Health Alert: Kidney Protection

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Kidney Disease & Diabetes
By Christine Miller
eDiets Diabetes Expert

As the epidemic of diabetes continues to grow, so too does the number of people who are affected by complications of their condition. Although positive lifestyle strategies, including tight control of blood glucose, can greatly reduce the risk of complications, they may still occur.
With more and more people living longer and being diagnosed with diabetes at younger ages, chronic kidney disease has become a reality for an increasing subgroup of those affected by diabetes. Fortunately, the presence of kidney disease does not mean that a person will necessarily progress to the most advanced and serious stage in which dialysis or kidney transplantation is needed.

The first step in protecting your kidneys begins with regular medical screening tests. Screening is essential because chronic kidney disease does not result in symptoms until very late stages. There are two specific tests that should be done annually and are recommended by the American Diabetes Association: urine microalbumin and Glomerular Filtration Rate (GFR).

The urine microalbumin test reveals whether protein is leaking out of the kidneys. Healthy kidneys act as a filter and keep essential components from the blood, such as protein, in the body. If the kidneys have been harmed by high blood glucose, high blood pressure, poor circulation, or other conditions, protein will begin to escape from the filtering system of the kidneys.
Normal results for urine microalbumin are <30 (ug/mg of creatine). Elevated values of 30-299 indicate that small amount of protein are leaking into the urine. This is called “microalbuminuria.” Values over 300 signify that large amounts of protein are undesirably leaking into the urine, indicating that the kidneys are compromised even more.

The second essential screening test, GFR, is normally calculated and available on lab reports from your physician. It can also be easily determined by entering your gender, age, race, and a blood measurement of a substance known as “serum creatinine” into a GFR calculator. A normal GFR is approximately 90-125. The five stages of chronic kidney disease (CKD) based on this measure are detailed below:



Stage of CKD Description GFR
1 Documented kidney damage with normal or increased GFR = 90
2 Documented kidney damage with mildly decreased GFR 60-89
3 Moderately decreased GFR 30-59
4 Severely decreased GFR 15-29
5 Kidney failure <15 or dialysis


Diabetes Care 2007;30 (supplement 1): 54-541 If you are diagnosed with any stage of CKD, there are several essential steps to halting the damage, or at least slowing down its progression. The most critical factors for preserving kidney function are keeping blood glucose and blood pressure levels under optimal control. According to studies, the A1c (2-3 month average glucose level) should be below 7 percent and blood pressure readings should not exceed 130/80 mm/hg.

Controlling blood fats such as cholesterol and triglycerides is also essential for protecting your overall health and your kidneys in particular. Poor circulation from high levels of blood fats not only affects the brain and heart, but can also impair blood flow to the kidneys, compromising their function and leading to kidney disease.

Smoking cessation is also a high priority for all aspects of health, but has also been identified as one of the five strategies to prevent and avoid accelerating chronic kidney disease.

Finally, controlling protein intake has also been shown to be an effective strategy for preserving kidney function. Protein-containing foods including poultry, fish, meat, and milk products form a waste product known as “urea” that must be filtered by the kidneys. As a result, higher protein intakes can accelerate CKD. Vegetable proteins such as soy, nuts, and seeds appear to be less harsh on kidney function than animal-based protein, but still have some effect.
This begs the question, how much protein is too much? Luckily researchers have provided some answers. Recommended protein intakes for people with diabetes who have stage 1 or 2 CKD are .8 to 1 gram per kilogram of body weight of protein per day. This can be calculated by multiplying your current weight in pounds by .45 for the upper limit and multiplying that number by .8 for the lower limit. For example, if you have stage 2 CKD and you weight 150 lbs, this would be a minimum of 54 grams and a maximum of 68 grams of protein per day.

An important point if you are watching protein intake: The protein goals include dietary protein from all sources, even the smaller amounts found in vegetable and grain products. Additionally, further reductions of protein below recommended levels do not result in additional benefits. Avoiding protein or eating insufficient amounts may actually result in malnutrition, which can compromise your health.

For those with CKD at stage 3 or beyond, you will need a referral to see a Registered Dietitian (RD) who can personalize a specific dietary program for you since other dietary parameters besides protein will need monitoring and adjustment on an individualized basis.

Protecting your kidneys begins with early screening. If you are affected by CKD, you can take steps now to keep your kidneys stable in the future.

Would you like to learn more about this topic and chat with eDiets.com Diabetes Expert, Christine Miller? If so, please join our live chat on Thursday December 6th at 9 PM/EST.