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Diabetic Kidney Disease, Ambulatory Care

Diabetic kidney disease

(DKD) is the gradual and permanent loss of kidney function. This occurs because of kidney damage caused by high blood sugar levels. Normally, the kidneys remove fluid, chemicals, and waste from your blood. These wastes are turned into urine by your kidneys. When you have DKD, your kidneys do not function properly. DKD may worsen over time and lead to kidney failure.


Common signs and symptoms of DKD include the following:

Your signs and symptoms will depend on how well your kidneys work. You may not have any symptoms, or you may have any of the following:

  • Changes in how often you need to urinate
  • Ankle and leg swelling
  • Fatigue or weakness
  • Itching
  • Muscle cramps
  • Nausea, vomiting, or loss of appetite

Call 911 for any of the following:

  • Seizure
  • Sudden chest pain or shortness of breath

Seek immediate care for the following symptoms:

  • Unusually fast heartbeat
  • Confusion and drowsiness

The goals of treatment for diabetic kidney disease

are to control your symptoms and prevent your DKD from getting worse. You may need any of the following:

  • Medicines may be given to decrease blood pressure and get rid of extra fluid. Blood pressure medicines can help to slow down the loss of kidney function.
  • Dialysis is a treatment that may be needed to remove chemicals and waste from your blood when your kidneys can no longer do this.
  • Surgery may be needed to create an arteriovenous fistula (AVF) in your arm or insert a catheter into your abdomen or chest. This is done so you can receive dialysis.
  • A kidney transplant may be done if your DKD becomes severe.

Manage diabetic kidney disease:

  • Control your blood sugar levels. If you use insulin or take diabetes medicine, take these as directed. Follow the meal and exercise plan recommended by your healthcare provider. Check your blood sugar levels every day, as often as your healthcare provider has recommended. Your healthcare provider may want you to have your A1c checked every 3 to 6 months. Most people should keep their A1c at or below 7%.
  • Follow your meal plan as directed. You may need to eat only a certain amount of protein at each meal. Work with your dietitian to develop a meal plan that is right for you.
  • Control your blood pressure. Decrease sodium (salt) in your diet to help control your blood pressure. Weight loss and regular physical activity can also help to decrease your blood pressure. Other things you can do to help decrease blood pressure include avoiding alcohol and quitting smoking, if you smoke.
  • Talk to your healthcare provider about over-the-counter (OTC) medicines you should avoid. Some OTC medicines, such as ibuprofen, can damage your kidneys.

Follow up with your healthcare provider as directed:

Write down your questions so you remember to ask them during your visits.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2016 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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