Kidney Disease 

of Diabetes 

National Kidney and Urologic Diseases Information Clearinghouse 

U.S. Department 

of Health and 

Human Services 

NATIONAL 

INSTITUTES 

OF HEALTH 

The Burden of Kidney 

Failure 

Each year in the United States, more than 

100,000 people are diagnosed with kidney 

failure, a serious condition in which the kidneys fail to rid the body of wastes.1 Kidney 

failure is the final stage of chronic kidney 

disease (CKD). 

Diabetes is the most common cause of kidney failure, accounting for nearly 44 percent 

of new cases.1 Even when diabetes is controlled, the disease can lead to CKD and 

kidney failure. Most people with diabetes 

do not develop CKD that is severe enough 

to progress to kidney failure. Nearly 24 million people in the United States have diabetes,2

 and nearly 180,000 people are living 

with kidney failure as a result of diabetes.1 

People with kidney failure undergo either 

dialysis, an artificial blood-cleaning process, 

or transplantation to receive a healthy kidney from a donor. Most U.S. citizens who 

develop kidney failure are eligible for federally funded care. In 2005, care for patients 

with kidney failure cost the United States 

nearly $32 billion.1 

1

United States Renal Data System. USRDS 2007 

Annual Data Report. Bethesda, MD: National Institute 

of Diabetes and Digestive and Kidney Diseases, 

National Institutes of Health, U.S. Department of 

Health and Human Services; 2007. 

2

National Institute of Diabetes and Digestive and 

Kidney Diseases. National Diabetes Statistics, 2007. 

Bethesda, MD: National Institutes of Health, U.S. 

Department of Health and Human Services, 2008. 

African Americans, American Indians, and 

Hispanics/Latinos develop diabetes, CKD, 

and kidney failure at rates higher than 

Caucasians. Scientists have not been able 

to explain these higher rates. Nor can they 

explain fully the interplay of factors leading to kidney disease of diabetes—factors 

including heredity, diet, and 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.

Primary Causes 


of Kidney Failure (2005)
 

2.3% Cystic 

diseases 

2.0% Urologic 

diseases 

26.8% 

High 

blood 

pressure 

7.6% 

Glomerulonephritis 

17.5% 

Other 

43.8% 

Diabetes 

Source: United States Renal Data System. USRDS 

2007 Annual Data Report. 
The Course of Kidney 

Disease 

Diabetic kidney disease takes many years 

to develop. In some people, the filtering 

function of the kidneys is actually higher 

than normal in the first few years of their 

diabetes. 

Over several years, people who are developing kidney disease will have small amounts 

of the blood protein albumin begin to leak 

into their urine. This first stage of CKD 

is called microalbuminuria. The kidney’s 

filtration function usually remains normal 

during this period. 

As the disease progresses, more albumin 

leaks into the urine. This stage may be 

called macroalbuminuria or proteinuria. 

As the amount of albumin in the urine 

increases, the kidneys’ filtering function 

usually begins to drop. The body retains 

various wastes as filtration falls. As kidney 

damage develops, blood pressure often 

rises as well. 

Overall, kidney damage rarely occurs in 

the first 10 years of diabetes, and usually 

15 to 25 years will pass before kidney failure 

occurs. For people who live with diabetes 

for more than 25 years without any signs of 

kidney failure, the risk of ever developing it 

decreases. 

Diagnosis of CKD 

People with diabetes should be screened 

regularly for kidney disease. The two key 

markers for kidney disease are eGFR and 

urine albumin. 

• 	 eGFR. eGFR stands for estimated 

glomerular filtration rate. Each kidney 

contains about 1 million tiny filters 

made up of blood vessels. These filters 

are called glomeruli. Kidney function can be checked by estimating how 

much blood the glomeruli filter in a 

minute. The calculation of eGFR is 

based on the amount of creatinine, a 

waste product, found in a blood sample. As the level of creatinine goes up, 

the eGFR goes down. 

Kidney disease is present when eGFR 

is less than 60 milliliters per minute. 

The American Diabetes Association 

(ADA) and the National Institutes of 

Health (NIH) recommend that eGFR 

be calculated from serum creatinine 

at least once a year in all people with 

diabetes. 

