Kidney Disease and Diabetes

Diabetes, medically known as diabetes mellitus, is a metabolic disorder that prevents glucose from breaking down correctly in the body. The body may not respond to insulin properly or the body may not produce enough insulin to control the blood sugar. When the condition is left untreated or an incorrect or inadequate treatment is prescribed, the continuous or recurring events of high blood sugar can do quite a bit of damage.

The most common problem in people with diabetes is that the sugar levels within the bloodstream begin to cause issues with the cardiovascular system. Oftentimes, high cholesterol goes hand-in-hand with diabetes. When the vessels become damaged, blood may not be able to pump efficiently.

Multiple Organs Affected

In addition to the heart, the vessels in other organs may also be affected. This leads to the entire organ potentially functioning improperly. For instance. the kidneys are comprised of many tiny blood vessels that work hard to filter the waste from the blood. Not only do they filter waste, but they also filter out excess fluid. When diabetes health is not taken care of properly, it can cause damage to the tiny vessels in the kidneys. This means that the waste and toxins will build up in the blood.

Besides the interruption of filtering the blood, the effect of hyperglycemia on the blood vessels and the nerves can lead to numbness and tingling in the extremities. When diabetes health is not managed properly, this nerve damage leads to pain and a burning sensation in the affected area. In the most severe cases, a patient may lose all feeling in the limb. This can lead to an injury, sore or infection arising and the patient being unaware until physical signs occur. With severe cases, amputation of the limb may be necessary.

Destructive to the Kidneys

According to the American Diabetes Association, diabetes is destructive to the process of the kidneys acting as a filter. While the kidneys remove waste and water through the tiny vessels known as nephrons, they leave protein and red blood cells in the blood, since these particles are too large to pass through the filtration system of the kidneys. When diabetes health is not controlled and high blood sugar levels get too excessive, they lead to the kidneys overworking and filtering too much blood. Eventually, beneficial protein slips through the nephrons and is released from the body with the urine.

The extent of the kidney damage from diabetes varies. In the early stages, it may go unnoticed. As it worsens, it may turn into end-stage renal disease or complete kidney failure that requires dialysis or a kidney transplant to correct.

To prevent kidney problems, patients with diabetes should control their condition with diet and exercise. Moreover, the patient should monitor his or her carbohydrate intake. In addition, he or she must take his or her diabetes medication as prescribed. The treatment options may include glyburide, insulin or metformin. The patient may also take Actos. However, while particular diabetes drug may be effective at regulating diabetes health, it may also lead to cardiovascular problems, including heart attack, stroke and congestive heart failure. Individuals with diabetes who take Actos for many years may experience bladder cancer. Due to this, thousands of lawsuits have been filed. The patient should be monitored for liver damage while he or she is taking the medication. ~DrugWatch.com~

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Saving Limbs & Lives!

Many Kidney Disease Patients Unaware

Many people diagnosed with chronic kidney disease do not know they have the disease, according to report published in the March issue of the American Journal of Kidney Diseases.


Researchers at Vanderbilt University Medical Center in Nashville, Tennessee, surveyed 401 people with kidney disease attending a nephrology clinic. More than 75 percent of participants had stage 3 chronic kidney disease or above. While 94 percent of patients surveyed were aware they had a kidney “problem,” more than 30 percent were unaware they had a serious, potentially life-threatening disease. All of the patients surveyed were under the care of a kidney specialist, or nephrologist.

“The lack of awareness of chronic kidney disease among those who are affected appears to be greater than other health conditions,” said study co-author Dr. Julie Anne Wright from Vanderbilt’s Division of Nephrology and Hypertension. “Even when patients are under the care of specialists, they frequently have a limited understanding of fundamental topics, including symptoms, the course of kidney disease and risk factors such as diabetes and hypertension. This study highlights the need for providers to ensure that communication is not only delivered but understood between all parties involved.”

Beyond diagnosis awareness, results of the 34-question survey also showed that 78 percent of participants did not know that the disease may progress with no symptoms. More than 34 percent were unaware that they were at increased risk for heart disease and 32 percent did not know that the kidneys make urine.

Read entire article at Renal Business Today

Kidney Patients Ask for More Information on Options

Many kidney failure patients want more detailed information about their treatment choices, according to a new study.

