The RenalTracker Team
November 16, 2020

I hope you enjoy reading this blog post. It has been written and vetted by RenalTracker's team of kidney experts and researchers. The same team was awarded the KidneyX Prize organized by the American Society of Nephrology and HHS for pre-dialysis solution in Washington DC in 2019.   

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Diabetic with CKD using glucometer

Diabetes is the primary cause of chronic kidney disease (CKD). When left unaddressed, CKD could eventually lead to kidney failure.

Statistics from the National Kidney Foundation states that diabetes added 51,000 new cases of kidney failure in the United States in 2013. About 247,000 people are living with kidney failure caused by diabetes.

Kidney failure or end-stage renal disease (ESRD) happens when the kidneys barely function or are unable to filter toxic wastes at a hundred percent capacity. A person with failing kidneys urgently needs dialysis or kidney transplant to survive.

However, through an active lifestyle and kidney-appropriate diet, people living with diabetes can better manage their condition and keep it from affecting their kidneys. Read on to learn more.

How does diabetes impact the kidneys?

Increased sugar levels in the blood can cause damage to the small blood vessels in the kidneys. Injury to the blood vessels diminishes the kidneys’ capacity to filter out waste from the blood. This results in the buildup of water and salt in the body, leading to weight gain and swelling of the hands, feet, and ankles (edema).

Diabetes can also cause nerve damage which can result in urine retention or difficulty emptying the bladder. If the bladder gets too full, urine can back up and increase pressure in the kidneys. This can increase the risk of kidney damage.

Another thing to keep in mind is that the damaging impacts of diabetes on the kidneys happen gradually. Research shows that controlling blood sugar levels is one of the most crucial steps in preventing the risk of declining kidney function and other complications caused by diabetes.

What are the risk factors of diabetes-induced CKD?

Diabetic patient with CKD taking pills

There are a number of factors that can put someone with diabetes at a greater risk of developing chronic kidney disease. For one, a person who’s been living with diabetes for more than 5 years may eventually experience kidney damage.

Other contributing factors include:

  • High blood pressure

  • High blood sugar

  • Ethnicity (American Indians, African Americans, and Latinos are more likely to develop diabetes and kidney disease than Caucasians)

  • Heart disease

  • Obesity

  • Family history of kidney failure

  • Medications (antibiotics and anti-inflammatory pain relievers may cause kidney damage)

Certain habits and lifestyle choices also predispose a person with diabetes to kidney damage including: 

  • Smoking

  • Eating foods high in salt and sugar

  • Eating heavily processed foods

  • Not following a diabetes diet plan

  • Lack of physical activity

What are the symptoms of diabetic kidney disease?

Diabetic senior  with kidney disease going to the toilet

At the onset, people with diabetes don’t always show symptoms that indicate they may have kidney disease. Regular checkups as well as blood and urine tests are important in determining the status of a diabetic person’s kidney function.

People with type 2 diabetes (or non-insulin dependent diabetes) and those who are living with diabetes for more than 5 years must get tested every year to routinely evaluate how well their kidneys are working.

Diabetic kidney disease can progress to advanced-stage chronic kidney disease or worse, kidney failure. The signs and symptoms include:

  • High blood pressure

  • High protein levels (albumin) in the urine

  • Itching

  • Swollen hands, legs, and ankles

  • Nausea and vomiting

  • Anemia, paleness, and weakness

  • Frequent trips to the bathroom during bedtime

  • Increased BUN and creatinine levels in the blood

If you or someone you know experiences any of these symptoms, visit your doctor right away. Schedule the necessary tests needed to confirm whether or not the symptoms are brought by kidney disease.

Kidney function may worsen over time. But there are preventive measures you can take to keep your kidneys in top shape and avoid or delay kidney failure.

Eating more fruits, vegetables, and whole grains, exercising, and keeping tight control of one’s blood pressure and sugar levels are effective ways to preserve kidney function.

What can people with diabetes do to protect their kidneys?

Whether or not you have already developed kidney disease, here are ways to secure your kidney health and optimize your kidney function:

1. Keep your blood glucose within the normal range. Your A1C blood test, which will be scheduled and supervised by your healthcare professional, will show your average blood sugar levels in a span of 3 months. Try to keep it under 7%, or as set by your physician.

2. Manage your blood pressure. Research suggests high blood pressure is the leading cause for diabetics to develop chronic kidney disease. People with diabetes must maintain a blood pressure below 140/90. 

Learn how to manage stress by doing relaxing activities like yoga and meditation. In urgent cases, your doctor may prescribe a high blood pressure medication.

3. Take your prescribed medication. Diligently follow the treatment plans set by your health care team. Take your medicines on time as you should take them and at the right dosage. DO NOT self-medicate or change your medication plan without consulting your health care team first.

4. Maintain a healthy lifestyle. Habits like exercising, maintaining a healthy weight, stopping cigarette or tobacco smoking, and getting adequate hours of sleep help you keep your blood sugar and blood pressure at healthy levels.

In addition to these steps, making healthy food choices is paramount to the prevention and management of diabetes and kidney disease.

How does diet help prevent the progression of diabetes and CKD?

What you eat on a daily basis can define the trajectory of your health. And eating the right foods can slow down the progression of diseases. This is why diets are a vital component in diabetes and CKD treatment plans. 

There’s growing evidence that shows that a plant-based diet can help manage diabetes and kidney disease as well as their symptoms. The diet also helps stop the progression of early-stage kidney disease.

