Diabetes and your kidneys: how to protect them

Dr. Joan J. Morales Lappot, MD
3 min read · Leer en español

In briefDiabetes is the most common cause of kidney failure in the United States. It is also one of the areas where kidney care has improved the most in recent years.

How diabetes harms the kidneys

Over years, high blood sugar damages the tiny blood vessels in the kidney filters. The first sign is usually albumin leaking into the urine. Without treatment, filtering slowly declines. High blood pressure, very common with diabetes, speeds this up.

The two tests everyone with diabetes needs

• A blood test for creatinine and eGFR, at least once a year
• A urine albumin-to-creatinine ratio (UACR), at least once a year

Both are needed: some people lose filtering without protein, and others leak protein while their eGFR still looks normal.

What protects the kidneys

• Blood sugar control with a target that is safe for you
• Blood pressure at your personal goal
• ACE inhibitors or ARBs when there is albumin in the urine
• SGLT2 inhibitors, which protect both kidneys and heart
• For some people, GLP-1 medicines or finerenone, which add further protection
• Less salt, more plants, no smoking and regular activity

Dosing matters

As kidney function changes, some diabetes medicines need lower doses and others should be stopped. Bring your full list to every visit so we can keep it safe.