• 	Urine albumin. Urine albumin is 

measured by comparing the amount of 

albumin to the amount of creatinine in 

a single urine sample. When the kidneys are healthy, the urine will contain 

large amounts of creatinine but almost 

no albumin. Even a small increase in 

the ratio of albumin to creatinine is a 

sign of kidney damage. 

2 	 Kidney Disease of Diabetes 
Kidney disease is present when urine 

contains more than 30 milligrams of 

albumin per gram of creatinine, with 

or without decreased eGFR. 

The ADA and the NIH recommend 

annual assessment of urine albumin 

excretion to assess kidney damage in 

all people with type 2 diabetes and 

people who have had type 1 diabetes 

for 5 years or more. 

If kidney disease is detected, it should 

be addressed as part of a comprehensive 

approach to the treatment of diabetes. 

Effects of High Blood 

Pressure 

High blood pressure, or hypertension, is a 

major factor in the development of kidney 

problems in people with diabetes. Both a 

family history of hypertension and the presence of hypertension appear to increase 

chances of developing kidney disease. 

Hypertension also accelerates the progress 

of kidney disease when it already exists. 

Blood pressure is recorded using two numbers. The first number is called the systolic 

pressure, and it represents the pressure in 

the arteries as the heart beats. The second 

number is called the diastolic pressure, 

and it represents the pressure between 

heartbeats. In the past, hypertension was 

defined as blood pressure higher than 

140/90, said as “140 over 90.” 

The ADA and the National Heart, Lung, 

and Blood Institute recommend that people 

with diabetes keep their blood pressure 

below 130/80. 

Hypertension can be seen not only as a 

cause of kidney disease but also as a result 

of damage created by the disease. As kidney disease progresses, physical changes in 

the kidneys lead to increased blood pressure. Therefore, a dangerous spiral, involving rising blood pressure and factors that 

raise blood pressure, occurs. Early detection and treatment of even mild hypertension are essential for people with diabetes. 

Preventing and Slowing 

Kidney Disease 

Blood Pressure Medicines 

Scientists have made great progress in 

developing methods that slow the onset 

and progression of kidney disease in 

people with diabetes. Drugs used to lower 

blood pressure can slow the progression 

of kidney disease significantly. Two types 

of drugs, angiotensin-converting enzyme 

(ACE) inhibitors and angiotensin receptor 

blockers (ARBs), have proven effective in 

slowing the progression of kidney disease. 

Many people require two or more drugs to 

control their blood pressure. In addition 

to an ACE inhibitor or an ARB, a diuretic 

can also be useful. Beta blockers, calcium 

channel blockers, and other blood pressure 

drugs may also be needed. 

3 Kidney Disease of Diabetes 
An example of an effective ACE inhibitor is lisinopril (Prinivil, Zestril), which 

doctors commonly prescribe for treating 

kidney disease of diabetes. The benefits of 

lisinopril extend beyond its ability to lower 

blood pressure: it may directly protect the 

kidneys’ glomeruli. ACE inhibitors have 

lowered proteinuria and slowed deterioration even in people with diabetes who did 

not have high blood pressure. 

An example of an effective ARB is losartan 

(Cozaar), which has also been shown to 

protect kidney function and lower the risk 

of cardiovascular events. 

Any medicine that helps patients achieve 

a blood pressure target of 130/80 or lower 

provides benefits. Patients with even mild 

hypertension or persistent microalbuminuria should consult a health care provider 

about the use of antihypertensive medicines. 

Moderate-protein Diets 

In people with diabetes, excessive consumption of protein may be harmful. Experts 

recommend that people with kidney disease 

of diabetes consume the recommended 

dietary allowance for protein, but avoid 

high-protein diets. For people with greatly 

reduced kidney function, a diet containing 

reduced amounts of protein may help delay 

the onset of kidney failure. Anyone following a reduced-protein diet should work with 

a dietitian to ensure adequate nutrition. 

