When people with diabetes experience kidney failure, they must undergo either dialysis or a kidney transplant. As recently as the 1970s, medical experts commonly excluded people with diabetes from dialysis and transplantation, in part because the experts felt damage caused by diabetes would offset benefits of the treatments. Today, because of better control of diabetes and improved rates of survival following treatment, doctors do not hesitate to offer dialysis and kidney transplantation to people with diabetes.

Currently, the survival of kidneys transplanted into patients with diabetes is about the same as survival of transplants in people without diabetes. Dialysis for people with diabetes also works well in the short run. Even so, people with diabetes who receive transplants or dialysis experience higher morbidity and mortality because of coexisting complications of the diabetes, such as damage to the:

* Heart
* Eyes
* Nerves.

Helpful Tips Regarding Diabetes and Kidney Disease
If you have diabetes. consider the following suggestions:

* Have your doctor measure your hemoglobin A1c level at least twice a year. The test provides a weighted average of your blood glucose level for the previous three months. Aim to keep it at less than 7 percent.

* Work with your doctor regarding insulin injections, medicines, meal planning, physical activity, and blood glucose monitoring.

* Have your blood pressure checked several times a year. If blood pressure is high, follow your doctor’s plan for keeping it near normal levels. Aim to keep it at less than 130/80.

* Ask your doctor whether you might benefit from taking an ACE inhibitor or ARB.

* Have your urine checked annually for microalbumin and protein. If there is protein in your urine, have your blood checked for elevated amounts of waste products, such as creatinine. The doctor should provide you with an estimate of your kidney’s filtration based on the blood creatinine level.

* Ask your doctor whether you should reduce the amount of protein in your diet. Ask for a referral to see a registered dietitian to help you with meal planning.

Statistics Regarding Diabetes and Kidney Disease

Diabetes and Kidney Disease: An Overview Preventing and Slowing Kidney Disease Dialysis and Transplantation

Diabetes is the most common cause of kidney failure, accounting for more than 40 percent of new cases. Even when drugs and diet are able to control diabetes, the disease can lead to nephropathy and kidney failure. Most people with diabetes do not develop nephropathy that is severe enough to cause kidney failure. About 17 million people in the United States have diabetes, and over 100,000 people are living with kidney failure as a result of diabetes.

People with kidney failure undergo either:

* Dialysis, which substitutes for some of the filtering functions of the kidneys
* Transplantation to receive a healthy donor kidney.

Most Americans who develop kidney failure are eligible for federally funded care. In 2000, care for patients with kidney failure cost the nation nearly $20 billion.

African Americans, American Indians, and Hispanic Americans develop diabetes, nephropathy, and kidney failure at rates higher than average. Scientists have not been able to explain these higher rates. Nor can they explain fully the interplay of factors leading to diabetic nephropathy — factors including:

* Heredity
* Diet
* Other medical conditions (such as high blood pressure).

They have found that high blood pressure and high levels of blood glucose increase the risk that a person with diabetes will progress to kidney failure.

While both types of diabetes can lead to kidney disease. type 1 diabetes is more likely to lead to kidney failure. Twenty percent to 40 percent of people with type 1 diabetes develop kidney failure by the age of 50. Some develop kidney failure before the age of 30. Between 1993 and 1997, more than 100,000 people in the United States were treated for kidney failure caused by type 2 diabetes.