Chronic kidney disease (CKD) is an insidious health threat with few symptoms until years of irreversible damage have been inflicted. It is also a complication of diabetes and high blood pressure (hypertension) that, likewise, cause harm long before they are detected.

The prevalence of diabetes and high blood pressure is increasing, and it is no coincidence that more people are also falling victim to CKD. Between the United States and Canada, an estimated 28 million adults have CKD. Worse yet is that most are unaware that they have the condition. By the time many people learn that they have CKD, the only treatment options are dialysis or transplant. CKD cannot be cured, but with early detection, it can often be slowed with changes in lifestyle and medication. The National Kidney Foundation recommends CKD screening for people who have diabetes, high blood pressure or a family history of kidney disease. People without these risk factors do not need to be routinely screened.

How diabetes harms kidneys

Kidneys filter waste and excess fluid from blood. The work is carried out by tiny blood vessels – glomeruli – that are located within these two fist-sized organs. High blood sugar caused by diabetes can irreparably damage glomeruli and lead to what is known as diabetic nephropathy. Forty percent of diabetics develop this condition.

To prevent or slow CKD caused by diabetes:

• Check blood and urine for CKD:
  • For type 2 diabetes, test every year.
  • For type 1 diabetes, test every year starting five years after diabetes onset.
• Keep blood pressure below 130/80 mmHg. (American Kidney Fund).
• Aim for blood glucose targets:
  • Upon waking and before meals: 70 to 130 mg/dL.
  • Two hours after starting a meal: under 180 mg/dL.
• Keep cholesterol levels in the 200 mg/dL range or lower.
• Take medicines as prescribed.
• Eat healthy and cut back on salt.
• Be physically active.

How high blood pressure harms kidneys

High blood pressure can cause the arteries that bring blood to the kidneys to stiffen. It can also lead to kidney scarring. Both affect the kidneys’ filtering abilities and can lead to kidney failure. A renal aneurysm or bulge in the wall of the artery leading to the kidney can also develop. If it ruptures, life-threatening internal bleeding can result.

To prevent or slow CKD caused by high blood pressure:

• Check blood and urine for CKD.
• Keep blood pressure below 130/80 mmHg (American Kidney Fund).
• Eat healthy with emphasis on fruits, vegetables, grains and low-fat foods.
• Limit daily sodium intake to one teaspoonful of salt or 2,300 mg; this includes salt that is already in foods as well as what you add.
• Be physically active.
• Limit alcohol to no more than one drink per day for women or two drinks per day for men (one drink is a can of beer, a glass of wine (4-5 oz) or one shot (jigger) of liquor).
• Take all medicines as prescribed – blood pressure medicines called ACE inhibitors and ARBs also protect kidneys.

Strict attention to diet, exercise and medication is essential with any chronic health condition. If you are at increased risk for CKD, vigilance can reduce the threat. If you already have CKD, vigilance will enhance your quality of life as you are more likely to delay or never need dialysis or transplant.

The LHSFNA’s Nutrition & Fitness for Laborers training manual as well as its Becoming Physically Active and Build a Better Body brochures are designed to help Laborers improve their dietary and exercise habits. Order them by clicking on Publications.

[Janet Lubman Rathner]