• Most people are born with 2 kidneys
• Located near the middle of your back at about waist level (bottom of rib cage)
• Each is about the size of your own fist
• Each contain about 1 million nephrons (filtering units)
• Many people with diagnosed Chronic Kidney Disease do not have any symptoms at all and may be peeing just fine. Many are unaware they have it. Denial of the kidney disease can be common because of the lack of symptoms, but needs to be taken seriously to slow the progression.

1. Clean the blood
2. Help control Blood Pressure
3. Help make red blood cells to carry oxygen to the body tissues/organs
4. Keep bones strong
5. Balance fluids, electrolytes, pH

Stage 1 GFR Greater than 90 / Repeat Labs 6-12 months or MD Preference
Stage 2 GFR 60-89 / Repeat Labs 6-12 months or MD Preference
Stage 3a GFR 45-59 / Repeat Labs 6-12 months or MD Preference
Stage 3b GFR 30-44 / Repeat Labs 4-6 months or MD Preference
Stage 4 GFR 15-29 / Repeat Labs 3-4 months or MD Preference
Stage 5 GFR Less than 15 / Repeat Labs every week – 3 months or MD

^{*Stage 3b / 4: Learn about ongoing dialysis treatment Options or Kidney Transplant for information only.
*Stage 4: If GFR is around 20, you can ask the kidney doctor for a referral for Kidney transplant evaluation to determine if good candidate & possibly receive a donor kidney to avoid dialysis or get off after starting dialysis.
*Stage 5: Your Kidney MD (Nephrologist) will help determine the best time to start dialysis to sustain life.}

• Long-term Uncontrolled Diabetes:
  • Leading cause of kidney disease. Blood sugar can build up if it’s not controlled and damage the nephrons (tiny filters in the kidneys).
• High Blood Pressure:
  • 2nd leading cause of kidney disease.
• _{*(Diabetes and High Blood Pressure account for about 75% of all cases of CKD. Just because a person has diabetes or high BP does not automatically mean they will develop CKD, but it does put them at a higher risk.)}
• Inherited Conditions:
  • Polycystic Kidney Disease
  • Other inherited tendencies such as Sickle Cell Anemia, etc…
  • Children sometimes born with Vesicoureteral Reflux where a faulty valve allows infected urine to travel backward under high pressure)
• Autoimmune Conditions:
  • Autoimmune Glomerulonephritis attack tissues and organs such as the kidneys.
  • Lupus, Berger’s Disease, Goodpasture Syndrome, Wegener’s granulomatosis, Scleroderma, Sjogren’s Disease, Atypical Hemolytic Uremic Syndrome (aHUS)
• Recurrent Urinary Tract Infections: Pyelonephritis / Urinary Tract Infections
• Longterm Urinary Obstructions / blockages: Kidney stones; enlarged prostate (in men) trap urine
• Longterm use of Certain Medications: Prolonged use of NSAIDs (Nonsteroidal Anti-inflammatory Drugs) such as ibuprofen (Advil or Motrin), Naproxen (Aleve). Sometimes, Intravenous dyes during imaging procedures especially if kidneys already have some damage. Certain other medications in high doses especially if kidneys already have some damage such as certain antibiotics, diabetes medications, etc. Always discuss any new medications with your Kidney MD
• Repeated Acute Kidney Injury (AKI) can cause CKD:
  • * Acute Kidney Injury can occur for many reasons. Common causes include severe dehydration, serious infections such as sepsis, medications that may affect the kidneys, temporary blockages of urine flow, low or high blood pressure, heart failure, rhabdomyolysis, major trauma, burns, surgery, and certain inflammatory kidney diseases.
  • In many cases, AKI can improve when the underlying cause is identified and treated promptly, but if AKI is repeated over and over, it can turn into Chronic Kidney Disease with permanent damage.

• High BP or hypertension is the 2nd leading cause of Chronic Kidney Disease.
•  Even if the initial cause of CKD was not high BP, current kidney damage can make it harder for the kidneys to regulate BP control and lead to more kidney damage if not monitored and controlled.
• Watch our step-by-step BP demo video.  https://youtu.be/BCbWcFa597U

BEFORE YOU CHECK YOUR BLOOD PRESSURE:

• Avoid the following for at least 30 minutes before checking BP:
  • Caffeine
  • Smoking or nicotine products
  • Exercise
• Also:
  • Empty your bladder if needed.
  • Rest quietly for at least 5 minutes before taking a reading.

WHICH ARM SHOULD YOU USE?

