Your kidneys are workhorses. Every day, these fist-sized organs filter 150–200 quarts of blood and produce four to eight cups of urine. They remove wastes, maintain proper blood composition and fluid levels, and produce the active form of vitamin D as well as hormones necessary for blood pressure control and red blood cell formation.
Each of your two kidneys contains about a million nephrons, made up of looping capillaries (glomeruli) and collection tubes (tubules) that filter blood and divert wastes and excess fluids to the bladder. It is estimated that if all these capillaries were laid end to end, they would stretch out well over 100 miles!
Optimal kidney function depends on robust blood flow through the nephrons, and conditions that damage these delicate blood vessels—especially diabetic nephropathy and hypertension—are the leading causes of chronic kidney disease. Some 20 million Americans are affected by chronic kidney disease, and half of them don’t know they have it.
Control your blood sugar with weight loss, exercise, diet, and berberine. Lower blood pressure with lifestyle changes, potassium- and nitrate-rich foods, and targeted supplements. And take multivitamins. A 2016 study linked high intakes of vitamins B12, C, D, and E, folate, magnesium, and potassium with a decreased incidence of diabetic nephropathy and chronic kidney disease.
Other risk factors within your control include obesity, smoking, and overuse of ibuprofen and other analgesics, and proton pump inhibitors (Nexium, Prilosec, and Prevacid).
How Does Diabetes Affect the Kidneys?
Kidney problems are very common in people who have diabetes. In fact, one-quarter to one-third of patients with diabetes end up developing diabetic nephropathy.
As blood flows through the microscopic blood vessels in the kidneys, waste products are filtered out, so they can be excreted in the urine. Diabetes can damage the kidneys, causing this filtering system to fail.
Excess blood sugar damages the blood vessels in the nephrons—the parts of the kidneys that are responsible for filtering blood; returning blood cells, proteins, minerals and other vital constituents to circulation; and passing excess water and wastes into tubules that drain into the bladder.
At first, the useful proteins that are important to the body start getting filtered into the urine, and eventually the stress on the kidneys causes their filtering abilities to fail altogether. This causes waste products to build up in the blood, creating the need for kidney dialysis.
The situation is made even worse by the excessive urination. Many of the water-soluble antioxidants and other nutrients that naturally protect the kidneys against damage are lost in the urine.
Usually there are no symptoms until kidney function is drastically impaired. At this point, symptoms typically include fluid buildup, as well as loss of sleep, lack of appetite, and weakness.
Kidney Disease & Diabetic Nephropathy Treatment
Treatment is challenging. In addition to diabetes and blood pressure medications, diuretics, iron supplements, and drugs for boosting red blood cells may be recommended. Statins are also often prescribed due to increased risk of cardiovascular disease, but a recent eight-year study linked statin use with a higher incidence of acute and chronic kidney disease.
Exercise improves muscle mass, and water-soluble vitamins and minerals help stave off malnutrition. Although a high sodium or protein intake does not cause kidney disease, both can accelerate progression of existing disease. Talk to your doctor about the right amount of sodium and protein for you.
Let me make it clear that there's no cure advanced kidney disease. Once it advances to end-stage disease, or kidney failure, dialysis or transplant are the only options.
But there are additional therapies for slowing progression and improving kidney function.
Supplements and Baking Soda
A 2016 clinical trial involving more than 15,000 participants with mild-to-moderate disease found that adding 800 mg of folic acid per day to drug therapy significantly delayed progression. Other recent studies demonstrate benefits of supplemental vitamin D and omega-3 fatty acids.
Then there’s good old baking soda. The kidneys (and lungs) are responsible for maintaining the body’s proper pH. If the blood is too acidic, the kidneys produce bicarbonate to balance pH; if it’s too alkaline, they excrete it. Diseased kidneys are less efficient, and acid levels may rise, resulting in a condition called metabolic acidosis that worsens function and overall health.
In a groundbreaking study, patients took 600 mg tablets of sodium bicarbonate (baking soda) or placebo tablets three times a day for two years. Sodium bicarbonate significantly slowed decline in kidney function—just 9 percent of this group had rapid progression compared to 45 percent in the placebo group. They were also able to tolerate more protein and had gains in muscle mass. And despite the sodium, there was no increase in blood pressure or edema.
Other Overlooked Therapies
Kidney disease is marked by damage to the blood vessels and accompanied by heightened risk of cardiovascular disease.
Enhanced external counterpulsation (EECP) is a noninvasive therapy that increases circulation and promotes new blood vessel growth throughout the body—including the kidneys. Although most of the EECP research involves patients with angina and heart failure, it has been shown to slow kidney disease and diabetic nephropathy, even in patients who are on dialysis.
EDTA chelation, which removes heavy metals from the body, also has proven benefits. Lead is a known kidney toxin, and several small studies have shown that chelation retards progression and improves markers of chronic kidney disease.
Take Care of Your Kidneys
More than 400,000 Americans are undergoing dialysis. Over 100,000 are on waiting lists for kidney transplants, but fewer than 17,000 are performed every year. Kidney disease remains our ninth leading cause of death.
One of these years, we’ll be regenerating diseased kidneys with stem cell therapy and growing new organs in the lab or creating them with 3D printing. Until that day, I hope you’ll get serious about protecting the health and function of your kidneys, especially if you have diabetes. Make sure you're under the care of an experienced nephrologist. And if you're in the later stages of disease, discuss these additional therapies with him or her.