Unraveling the connection between type 2 diabetes and chronic kidney disease
Sponsored and provided by Bayer
When you are newly diagnosed with type 2 diabetes (T2D), many concerns, questions and emotions can rise to the surface. With an incredible amount of new information to learn, you might be asking yourself, "How will I manage it all?" From monitoring your glucose levels and blood pressure, administering your medications and making changes to your diet and exercise to maintain a healthy weight – it may feel like there are endless new lifestyle changes to adopt.
However, lifestyle changes alone may not eliminate the other health concerns associated with the condition. T2D can put a strain on many organs in the body, including your heart and kidneys. This can impact your overall health, how you feel day to day, and in some cases, can increase your risk of more serious conditions like chronic kidney disease (CKD), a progressive, irreversible condition that slowly worsens kidney function over time.[1]
Luckily for those living with T2D, there are steps you can take to understand the risk of CKD and manage your condition. Eddie Manuel Rodriguez-Castro, M.D., a nephrologist with a private practice based in Bayamon, Puerto Rico, shares some of the common but severe, and in some cases, life-threatening complications of CKD in T2D, and what you can do to proactively help protect your kidneys.
CKD associated with T2D does unseen damage – understanding your risk is an important first step
"CKD is one of the most frequent complications associated with T2D that people must prepare for but often lack awareness of," shares Dr. Rodriguez. "Patients are often overcome with shock, fear and anger when first diagnosed, previously unaware of their risk and the seriousness of the condition. This need for education can also be seen in numbers nationwide – while approximately one in three adults with diabetes will go on to develop CKD[2], it is reported that 90% of people with CKD are unaware of their condition."[3]
One of the reasons for this lack of awareness is that CKD often doesn't cause noticeable symptoms until its later stages. Over time, damage to your kidneys can result in a gradual loss of kidney function, and ultimately may result in kidney failure and the need for dialysis or a kidney transplant.[4]
"Allowing the silent symptoms of CKD in T2D to go unchecked can often lead to severe kidney damage and other cardiovascular risks, such as a heart attack," Dr. Rodriguez explains. "In fact, those with CKD in T2D are three times more likely to die from a cardiovascular event than people who have T2D alone, making early diagnosis and intervention vital."[5]
Early detection is crucial to delay further disease progression, and it only takes two tests
It is critical to ask your doctor if they are regularly testing you for CKD and work with them to understand your results. CKD in T2D can be diagnosed and monitored using two common tests you can request from your doctor: a urine test called urine albumin-creatinine ratio (uACR) that detects the presence of protein in the urine – one of the earliest indicators of CKD; and a blood test called an estimated glomerular filtration rate (eGFR) that measures how well your kidneys are functioning.[6] According to the American Diabetes Association's 2024 guidelines, these screenings are recommended annually for those with T2D to support early detection and intervention of CKD.
"Regular screening with both a urine test and blood test is recommended by clinical guidelines, yet a study suggests that only half of patients are screened with both," shared Dr. Rodriguez. "Patients need to advocate for themselves, be proactive and ask their doctors for both tests, which may help identify CKD associated with T2D earlier."
With the right team and treatment in place, you can support your kidney health
Because the damage caused by CKD is irreversible, it's important to plan with your doctor as soon as you know you have CKD. This can include lifestyle changes, such as exercising for 30 minutes a day to help you reduce stress, manage weight and reach your blood pressure and blood sugar goals[7], in addition to developing meal plans full of kidney healthy foods, which typically have lower amounts of sodium, protein, potassium, or phosphorus.[8]
In addition to building these healthy habits, there are pharmaceutical therapies available, such as the prescription treatment option Kerendia® (finerenone), a once-daily tablet. Kerendia treats CKD in adults with T2D to reduce the risk of worsening of kidney disease, kidney failure, death due to cardiovascular disease, heart attack and hospitalization for heart failure.