Here are the specific benefits of going plant-based:

  • Reduced inflammation - People with type 2 diabetes are resistant to insulin. Reduced sensitivity to insulin leads to inflammation. Increased inflammation can scar the glomeruli (the filters in the kidneys) which in turn results in kidney damage

    Inflammation can be prevented by eating a fiber-rich diet of fruits, vegetables, and whole grains. Increasing fiber intake helps produce more anti-inflammatory compounds.
  • Better weight management - Plant-based foods contain lesser calories compared to animal-based foods. This makes it easier for you to maintain a healthy weight.
  • Lower blood pressure and cholesterol levels - A constantly high blood pressure can result in heart disease and may further damage the kidneys. 

    By eating more fruits, vegetables, whole grains, avoiding saturated fats, and cutting back on sodium/salt intake, you can lower your blood pressure. Following a plant-based diet also prevents cholesterol buildup in the arteries.
  • Lower risk of diabetes - Research suggests that people with diabetes can prevent their condition from worsening, bring their blood sugar to a healthy level, and protect their kidneys from damage by embracing a plant-based diet.

    A diet that consists mostly of fruits, vegetables, and whole grains may even keep pre-diabetes from progressing to type 2 diabetes by reducing the risk of excess weight gain. Studies also show that eating plant protein can reduce insulin resistance.

What dietary adjustments should people with diabetes make to prevent kidney disease risks?

Renal plant-based diabetic diet

1. Eat more fruits, vegetables, plant proteins, healthy fats, and whole foods. Below are a few examples of plant-based foods people with diabetes and at risk of kidney disease can eat:

  • Fruits - Apples, berries, cherries, grapes, plums

  • Vegetables - Broccoli, cauliflower, carrots, eggplant, onions

  • Proteins - Beans, chickpeas, lentils, nuts, seeds, tofu, tempeh

  • Carbs - Bagel, white bread, pasta, unsalted crackers

  • Fluids - Water, pure cranberry juice, unsweetened tea

  • Oil - Olive oil, peanut oil, sunflower oil, corn oil

2. Eat at least 3 meals every day that have 3 to 5 carb choices. Source your carbs from, for example:

  • Fruits - Apples and berries

  • Grains - Wheat and oats

  • Dairy alternatives - Almond milk and soya milk

For your snacks, choose 1 to 2 carbohydrate choices like:

  • 1 sliced bread with 1 tablespoon of saltless peanut butter

  • Half a cup of corn bran cereal

  • 1 piece fresh fruit

  • 1 English muffin with 1 teaspoon of non-hydrogenated margarine

Note that these are just examples of foods and serving sizes. Check with your dietitian to determine which foods and serving sizes are healthy for you.

3. Spread out carbohydrate foods throughout the day at every meal and snacks to better control your blood sugar levels. 

4. Lessen your intake of foods high in salt, sugar, and refined carbohydrates (e.g. crackers, cookies, juices, and soda).

5. Work with your doctor and dietitian in creating a meal plant that’s tailored to your condition. Sticking to your meal plan will help keep your blood sugar at a healthy range, which in turn reduces the risk of damage to your kidneys.

6. Cut back on salt or sodium to lower your blood pressure and prevent the buildup of fluid in your body. Instead of using salt or salt substitutes, use natural herbs and spices to flavor up your foods.

7. Watch your protein, phosphorus, and potassium intake. They may serve as fuel in a number of bodily functions, but an overabundance of protein, phosphorus, and potassium can have harmful effects to your kidneys.

8. As  much as possible, avoid too much packaged foods and restaurant foods as they are loaded with sodium.

This list is not exhaustive, your dietitian can provide you with more options and recommendations. Kidney disease and diabetes change over time, along with your nutrient requirements and diet. 

Always consult with your dietitian for proper dietary advice on the right food choices, how to plan your meals, and how to meet your daily nutrient needs.

How to get started with plant-based dieting

When switching to a new diet, every person has unique goals and individual pace. Some people can completely eliminate animal products from their diet. Others start with baby steps; they slowly introduce plant proteins one meal per day and build a momentum from there. Both ways are okay.

How you proceed from here is entirely up to you. What’s important is you honor your pace with the help of your health care team. The following are a few tips to get started with a diabetes- and kidney-friendly plant-based diet:

1. Start small. Small yet decisive and consistent steps are better than an explosive one-off change. Begin with plant-based dishes that you love (just make sure these meals are approved by your dietitian) and rotate them throughout the week.

Consider the first few weeks as an adjustment period where you allow your tastebuds to get used to the taste of plant-based foods.

2. Gradually introduce plant-based dishes to your meals. A few weeks into the diet, you can now take it up a notch. Eat at least one plant-based meal per day. Start with breakfast. Afterwards work your way up to your lunch, snacks, and dinner.

3. Watch your protein intake. More protein in the body means more work for your kidneys. Consult your dietitian to know your exact protein limit and stick to it.

4. Reduce your intake of meat and processed food. Adjust the proportion of plant foods and animal foods on your plate. This way, you can give your mind and body the time to get accustomed to the new diet. 

Add a bowl of fresh fruit to every meal. When cooking your favorite meals, swap animal-sourced ingredients with plant-based substitutes (e.g. tofu/mushroom for meat, or quinoa/cauliflower for ground meat).

5. Track your daily food intake. Keeping a food journal or food diary helps you stay on top of your diet. It’s an effective way to track your progress as well. In every meal, jot down what you eat, how much you eat, as well as the amount of sodium, phosphorus, protein, and potassium in the food.

Switching to a plant-based kidney friendly lifestyle takes time. It can take weeks, months, or years before you get fully adjusted to it. As you get into it, there will be days where you’ll slip or lack the motivation to go on. And that’s normal. When such challenges come, stay kind and compassionate to yourself. Keep going and try again the next day.