Diabetic kidney disease treatment: An expert answers FAQs

Diabetes can lead to a range of complications, including diabetic kidney disease, which is also known as diabetic neuropathy. Diabetic kidney disease can lead to kidney failure, so it is important to treat it effectively.

Doctors may treat the condition using medications, lifestyle adjustments, or a combination of these. Proper treatment and management can prevent the condition from worsening.

Keep reading to learn more about how doctors treat diabetic kidney disease and why treatment is so important.

The main aim of treatment for diabetic kidney disease is to prevent the progression or worsening of the disease. Controlling blood pressure can help prevent this progression, minimizing further damage to the kidneys.

According to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, having a systolic blood pressure of less than 120 millimeters of mercury can help prevent the progression of kidney disease. KDIGO guidelines also recommend keeping hemoglobin A1c levels — which show average blood sugar levels over a recent period — below a figure in the range of 6.5% to 8.0%. An individual’s risk factors will determine the specific target.

Other recommendations include limiting salt intake to less than 2 grams of sodium per day and doing moderate intensity exercise for a total of at least 150 minutes per week.

The Food and Drug Administration (FDA) has approved two medications that can help decrease the progression or worsening of chronic kidney disease.

Research has shown that dapagliflozin (Farxiga) may reduce the progression of chronic kidney disease in people living with or without diabetes. Finerenone (Kerendia) may also reduce the progression of chronic kidney disease in those living with diabetes, but the long-term side effects of this medication are currently unknown.

Three classes of medications have shown good outcomes in reducing kidney disease:

  • angiotensin converting enzyme (ACE) inhibitors, such as lisinopril (Qbrelis, Prinivil, Zestril)
  • angiotensin receptor blockers (ARBs), such as losartan (Cozaar)
  • sodium-glucose co-transporter-2 (SGLT2) inhibitors, including Farxiga and empagliflozin (Jardiance)

ACE inhibitors and ARBs may reduce the progression of chronic kidney disease in people living with high blood pressure. These blood pressure medications help by reducing blood pressure and decreasing protein in the urine. SGLT2 inhibitors, which doctors use to treat diabetes, have shown improved long -term outcomes regarding kidney function.

It is not possible to reverse chronic kidney disease, but the careful control of medical conditions that cause chronic kidney disease, such as diabetes and high blood pressure, can prevent kidney function from worsening.

This control may involve eating a nutritious diet, engaging in plenty of exercise, and taking medications to help control diabetes and high blood pressure. The Kidney Failure Risk Equation is a resource that may help people learn about kidney disease progression.

Diabetic kidney disease can be very serious and even life threatening. Without treatment, it can cause a buildup of waste products and toxins in the body. This accumulation can lead to swelling in the legs and other symptoms, including fatigue, weakness, nausea, and shortness of breath.

Worsening kidney disease can lead to kidney failure and the need for hemodialysis if it goes untreated. However, controlling medical conditions that can lead to kidney disease, including diabetes and high blood pressure, can prevent kidney disease from progressing.


Dr. Avi Varma is an ABMS board certified family medicine physician and public health advocate.

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