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Diabetic Kidney Disease: General Management

It is very important to slow down the progression of diabetic kidney disease (DN) and protect against other diabetes complications. This will reduce long-term ill-health and premature deaths .

What can you do?

Make healthy diet/ lifestyle changes

Protein restriction

  • A low protein diet of 0.6 – 0.8 g/kg/day may be helpful in slowing progression of kidney disease
  • Dietary protein restriction should be supervised by a dietician
  • Important to ensure adequate energy intake i (30 – 35 kcal/kg/day) to prevent protein-energy malnutrition

Sodium restriction

  • Increasing sodium intake is associated with worsening protein leak in urine and increased blood pressure levels
  • Hence, it is advisable to restrict total intake of sodium to < 2,400 mg/day
  • A low sodium diet also enhances the effects of certain medications known as ARBs/ ACEIs that are usually recommended for people with diabetic kidney disease

Smoking cessation

  • Cessation of smoking slows the decline of renal function and will also reduce the risk of disease of the heart and blood vessels. (Cardiovascular disease or CVD)

Achieve optimum weight

  • For patients who are obese, weight reduction has been shown in some studies to retard the decline in renal function and reduce ‘proteinuria’
  • Weight reduction can be achieved with the following measures :
    1. increased exercise ( recommended 20 minutes /day but please refer to “rehabilitation of patients with end-stage renal disease” article on how to exercise safely)
    2. Reduced intake of saturated fat, cholesterol and calories

Patients with chronic kidney disease are at increased risk of cardiovascular disease ( see section Cardiovascular disease in CKD. Hence, apart from measures slowing down kidney disease progression, the following issues should be addressed:

Correction of abnormal lipid levels

  • A blood test known as a “Full lipid profile” should be performed at least once a year to check on the level of fats in your blood
  • If this test is abnormal , you should be advised on how to make lifestyle changes in your diet, exercise, etc . Blood tests should be repeated to check that target levels are achieved.
  • The target to achieve:+ LDL cholesterol less than 2.6 mmol/l . However, the target may be set even lower for those with known coronary artery.
  • The usual drug therapy given to lower LDL-cholesterol levels is Statin therapy . Statin is recommended in patients with diabetes when LDL-cholesterol levels exceed 2.6 mmol/L. Is has been shown to prevent cardiovascular events in patients with CKD and raised lipid levels.

Antiplatelet agent

  • Aspirin should be used in patients with DN who are known to have cardiovascular disease or who are considered at high risk of developing cardiovascular disease – this risk needs to be assessed by your doctor.

References

Malaysian Clinical Practice Guideline: Diabetic Nephropathy July 2004

Malaysian Clinical Practice Guideline: Management of Chronic Kidney Disease in Adult 2011

Malaysian Clinical Practice Guidelines : Management of Dyslipidaemia 4th edition, 2011

Last Reviewed : 3 May 2016
Writer : Dr. Shahnaz Shah Firdaus Khan
Accreditor : Dr. Sunita Bavanandan

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