Intensive Management of 

Blood Glucose 

Antihypertensive drugs and low-protein 

diets can slow CKD. A third treatment, 

known as intensive management of blood 

glucose or glycemic control, has shown 

great promise for people with diabetes, 

especially for those in the early stages of 

CKD. 

The human body normally converts food to 

glucose, the simple sugar that is the main 

source of energy for the body’s cells. To 

enter cells, glucose needs the help of insulin, a hormone produced by the pancreas. 

When a person does not make enough 

insulin, or the body does not respond to the 

insulin that is present, the body cannot process glucose, and it builds up in the bloodstream. High levels of glucose in the blood 

lead to a diagnosis of diabetes. 

Intensive management of blood glucose is a 

treatment regimen that aims to keep blood 

glucose levels close to normal. The regimen 

includes testing blood glucose frequently, 

administering insulin throughout the day 

on the basis of food intake and physical 

activity, following a diet and activity plan, 

and consulting a health care team regularly. 

Some people use an insulin pump to supply 

insulin throughout the day. 

A number of studies have pointed to the 

beneficial effects of intensive management 

of blood glucose. In the Diabetes Control and Complications Trial supported 

by the National Institute of Diabetes and 

Digestive and Kidney Diseases (NIDDK), 

researchers found a 50 percent decrease in 

both development and progression of early 

diabetic kidney disease in participants who 

followed an intensive regimen for controlling blood glucose levels. The intensively 

managed patients had average blood glucose levels of 150 milligrams per deciliter— 

about 80 milligrams per deciliter lower than 

4 Kidney Disease of Diabetes 
the levels observed in the conventionally 

managed patients. The United Kingdom 

Prospective Diabetes Study, conducted 

from 1976 to 1997, showed conclusively 

that, in people with improved blood glucose 

control, the risk of early kidney disease 

was reduced by a third. Additional studies 

conducted over the past decades have clearly 

established that any program resulting in 

sustained lowering of blood glucose levels 

will be beneficial to patients in the early 

stages of CKD. 

Dialysis and Transplantation 

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 people with diabetes is about 

the same as the 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 diabetes—such as damage to the heart, eyes, 

and nerves. 

Good Care Makes a 

Difference 

People with diabetes should 

• 	have their health care provider measure their A1C level at least twice a 

year. The test provides a weighted 

average of their blood glucose level 

for the previous 3 months. They 

should aim to keep it at less than 

7 percent. 

• 	work with their health care provider 

regarding insulin injections, medicines, meal planning, physical activity, and blood glucose monitoring. 

• 	have their blood pressure checked 

several times a year. If blood pressure is high, they should follow 

their health care provider’s plan for 

keeping it near normal levels. They 

should aim to keep it at less than 

130/80. 

• ask their health care provider whether 

they might benefit from taking an 

ACE inhibitor or ARB. 

• 	ask their health care provider to measure their eGFR at least once a year 

to learn how well their kidneys are 

working. 

• 	ask their health care provider to 

measure the amount of protein in 

their urine at least once a year to 

check for kidney damage. 

• ask their health care provider whether 

they should reduce the amount of 

protein in their diet and ask for a 

referral to see a registered dietitian 

to help with meal planning. 

5 Kidney Disease of Diabetes 
Points to Remember 

• 	Diabetes is the leading cause of 

chronic kidney disease (CKD) and 

kidney failure in the United States. 

• 	People with diabetes should be 

screened regularly for kidney disease. 

The two key markers for kidney disease are estimated glomerular filtration rate (eGFR) and urine albumin. 

• 	Drugs used to lower blood pressure 

can slow the progression of kidney 

disease significantly. Two types 

of drugs, angiotensin-converting 

enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), 

have proven effective in slowing the 

progression of kidney disease. 

• 	In people with diabetes, excessive 

consumption of protein may be 

harmful. 

• 	Intensive management of blood glucose has shown great promise for 

people with diabetes, especially for 

those in the early stages of CKD. 

Hope through Research 

The number of people with diabetes is 

growing. As a result, the number of people 

with kidney failure caused by diabetes 

is also growing. Some experts predict 

that diabetes soon might account for half 

the cases of kidney failure. In light of 

the increasing illness and death related 

to diabetes and kidney failure, patients, 

researchers, and health care professionals 

will continue to benefit by addressing the 

relationship between the two diseases. The 

NIDDK is a leader in supporting research 

in this area. 