• Avoid using an arm with:
  • Dialysis access (AV fistula or graft)
  • Lymph node removal
  • Lymphedema or swelling
  • Recent surgery or injury
  • IV or PICC line
  • Paralysis or significant weakness
• Additional tips:
  • When first monitoring your blood pressure, check both arms.
  • If one arm consistently gives a higher reading, use that arm for future measurements.
  • Report a consistent difference of more than 10–15 mmHg between arms to your healthcare provider.
  • If both arms are affected, ask your healthcare provider which arm to use.
  • If neither arm can be used, ask your healthcare provider whether leg blood pressure measurement is appropriate and how to perform it correctly.

BODY POSITION MATTERS:

• Sit in a chair with your back supported.
• Keep both feet flat on the floor.
• Do not cross your legs.
• Rest your arm on a table at heart level.
• Remain still
• Do not talk during the measurement.

USING AN UPPER ARM CUFF (PREFERRED METHOD):

• Use the correct cuff size.
  • A cuff that is too small may give a falsely high reading.
  • A cuff that is too large may give a falsely low reading.
• Place the cuff on a bare upper arm whenever possible.
• Position the cuff about 1 inch (2–3 cm) above the bend of the elbow.
• For cuffs with tubing, align the tubing with the center of the inside of your arm.
• For cuffs with an artery marker (dot), place the marker just above the middle of the inside elbow crease.
• The cuff should feel snug, but not tight.

WRIST BLOOD PRESSURE CUFFS (Upper arm BP cuffs are preferred whenever possible)

• Wrist cuffs are more likely to give inaccurate readings than upper arm cuffs due to smaller artery in wrist.
• Keep your wrist at heart level.
• Keep your wrist straight, but relaxed

RECORD YOUR RESULTS

• Write down:
  • Date and time
  • Systolic blood pressure in mmHg (top number)
  • Diastolic blood pressure in mmHg (bottom number)
  • Pulse
• Example: 140/79 P 74
• Circle or highlight BP / Pulse, if greater then BP target given by your doctor
• Additional tips:
  • Bring your BP log to healthcare appointments.
  • Bring your home BP cuff/monitor to an office visit occasionally to compare readings and confirm that your device is accurate.

UNDERSTANDING YOUR BLOOD PRESSURE READING

• American Heart Association (AHA) Blood Pressure Categories:
  • Normal: Less than 120 systolic AND less than 80 diastolic
  • Elevated: 120–129 systolic AND less than 80 diastolic
  • Hypertension Stage 1: 130–139 systolic OR 80–89 diastolic
  • Hypertension Stage 2: 140 or higher systolic OR 90 or higher diastolic
  • Hypertensive Crisis: Higher than 180 systolic AND/OR higher than 120 diastolic
• Important:
  • Blood pressure is not diagnosed based on a single reading.
  • If your blood pressure is greater than 180/120 mmHg and/or you have symptoms such as chest pain, shortness of breath, severe headache, confusion, weakness, or vision changes, seek emergency medical care immediately.
  • Many people with CKD, diabetes, or cardiovascular disease may have differing individualized blood pressure goals. 
  • Follow the target recommended by your healthcare provider.

.

Diabetes is the leading cause of chronic kidney disease (CKD). However, developing kidney disease is not inevitable. When diabetes is detected early and managed well, many people can slow or even prevent kidney damage.

Even if you already have CKD or are receiving dialysis, managing diabetes remains one of the most important ways to protect your overall health and reduce the risk of complications.

What Is Diabetes?

Diabetes is a condition in which the body has difficulty producing insulin, using insulin effectively, or both.

Insulin helps move glucose (sugar) from the bloodstream into the body’s cells where it is used for energy.

When insulin does not work properly, glucose remains in the bloodstream, causing blood sugar levels to rise.

Over time, high blood sugar can damage blood vessels throughout the body, including the tiny filtering units inside the kidneys.

Types of Diabetes: 

  Type 1 Diabetes

• The body produces little or no insulin.
• Usually develops earlier in life but can occur at any age.
• Requires insulin therapy.

  Type 2 Diabetes

• The body becomes resistant to insulin and may gradually produce less insulin.
• Most common form of diabetes.
• Often develops gradually.

  Pre-diabetes

• Blood sugar is higher than normal but not high enough for a diagnosis of diabetes.
• Lifestyle changes may help delay or prevent progression to Type 2 diabetes.

Why Diabetes Affects the Kidneys

Healthy kidneys filter waste products and excess fluid from the blood.

High blood sugar damages the small blood vessels inside the kidneys. Over time, this damage reduces the kidneys’ ability to filter properly.

  Untreated diabetes may eventually lead to:

• Chronic kidney disease
• Protein leaking into the urine
• Reduced kidney function
• Kidney failure

Good diabetes management helps reduce these risks.

How Diabetes Is Diagnosed

Healthcare providers may use several tests.

A1C Test

 Measures your average blood sugar over approximately the previous 2 to 3 months.

