How does diabetes affect my kidneys?

One side effect of diabetes is that it injures small blood vessels throughout the body, including those found in the kidneys¹.

When blood vessels in the kidneys are injured, your kidneys may not be able to clean your blood as effectively as before, thus causing water and waste to build up in your bloodstream. This build-up of waste products is called uremia² and can harm your body. 

To get rid of the toxic build-up, you will need to go for regular dialysis sessions so that the waste products in the bloodstream and excess water can be filtered out.

What is dialysis?

Dialysis is an artificial filtering procedure that acts like the normal kidney to remove and reduce the amount of water in your body and the waste products built up in the blood.

There are two types of dialysis treatment – hemodialysis and peritoneal dialysis.

Hemodialysis (HD) removes toxins and excess fluid from the body by continually circulating the blood through a filter called dialyzer³. This filter is used with a dialysis machine three to four times a week. In peritoneal dialysis (PD), the abdominal cavity (which houses most of your vital organs) is filled with a cleansing solution called dialysate4, the dialysis fluid.

The abdominal cavity walls are lined with a membrane called the peritoneum, which allows waste products and extra fluid to pass from the blood into the dialysate. The dialysate typically stays in your body for about four to five hours before being drained and replaced as part of the dialysis session.

Why does diet matter for dialysis?

Between dialysis sessions, toxic waste can build up in the bloodstream and make you unwell. Healthy eating can help manage the side effects of dialysis sessions and the periods in between each session.

A proper diet catered to your dialysis schedule and diabetes condition is thus vital to helping you feel better and reduce the amount of waste products in the blood and replenish some of the nutrients you might lack.

If you are on peritoneal dialysis, the dietitian will also consider the quantity of dialysate solution you’re using. This is because the dialysate is usually a sugar-based solution, and its use can affect your blood sugar levels.

Keeping a close watch on your diet may also prevent certain minerals from building up in your bloodstream. For people on dialysis, the kidneys can no longer remove high levels of minerals such as potassium and phosphorus.

Extra potassium in the bloodstream can lead to irregular heartbeat, weakness, and shortness of breath. At the same time, high phosphate levels can attract calcium from the bones, making them weak and brittle, among other side effects.

You should also consume more protein to replace the protein you lose during dialysis treatments and build muscle and lower your risk for infection.

On top of that, you need to make sure you are getting enough calories every day because they are important to keep your energy levels up.

Why do I need to watch how much I drink?

Besides keeping a careful watch on the food you eat, you should also consider the amount of fluids you drink. Fluids can build up quickly between dialysis treatments and cause bloating and discomfort. The right amount of fluid intake can help you feel your best.

Dialysis filters the blood to remove excess fluid, but it cannot do the job as effectively as healthy kidneys, which work around the clock. However, most people on dialysis make little to no urine because their kidneys can no longer remove wastes and extra fluid from the body effectively. Without urination, fluid builds up in the body and can cause swelling, shortness of breath, and weight gain.

What is albumin and why is it important?

Albumin is a type of protein normally found in the blood after it's been filtered out by the kidneys. When your kidneys are healthy, there should be a minimal amount of albumin detected in your urine⁵. 

Unusual amounts of albumin in your urine are a sign of kidney damage typically caused by diabetes. Your albumin level should be tested regularly through a urine test to prevent severe kidney damage. You also lower your risk of complications like infections or hospitalization with the right albumin level.

Consult your doctor to determine your target albumin level, and talk to your dietitian about healthy options to help you reach that target.

¹ National Kidney Foundation. Retrieved on Sept 9, 2015 from: https://www.kidney.org/atoz/content/diabetes.

² WebMD. Retrieved on Sept 9, 2015 from: http://www.webmd.com/a-to-z-guides/uremia-topic-overview.

³ Mayo Clinic. Retrieved on Sept 9, 2015 from: http://www.mayoclinic.org/tests-procedures/hemodialysis/basics/definition/prc-20015015.

⁴ Mayo Clinic. Retrieved on Sept 9, 2015 from: http://www.mayoclinic.org/tests-procedures/peritoneal-dialysis/basics/definition/prc-20013164. 

⁵ WebMD. Retrieved on Sept 9, 2015 from: http://www.webmd.com/diabetes/microalbumin-urine-test.