Dr. Ahmad Shahzad
Founder | Lyallpur Diabetes Foundation
Consultant Diabetologist | Educator | Advocate for Preventive Care
Worldwide, diabetes is among the top causes of renal failure; when kidney function deteriorates significantly, dialysis offers a crucial treatment choice. Dialysis and diabetes’s relationship emphasizes how long-term elevated blood sugar damages the kidneys, resulting in chronic kidney disease. For diabetic patients to maintain general health and enhance quality of life, it is imperative to know the process of dialysis, its many forms, and how to successfully treat both diseases.
What Is Diabetes and How Does It Affect the Kidneys?
Diabetes is a disorder characterized by the body having too much blood sugar (glucose) brought on by either insufficient or ineffective insulin. By impairing the fragile filtering system of the kidneys, diabetic nephropathy—a disease—it can damage them. Over time, this damage can lead to chronic kidney disease (CKD) and eventually, kidney failure.
How diabetes affects the kidneys
- Kidneys have millions of little filters known as nephrons that purify the blood. High blood sugar can harm these nephrons as well as their blood vessels.
- Weak filtration: Damaged blood vessels and nephrons cannot correctly filter excess fluid and waste from the blood.
- One of the consequences of the injury is damage to the filters, which causes them to begin leaking and lets beneficial protein escape into the urine. Early indicators of kidney damage.
- Accumulation of waste: As kidney function degrades, poisonous substances and waste products collect in the blood.
- Diabetes sometimes causes high blood pressure, which adds extra strain on and damage to the kidneys.
- If uncontrolled, this escalating damage can cause end-stage renal disease (ESRD), wherein the kidneys shut down completely. Dialysis or a kidney transplant are both possibilities here.
When Does a Diabetic Patient Need Dialysis?
Usually, in stage 5 of chronic kidney disease (CKD), when their kidneys have progressed to end-stage renal disease (ESRD), a diabetic patient needs dialysis. When the kidneys are operating at only 10–15% of their usual ability. At this point, the kidneys can no longer efficiently filter waste from the blood; dialysis or a kidney transplant is therefore required to support life. Usually, following a period in which kidney damage from high blood sugar has grown severe, resulting in symptoms like high blood pressure, swelling, and foamy urine, this phase is frequently preceded by one.
Types of Dialysis for Diabetic Patients
The two main forms of dialysis for diabetic patients are peritoneal dialysis, which filters blood outside the body using an artificial kidney, and hemodialysis (HD). (PD), which filter the blood using the abdominal lining. Although both treatments are effective renal replacement for end-stage kidney disease, their usefulness can vary on personal patient requirements and medical factors.
Hemodialysis (HD)
- Blood is extracted from the body, filtered by an artificial kidney (dialyzer) to get rid of waste and excess fluid, and then sent back to the body.
- Access: Calls for a surgical operation to establish permanent access, like an arteriovenous fistula or graft. Initially, one can utilize temporary catheters.
- Involves frequent in-center treatments that could result in blood-borne illness exposure and cardiovascular strain.
Peritoneal dialysis (PD)
- An acting filter, dialysis solution is introduced into the peritoneal cavity, which is the lining of the abdomen. Then the solution with waste products is drained out.
- Access entails surgically inserting a permanent abdominal catheter.
- Includes automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD), both of which employ a machine at night.
- Considerations: Provides more flexibility for at-home treatment, could protect residual renal function, and could help to better manage blood pressure. It presents hazards, including hyperinsulinemia, central obesity, and dyslipidemia.
You may also like to read: Role of Diet in Diabetes Management
Managing Diabetes While on Dialysis
Dialysis diabetes management calls for a thorough strategy including frequent blood sugar monitoring, a deliberately designed kidney-friendly diet, and consistent drug administration. Managing blood sugar variations and safe fluid intake requires close collaboration with a healthcare team, including a dietitian, to modify drugs and diet. Light exercise can also be beneficial; therefore, you should inform your dialysis staff of any changes in blood sugar results.
Dietary management
- Working with a dietitian is necessary to design a meal plan that harmonizes your kidney health and diabetes.
- Aim for three balanced meals a day, with nutritious snacks if necessary to stop blood sugar from falling too low or rising too high.
- Select low-potassium foods: Concentrate on low-potassium fruits and vegetables like cabbage and apples.
- Limit specific foods: Stay away from sugary beverages, fried meals, and meals heavy in salt or processed carbohydrates.
- Choose sugar-free substitutes in meals and baking.
Medication and monitoring
- Regularly check your blood sugar and talk with your care team about healthy ranges.
- Adhere to a regular timetable; even on days for dialysis, take your meds as directed. Particularly for insulin, your care team could modify the timing or amount to accommodate dialysis sessions.
- Pay particular attention to modifications in insulin doses: On the day of dialysis, physicians could have to lower insulin doses, especially basal insulin.
- Medications should be discussed with your physician since their effect on kidney function can call for changes or substitutions of some oral diabetes drugs. One might think about oral medications with a reduced hypoglycemia risk.
- Report unexpected readings: Whether they are too high or too low, let your dialysis staff know of any strange blood sugar levels.
Lifestyle and other health factors
- Keep active: Walk or stretch as authorized by your medical staff to help regulate blood sugar and enhance circulation by means of light, safe activities.
- Manage fluid intake: Since this is crucial on dialysis, adhere to the advice of your care team.
- Be mindful of hypoglycemia, or low blood sugar, particularly if your appetite is poor or you have nausea. For those undergoing dialysis, this presents a greater risk.
- Monitor other factors: Regular examinations for heart and blood vessel disease are crucial, given that it is a frequent consequence for patients with both kidney and diabetes.
Bottom Line
Early diagnosis, good blood sugar management, and consistent medical attention emphasize the link between diabetes and dialysis. Effective diabetes control is still essential in preventing extra issues, even if dialysis helps to replace some kidney capabilities. Following a balanced diet, keeping track of glucose levels, and closely consulting with medical professionals help patients enhance their well-being and live a more healthful life. A more steady life despite the difficulties of both situations.