More than 30 percent of the 1,000 U.S. patients who took part in an Internet survey said they felt that the different therapies -- in-center hemodialysis, peritoneal dialysis, home hemodialysis and kidney transplantation -- were not "equally or fairly presented to them."

Nearly 70 percent of the respondents told the researchers that they were not provided with specific education and training about home hemodialysis, a relatively new option that may offer some advantages -- including ease of treatment -- over in-center dialysis.

Overall, the participants were moderately to highly satisfied with their current treatment, but satisfaction was highest among transplant patients and home dialysis patients, and lowest among in-center dialysis patients.

Doctors had the most influence over people's choice of therapies, the survey found. And, what patients said they wanted most was more information on new treatment and improved medications.

The study was published online Feb. 17 in the Clinical Journal of the American Society of Nephrology.

"Dialysis patients should be provided with enough information to choose optimal therapies," Dr. Stephen Fadem, of Baylor College of Medicine in Houston, and lead author of the report, said in a news release from the American Society of Nephrology.  "Our survey shows that dialysis patients do not always receive uniform, thorough information about all possible treatment methods and, as a result, are only moderately satisfied with their pre-treatment education."

~BusinessWeek.com~

Patients need wake-up call about link between kidney disease, diabetes

A multicultural study that will appear in the March issue of the Journal of Renal Care underscored the relationship between kidney disease and diabetes, and the need for greater awareness of this link.

In this small study, 23 South Asian diabetes patients and 25 white diabetes patients between the ages of 34 years and 79 years — with an average age of just older than 70 years — were surveyed to note any differences in the experiences, knowledge and attitudes of the two groups.

The researchers, led by Gurch Randhawa, director of the Institute for Health Research at the University of Bedfordshire, and research fellow Emma Wilkinson, found that many of the patients studied were unaware of possible kidney problems before their referral to specialist services. Overall, patients felt that they had received limited information about possible complications when they were diagnosed with diabetes, the researchers noted.

"Our research shows that low awareness and lack of information about kidney problems are common in both the South Asian and white patients we spoke to," Randhawa said. "In some cases, this was exacerbated by language barriers. The findings also demonstrate that the long-term educational needs of patients who have had diabetes for many years are just as important as the need to make newly diagnosed patients aware of all the health risks they face."
~ Drug Store News ~

Foot Problems Common Among Dialysis Patients

What is the problem and what is known about it so far?
Foot problems are common among people with diabetes. Most often, they occur because of nerve damage or poor blood circulation in the feet and legs. People with diabetes can develop serious ulcers (open sores) on their feet that are likely to get infected and are difficult to heal. As a result, people with diabetes are more likely than others to eventually need foot or leg amputations. Studies have shown that diabetic foot problems are more common among some ethnic groups than others. Studies have also found links between foot problems and other complications of diabetes, such as kidney disease. More study is needed to fully understand such links and how they may help to identify those in need of help to avoid foot problems and amputations.

Why did the researchers do this particular study?
The researchers wanted to learn more about how frequent foot problems are among people from different ethnic groups who have diabetes and advanced kidney disease.

Who was studied?
The study included 466 patients with diabetes from different ethnic backgrounds in the United States and the United Kingdom. The patients were receiving dialysis therapy for kidney failure.

Read entire article here

CMS issues final rule for dialysis facility quality incentive program

The Centers for Medicare & Medicaid Services issued a final rule for the Quality Incentive Program that will establish performance standards for dialysis facilities and provide payment adjustments to individual End-Stage Renal Disease facilities based on how well they meet these standards.

The final rule establishes the ESRD QIP performance standards, sets out the scoring methodology CMS will use to rate providers quality of dialysis care, and establishes a sliding scale for payment adjustments based on the facilities performance.  CMS will assess each dialysis facility on how well its performance meets the standard for each measure and will calculate each facilities Total Performance Score. The maximum Total Performance Score a facility can achieve is 30 (10 points per measure).  Facilities that do not meet or exceed performance standards will be subject to a payment reduction of up to 2% depending on how far their performance deviates from the standards.

CMS finalized three measures as the initial measure set during the first program year.  Two of these measures are designed to assess whether patients hemoglobin levels are maintained in an acceptable range, while the third measures the effectiveness of the dialysis treatment in removing waste products from patients blood.   
 
In future years CMS may add quality measures and establish additional performance standards that facilities will need to meet to receive full payment for the services they furnish to Medicare beneficiaries.

Read entire article here