  General ADA ranges:

• Below 5.7% — Normal
• 5.7% to 6.4% — Prediabetes
• 6.5% or higher — Diabetes (consult with/doctor for confirmation of diagnosis)

 Other common tests include:

• Fasting Blood Sugar
• Oral Glucose Tolerance Test

Your healthcare provider will determine which test is appropriate for you.

Blood Sugar Goals

  General ADA targets include:

    Fasting Blood Sugar

      80–130 mg/dL

      Usually checked before eating or drinking in the morning.

    1–2 Hours After Meals

      Less than 180 mg/dL

These are general recommendations.

Your healthcare provider may recommend different targets based on:

• Age
• Kidney function
• Medications
• Risk of low blood sugar
• Other medical conditions

Always follow your provider’s recommendations.

Avoid Blood Sugar Roller Coasters

Large swings between high and low blood sugar place additional stress on the body.

Frequent highs and lows increase the risk of complications affecting:

• Kidneys
• Eyes
• Nerves
• Blood vessels

If your blood sugars frequently fluctuate, speak with your healthcare provider. Medication adjustments, meal planning, exercise, or changes in meal timing may help improve stability.

Monitoring Blood Sugar

  Your provider may recommend checking blood sugar:

• Occasionally
• Before meals
• After meals
• At bedtime
• Several times each day

Monitoring methods include:

  Finger Stick Testing

    Uses a glucose meter to measure blood sugar at specific times.

  Continuous Glucose Monitor (CGM)

    A wearable device that continuously measures glucose throughout the day and night.

Diabetes Medications

Many medications are available today.

Some are:

• Pills
• Daily injections
• Weekly injections

Certain medications may also:

• Improve blood sugar control
• Promote weight loss
• Help protect the kidneys
• Lower cardiovascular risk

Your medication plan should always be individualized by your healthcare provider.

Healthy Eating for Diabetes

The goal is not to eliminate carbohydrates.

The goal is to choose healthier carbohydrates and balance them with protein, healthy fats, and fiber.

Pairing carbohydrates with protein or healthy fat may reduce large increases in blood sugar after meals.

Example:

Instead of eating an apple alone, consider pairing it with:

• Plain Greek yogurt
• A boiled egg

Helpful habits include:

• Eating regular meals
• Avoiding sugary beverages
• Limiting highly processed foods
• Including fiber-rich foods
• Choosing lean proteins
• Including healthy fats

If you also have CKD, your diet may need to be adjusted based on your kidney function and laboratory results.

Examples of Healthy Food Choices (check w/your care team if appropriate for your kidney diet based on your stage of CKD, labs, etc)

Fiber-rich foods:

• Non-starchy vegetables
• Apples
• Berries
• Whole grains

Lean proteins:

• Fish
• Skinless chicken
• Turkey
• Eggs
• Tofu
• Plain Greek yogurt

Healthy fats:

• Olive oil
• Avocados
• Fatty fish

Physical Activity

With your healthcare provider’s approval:

Aim for approximately 30 minutes of physical activity most days.

Walking is an excellent choice.

Even shorter periods of activity provide health benefits.

Other Healthy Habits

Healthy diabetes management also includes:

• Adequate sleep
• Stress management
• Staying appropriately hydrated
• Taking medications as prescribed
• Keeping healthcare appointments

Small habits practiced consistently often lead to the biggest improvements.

Kidney Tests Everyone With Diabetes Should Know

  eGFR

    Estimates how well your kidneys are filtering blood.

  Urine Albumin Test

    Looks for protein (albumin) in the urine.

    Protein in the urine may be early sign of diabetic kidney damage.

    Routine testing allows early detection before symptoms develop.

Symptoms of High Blood Sugar

  High blood sugar may cause:

• Increased thirst
• Frequent urination
• Blurred vision
• Fatigue

Symptoms of Low Blood Sugar

  Low blood sugar may cause:

• Shakiness
• Sweating
• Hunger
• Dizziness
• Confusion

Follow your healthcare provider’s treatment plan if these symptoms occur and seek medical attention when appropriate.

When to Contact Your Healthcare Provider

  Contact your healthcare provider if:

• Blood sugars are consistently above or below your target range.
• You have difficulty managing diabetes.
• Illness causes blood sugars to become difficult to control.
• You have concerns about your medications or treatment plan.

Your Diabetes Care Team

  Depending on your needs, your healthcare team may include:

• Primary Care Provider
• Nephrologist (Kidney Specialist)
• Endocrinologist (Diabetes Specialist)
• Registered Renal Dietitian
• Certified Diabetes Care and Education Specialist (CDCES)

Each member of the team plays an important role in helping you manage diabetes and protect your kidneys.

Reliable Resources

For additional information, visit:

• American Diabetes Association (ADA)
• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
• Centers for Disease Control and Prevention (CDC) Diabetes Resources
• Diabetes Food Hub