Diabetes and Chronic Kidney Disease Basics: Part One

Abstract

An estimated 14.8% of adults have chronic kidney disease (CKD).1United States Renal Data SystemUSRDS Annual Data Report. Introduction to Volume 1: CKD in the United States.Am J Kidney Dis. 2017; 69: S1-S32PubMed Google Scholar Diabetic kidney disease (DKD) is classified according to the presence of microalbuminuria or macroalbuminuria.2National Kidney FoundationKDOQI clinical practice guideline for diabetes and CKD: 2012 update.Am J Kidney Dis. 2012; 60: 850-886Abstract Full Text Full Text PDF PubMed Scopus (951) Google Scholar Of the 30 million United States (US) individuals with diabetes, those who met any criteria for DKD is estimated at 26.2%. Using 2010 census data, this translates to a prevalence of approximately 8.2 million people with any DKD, including 4.6 million people with albuminuria, 1.9 million people with macroalbuminuria, 4.5 million people with reduced estimated glomerular filtration rate (eGFR), and 0.9 million people with severely reduced eGFR.3Afkarian M. Zelnick L.R. Hall Y.N. et al.Clinical manifestations of kidney disease among US adults with diabetes, 1988-2014.JAMA. 2016; 316: 602-610Crossref PubMed Scopus (513) Google Scholar DKD typically develops after a diabetes duration of 10 years in type 1 diabetes but may be present at diagnosis in type 2 diabetes. DKD can progress to end-stage renal disease requiring dialysis or kidney transplantation and is the leading cause of renal failure in the US. In addition, among patients with type 1 or type 2 diabetes, the presence of CKD markedly increases cardiovascular risk.4American Diabetes Association10. Microvascular complications and foot care: standards of medical care in diabetes – 2018.Diabetes Care. 2018; 41: S105-S118Crossref PubMed Scopus (235) Google Scholar The primary nutrition recommendations for diabetes include an individualized meal pattern, but to maintain stable blood glucose levels, it is important to focus on the amount of carbohydrate at meals. Carbohydrate intake from vegetables, fruits, legumes, whole grains, and dairy products, with an emphasis on foods higher in fiber, is preferred over other sources, especially those containing added sugars. For individuals with type 1 diabetes and those with type 2 diabetes who are prescribed a flexible insulin therapy program, education on carbohydrate counting and, in some cases, fat and protein gram estimation to determine mealtime insulin dosing is recommended to improve glycemic control. For diabetics whose daily insulin dosing is fixed, a consistent pattern of carbohydrate intake with respect to time and portions may be recommended to improve glycemic control and reduce the risk of hypoglycemia.4American Diabetes Association10. Microvascular complications and foot care: standards of medical care in diabetes – 2018.Diabetes Care. 2018; 41: S105-S118Crossref PubMed Scopus (235) Google Scholar Appropriate nutrition interventions may have an effect on clinical outcomes in the DKD population.5Tuttle K.R. Bakris G.L. Bilous R.W. et al.Diabetes kidney disease: a report from an ADA consensus conference.Diabetes Care. 2014; 37: 2864-2883Crossref PubMed Scopus (639) Google Scholar The optimal meal plan for DKD varies depending on eGFR or stage of kidney disease and the presence of additional comorbidities such as hypertension or heart failure. Although meal planning for diabetes requires changes to an individual's daily life, the addition of adjustments for CKD adds an extra level of complexity and confusion. Teaching the person with DKD requires extensive ongoing education regarding the effect of carbohydrate on blood glucose levels along with dietary adjustments of protein, potassium, phosphorus, and sodium. It is beyond the scope of this article to compile an extensive handout for DKD, but rather to focus on carbohydrate-containing foods with key nutrients that should be limited with DKD. This is the first of a 2-part series covering basic information for individuals with DKD. This first handout is not meant to replace the registered dietitian nutritionist who specializes in renal nutrition but rather provides a starting point to be used by the nonspecialist with the individual with DKD to focus on phosphorus, potassium, and carbohydrate sources. Given that protein and sodium content is readily available on nutrition facts labels, this handout will cover items that are not as easily identified by individuals and health care professionals. The second part of this series provides an overview of DKD nutrition recommendations, along with a 7-day sample menu to be used with individuals. View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)