Several areas of research supported by the 

NIDDK hold great potential. Discovery 

of ways to predict who will develop kidney 

disease may lead to greater prevention, as 

people with diabetes who learn they are at 

risk institute strategies such as intensive 

management of blood glucose and blood 

pressure control. 

Participants in clinical trials can play a more 

active role in their own health care, gain 

access to new research treatments before 

they are widely available, and help others by 

contributing to medical research. For information about current studies, visit 

www.ClinicalTrials.gov. 

6 Kidney Disease of Diabetes 
For More Information 

National Diabetes Information 

Clearinghouse 

1 Information Way 

Bethesda, MD 20892–3560 

Phone: 1–800–860–8747 

TTY: 1–866–569–1162 

Fax: 703–738–4929 

Email: ndic@info.niddk.nih.gov 

Internet: www.diabetes.niddk.nih.gov 

National Diabetes Education Program 

1 Diabetes Way 

Bethesda, MD 20892–3560 

Phone: 1–800–438–5383 

TTY: 1–866–569–1162 

Fax: 703–738–4929 

Email: ndep@mail.nih.gov 

Internet: www.ndep.nih.gov 

National Kidney Disease 

Education Program 

3 Kidney Information Way 

Bethesda, MD 20892 

Phone: 1–866–4–KIDNEY (454–3639) 

TTY: 1–866–569–1162 

Email: nkdep@info.niddk.nih.gov 

Internet: www.nkdep.nih.gov 

American Diabetes Association 

1701 North Beauregard Street 

Alexandria, VA 22311 

Phone: 1–800–342–2383 

Email: AskADA@diabetes.org 

Internet: www.diabetes.org 

National Kidney Foundation 

30 East 33rd Street 

New York, NY 10016 

Phone: 1–800–622–9010 or 212–889–2210 

Fax: 212–689–9261 

Internet: www.kidney.org 

7 Kidney Disease of Diabetes 
You may also find additional information about this 

topic by visiting MedlinePlus at www.medlineplus.gov.

This publication may contain information about medications. When prepared, this publication included 

the most current information available. For updates 

or for questions about any medications, contact 

the U.S. Food and Drug Administration toll-free at 

1–888–INFO–FDA (463–6332) or visit www.fda.gov. 

Consult your doctor for more information.

The U.S. Government does not endorse or favor any 

specific commercial product or company. Trade, 

proprietary, or company names appearing in this 

document are used only because they are considered 

necessary in the context of the information provided. 

If a product is not mentioned, the omission does not 

mean or imply that the product is unsatisfactory.

National Kidney and 

Urologic Diseases 

Information Clearinghouse

3 Information Way 

Bethesda, MD 20892–3580 

Phone: 1–800–891–5390 

TTY: 1–866–569–1162

Fax: 703–738–4929 

Email: nkudic@info.niddk.nih.gov 

Internet: www.kidney.niddk.nih.gov

The National Kidney and Urologic Diseases 

Information Clearinghouse (NKUDIC) is a 

service of the National Institute of Diabetes 

and Digestive and Kidney Diseases (NIDDK). 

The NIDDK is part of the National Institutes 

of Health of the U.S. Department of Health 

and Human Services. Established in 1987, the 

Clearinghouse provides information about 

diseases of the kidneys and urologic system to 

people with kidney and urologic disorders and 

to their families, health care professionals, and 

the public. The NKUDIC answers inquiries, 

develops and distributes publications, and works 

closely with professional and patient organizations and Government agencies to coordinate 

resources about kidney and urologic diseases.

Publications produced by the Clearinghouse are 

carefully reviewed by both NIDDK scientists 

and outside experts. 

This publication is not copyrighted. The Clearinghouse encourages users of this fact sheet to duplicate 

and distribute as many copies as desired.

This fact sheet is also available at 

www.kidney.niddk.nih.gov.

U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES

National Institutes of Health

NIH Publication No. 08–3925

September 2008