Diabetes/CKD Patient Education

Diabetes and CKD What is the Connection?

Discussion topics
Number of people in U.S. with diabetes
Diabetes and related problems
Diabetes and Chronic Kidney Disease (CKD)
Stages of CKD
What you can do to help yourself

You are not alone
20.8 million people in U.S. have diabetes –
that is 7% of the population
Majority are Type 2
Diabetes to increase 165% between 2000 and 2050
There is a 1.8 times greater risk among African Americans

Possible complications of diabetes Stroke Blindness Peripheral Vascular Disease CKD High Blood Pressure Heart disease Diabetes

Diabetes and CKD
Diabetes is the leading cause of CKD in U.S.
Early kidney disease has no symptoms
When not diagnosed it can progress to kidney failure with little or no warning

Control your diabetes
High blood sugar levels can lead to many health problems including kidney disease
30% of people with Type 1 diabetes develop CKD
10-40% of people with Type 2 diabetes develop CKD

What is the kidney
The kidneys weigh about a pound each
Located in the retroperitoneal space
About the size of an adult fist
Shaped like a kidney bean
Attached to blood stream through renal arteries
Each renal lobe is made of tiny blood vessels

Kidney functions
Remove waste
Remove excess fluid
Secrete Erythropoetin to make red blood cells
Regulate bone metabolism
Regulate blood pressure
Maintain electrolyte and acid balance

How does diabetes cause CKD?
Damages small blood vessels in kidneys and other organs
Proteins begin to leak into the urine
Ability to filter waste decreases
Waste products begin to build up
Kidneys may fail
May need dialysis or transplant to live

Signs of kidney damage
Damage to kidneys may or may not involve kidney failure. Some signs of damage:
Blood in urine
Protein in urine (Proteinuria)
Abnormal blood or other urine tests
Abnormal imaging tests
Abnormal kidney biopsy

CKD symptoms
Decreased appetite
Nausea, vomiting
Weight gain/loss
Change in bowel habits
Decreased sensation in hands and feet (neuropathy)
Tired
Decreased concentration
Frail appearance
Decreased sexual functioning
Bronze or discolored skin

NKF definition of CKD
The National Kidney Foundation defines CKD as kidney damage for 3 or more months based on findings of abnormal structure (Imaging studies) or abnormal function (blood or urine tests)
OR
GFR < 60 mL per minute for 3 or more months with or without evidence of Kidney damage

Detecting CKD
Detect CKD with 2 simple tests:
Urine test for detecting proteinuria
Blood test for estimating glomerular filtration rate (eGFR)

Stages of Chronic Kidney Disease Stage Description GFR* mL/min/1.73m 2 1 Slight kidney damage with normal or increased filtration More than 90 2 Mild decrease in kidney function 60-89 3 Moderate decrease in kidney function 30-59 4 Severe decrease in kidney function 15-29 5 Kidney failure requiring dialysis or transplantation Less than 15 *GFR is glomerular filtration rate, a measurement of the kidney's function.

Stage 5 CKD or ESRD
Stage 5 CKD is more commonly called ESRD or End Stage Renal Disease.
Treatment required
Some form of dialysis to maintain life
Medications
Diet modification

Delayed CKD detection can lead to serious consequences
Lack of treatment for early complications
Diabetes - High blood pressure
Cardiovascular disease - Malnutrition
Late referral to nephrologist/cardiovascular specialist or dietitian
Lack of patient education for prevention or treatment options
Lack of access placement prior to the start of dialysis

CKD risk factors
Diabetes
Hypertension
Smoking
High Cholesterol
Family history of CKD
Age
Gender
Racial /ethnic background
African American
Native American
Asian American
Pacific Islander
Hispanic

CKD risk factors continued
Exposure to Nephrotoxic drugs
Contrast Dye
NSAIDS
Ibuprofen
Advil
Motrin
Naproxen

USRDS 2004

Why CKD prevention is important with diabetes & hypertension
More than 90% of Medicare patients with CKD also have diabetes, hypertension, or both
Approximately 83,000 Medicare beneficiaries with diabetes in Missouri (Fee-for-Service 4/06-3/07)
Diabetes and hypertension both cause CKD and make complications worse

When to get tested
Type 1 Diabetes: 5 years after diagnosis, then annually*
Type 2 Diabetes: at diagnosis, then annually*
Hypertension: at diagnosis and initiation of therapy, then every 3 years if eGFR and microalbumin tests are normal
Family history of kidney disease: every 3 years, as long as tests are normal
These testing intervals are recommendations; physician opinion may differ
*KDOQI Guideline 1

Help prevent or delay CKD
Control Blood Sugar - Goal of A1C < 6.5
Eat at about the same time every day
Eat a meal or snack every 3-4 hours and do not skip meals
Eat the same amount of carbohydrates in meals or snacks each day
Check blood sugar as instructed
Take your medicine and /or insulin as directed
Keep your doctor appointments; take your blood sugar record with you

Control blood pressure
Monitor your own blood pressure
Try to keep it at 125/70 or lower
Take medication as directed
Limit salt and sodium intake

Watch your weight
Achieve and maintain desirable body weight (target BMI to normal range of 18.5-24.9 kg/m2)

If you smoke
STOP

Take an active role in your health care
Monitor your own blood pressure and blood sugar
Know what your levels should be
See your doctor regularly
Ask if you are on an ACE or an ARB for your BP
Ask if you had a urine test for protein
Know your eGFR
If you have CKD, know what stage

CKD Stage 3
Limit protein and phosphorous intake
High protein levels increase the workload of the kidney

CKD Stage 4 or 5
Limit phosphorus intake in your diet
High levels of phosphorus can cause damage without any symptoms

Foods high in phosphorus
Milk and dairy products
Cola drinks and Dr. Pepper
Chocolate
Nuts and butters
Pancakes, waffles and biscuits
Dried beans
Processed meats like hot dogs, sausage, bologna
Whole grain foods

Take better care of yourself
Changes in diet, fluid intake and medications can be confusing and challenging.
These changes can help you feel better and slow kidney disease
Go to your doctor and ask questions
Take your medications as instructed
Report any changes

It takes a team

Now is the time to ask
Questions

Information Resources
National Kidney Foundation - www.kidney.org
Missouri Kidney Program - http://som.missouri.edu/mokp
Heartland Kidney Network - www.network12.org
American Assoc. of Kidney Patients - www.aakp.org
Renal Support Network - www.ikidney.com

Diabetes/CKD Patient Education

by ringer21 on Oct 20, 2010

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Diabetes/CKD Patient Education Presentation Transcript