At Avidhrt, we advocate for the prevention and early detection of cardiovascular diseases. So today, we will tackle how diabetes, renal complications, and cardiovascular disease (CVD) are related and what to look for to prevent complications.
Diabetes is a leading cause of kidney failure and the most common cause of kidney disease in the western world. Blood pressure, glucose, and lipids are vital to managing when we talk about cardiovascular disease risk and kidney preservation. If you develop kidney disease, your cardiovascular risk dramatically increases. So let's dig deeper into why this happens.
Clinical nephropathy (also called diabetic kidney disease) manifests 15-25 years after the diagnosis of diabetes (DM) and is a leading cause of premature death in young diabetic patients. With DM and poor glycemic control, the kidneys get damaged, increasing the intraglomerular filtration pressure, which also damages the capillaries in the kidney. The changes that follow this insult eventually disrupt the effective filtering mechanism in the kidney. In consequence, there is a progressive leak of large molecules (mainly proteins) into the urine. At first, the small low molecular weight proteins start to leak, which is why microalbuminuria is an early sign.
Albumin is a globular protein essential for maintaining the pressure needed for proper distribution of body fluids between blood vessels and body tissues. Without albumin, blood vessels' high pressure would force more fluids out into the tissues. Albuminuria is a pathological condition wherein the protein albumin is abnormally present in the urine.
The earliest evidence of diabetic nephropathy is "microalbuminuria" this level is undetectable by a standard dipstick. It is a predictive marker of progression to nephropathy in type 1 diabetes and increased cardiovascular risk in type 2 diabetes. This microalbuminuria will progress over the years up to persistent proteinuria. At the stage of persistent proteinuria is 5-10 years from end-stage kidney disease and may have normal plasma creatinine. Patients with nephropathy will show signs of anemia, high ESR, and hypertension.
According to the American Heart Association, Albuminuria can be a cardiovascular risk predictor. When the GFR (Glomerular Filtration Rate, a test that rates how well the kidneys are working) is low, and the albumin to creatinine ratio is high, there may be a risk of a cardiovascular event.
Diabetes is the number one cause of kidney failure, followed by hypertension, and together they account for 76% of people in dialysis today. Hypertension and kidney disease are silent killers. But very often, you don't get symptoms of advanced kidney disease until you're ready to start dialysis. Even then, you may not have them. Knowledge is power, so next time you get an exam, make sure to check your results for estimated GFR, albumin to creatinine ratio.
The urine of all diabetic patients should be checked regularly, at least annually, for the presence of protein. With proper glycemic control and early detection of proteinuria, the progression to end-stage kidney disease can be delayed. Suitable lifestyle modifications and following the management plan you discuss with your doctor can help you fight the complications of diabetes.
For all the reasons mentioned, this is why it is important to be alert to symptoms, check your exam results carefully, and ask as many questions as possible to your doctor. With Avidhrt, you can check your vitals anytime, anywhere. The Avidhrt sense is your personal and portable electrocardiogram (ECG), pulse oximeter, and infrared thermometer. This is essential for people with diabetes, renal complications, or CVD, who are at a higher risk for arrhythmias since an ECG taken at the doctor's office may not always detect the arrhythmia.
Having a device in the palm of your hand is key to monitoring and detection. Get heart health right at your fingertips with Avidhrt.
Kumar and Clark's Clinical Medicine - 9th edition
Know Diabetes By Heart Podcast: 2020 Episode 5 – Identifying and Managing Renal Complications in Patients with T2D and CVD