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Healthy Kidney

Keep Your Kidneys Healthy: Bring Down Your Blood Pressure

The AACE and ADA set blood pressure guidelines for nonpregnant patients 18 years of age and older at <130 mmHg systolic and <80 mmHg diastolic (<85 mmHg diastolic, per AACE). Treatment strategies for diabetes-related hypertension include weight loss, smoking cessation, and dietary modifications (i.e., a low-sodium, low-cholesterol diet). If these lifestyle modifications fail to control blood pressure, medications such as statins, angiotension converting enzyme (ACE) inhibitors, angiotension II recptor blockers (ARBs), and calcium channel blockers may be prescribed.

Control Blood Sugar Levels

Keeping blood glucose levels as close to normal as possible is one of the best weapons against diabetic kidney disease. The landmark Diabetes Control and Complications Trial found that patients with type 1 diabetes who maintained an average A1C of 7.2% reduced the risk of the development of nephropathy and other complications up to 75% — an effect that continued for at least eight years after the initial ten-year study concluded.(1)

Some medical conditions, such as hypoglycemic unawareness, may make tight control of blood sugars unadvisable. Patients should always consult their healthcare provider and/or diabetes care team before attempting a tight control treatment regimen.

Keep an Eye on Dietary Protein

Overloading on dietary protein can speed the progression of kidney problems in people with existing kidney disease, so some physicians may recommend restricting levels as a precautionary measure. A registered dietitian experienced in diabetes and renal care can develop a meal plan, that is low in dietary protein and compatible with blood sugar control goals.

It's not advisable to cut protein completely out of the picture. Insufficient dietary protein can cause nutritional deficiencies, and studies are still inconclusive on the benefits of protein reduction in lowering the risk of kidney disease in humans. The ADA currently recommends that most adults with diabetes who have no overt signs of kidney damage include the recommended daily allowance (RDA) of approximately 10% of total calories from protein in their diets. Consult with your diabetes care team before attempting a low-protein diet.

Stay Away from Nephrotoxic Substances

Nephrotoxic substances are those that have the potential to damage the kidneys. Advise your healthcare team of all prescription drugs, over-the-counter medications, and herbal remedies you are taking so they can monitor for the possibility of renal problems. Some potential hazards:

• Analgesics. Potentially harmful in high doses or when taken over an extended period of time.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). Can be toxic to patients who have reduced kidney function.
• Aminoglycoside antibiotics. Nephrotoxic to patients with kidney impairment.
• Contrast media. The injectable dye used in computerized tomography (CT scans) and some other radiographic tests. Other environmental agents, such as lead, pesticides, and solvents, can also cause kidney damage.

SOURCES:

1-American Association of Clinical Endocrinologists. AACE Medical Guidelines for Clinical Practice for Diagnosis and Treatment of Hypertension. https://www.aace.com/sites/default/files/HypertensionGuidelines.pdf. (PDF) (Accessed 8/12/11.)
2-American Diabetes Association. High Blood Pressure. http://www.diabetes.org/living-with-diabetes/complications/high-blood-pressure-hypertension.html. (Accessed 8/12/11.)
3-National Diabetes Information Clearinghouse. Prevent diabetes problems: Keep your kidneys healthy. http://diabetes.niddk.nih.gov/dm/pubs/complications_kidneys/. (Accessed 8/12/11.)