication. Take control of your own health and well-being and speak to your doctor about what can be done to ensure that you prevent any further damage to the kidneys.
MEET THE EXPERT
Dr Paula Diab is a specialist family physician who enjoys the challenges that diabetes management has to offer. She runs a multi-disciplinary practice in Kloof, KZN, where she works with patients with diabetes and their families to allow them to gain control of their disease rather than being overwhelmed by the complexities and complications often associated with diabetes.
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