In adults with CKD in T2D, Kerendia fights CKD differently than diabetes medications. Kerendia doesn't replace your diabetes and high blood pressure medications, so even if you are already taking medications for your diabetes and high blood pressure, there may be more you can do to help protect your kidneys and delay the damage that can lead to dialysis and kidney transplant. Do not take Kerendia if you have problems with your adrenal glands, or take certain medications called CYP3A4 inhibitors. Ask your healthcare provider if you are not sure if you are taking any of these medications. The Important Safety Information for Kerendia is continued at the end of the article.
Living with CKD and T2D can impact various elements of your health, making it important to build the right team of experts around you. "A multidisciplinary team will look different for each person," Dr. Rodriguez explains. "You'll want the expertise and care of those who know T2D best as well as doctors who are experts in the other health issues commonly associated with T2D." This may include your primary care physician, an endocrinologist for diabetes management, a nephrologist who specializes in the care of kidneys, or a cardiologist to support your heart health – each can help manage conditions like CKD that your T2D has caused over time.
"Treating CKD in T2D is not a one-size-fits-all approach. But with appropriate steps, we can raise awareness of T2D patients at risk for CKD, while reducing the risk of kidney failure, and cardiovascular complications like heart attack," says Dr. Rodriguez. "If you have T2D, make sure to speak with your doctor about getting tested for CKD annually; and if diagnosed with CKD in T2D, discuss with your doctor whether Kerendia is the right treatment option for you."
Indication and Important Safety Information
Kerendia (finerenone) is a prescription medicine used to treat chronic kidney disease in adults with type 2 diabetes to reduce the risk of worsening of kidney disease, kidney failure, death due to cardiovascular disease, heart attack, and hospitalization for heart failure.
Do not take KERENDIA if you:
- Have problems with your adrenal glands
- Take certain medications called CYP3A4 inhibitors. Ask your healthcare provider if you are not sure if you are taking any of these medications
Before you take KERENDIA, tell your healthcare provider about all your medical conditions, including if you:
- Have high potassium levels in your blood (hyperkalemia) or take medications that may increase potassium levels in your blood. KERENDIA can cause hyperkalemia. Your healthcare provider will check your potassium levels before and during treatment with KERENDIA
- Have severe liver problems
- Are pregnant or plan to become pregnant, or are breastfeeding or plan to breastfeed. Avoid breastfeeding during treatment with KERENDIA and 1 day after treatment
Tell your healthcare provider about all the prescription and over-the-counter medicines you take, including: salt substitutes, vitamins, and herbal or potassium supplements.
- KERENDIA may affect the way other medications work, and other medications may affect how KERENDIA works. Do not start or stop any medicine before you talk with your healthcare provider. Avoid grapefruit or grapefruit juice as it may increase KERENDIA levels in the blood
The most common side effects of KERENDIA include:
- Hyperkalemia (potassium level in your blood that is higher than normal)
- Hypotension (blood pressure that is lower than normal)
- Hyponatremia (sodium level in your blood that is lower than normal)
Please see the Prescribing Information for KERENDIA.
You are encouraged to report side effects or quality complaints of products to the FDA by visiting www.fda.gov/medwatch or calling 1-800-FDA-1088.
Visit Kerendia.com to learn more.
Dr. Eddie Manuel Rodriguez-Castro provides paid consultation services to Bayer and was paid by Bayer to provide this information.
PP-KER-US-2230-1 5/24
References
1. National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Slow progression & reduce complications. Retrieved from https://www.niddk.nih.gov/health-information/professionals/clinical-tools-patient-management/kidney-disease/identify-manage-patients/manage-ckd/slow-progression-reduce-complications
3. https://nccd.cdc.gov/CKD/Documents/Chronic-Kidney-Disease-in-the-US-2021-h.pdf
5. https://www.kidney-international.org/article/S0085-2538(20)31210-2/fulltext
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3559486/?report=printable
7. https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/managing
8. https://www.kidney-international.org/article/S0085-2538(23)00766-4/fulltext