How does Diabetes Mellitus (DM) cause Chronic Kidney Disease (CKD)?

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Last updated: May 11, 2025 • View editorial policy

From the Guidelines

Diabetes causes chronic kidney disease primarily through persistent high blood sugar levels that damage the kidneys over time, leading to diabetic nephropathy and a gradual reduction in kidney function. This damage is a result of the injury to the small blood vessels (glomeruli) in the kidneys that filter waste from the blood, as well as the promotion of inflammation and oxidative stress in kidney tissue, accelerating damage 1. The disease also often causes hypertension, which further stresses the kidneys. As kidney function declines, waste products accumulate in the blood, eventually leading to symptoms like fluid retention, fatigue, and electrolyte imbalances.

  • Persistent high blood sugar levels
  • Damage to the small blood vessels (glomeruli) in the kidneys
  • Promotion of inflammation and oxidative stress in kidney tissue
  • Hypertension, which further stresses the kidneys

Both type 1 and type 2 diabetes can cause this progressive kidney damage, though it typically develops after several years of diabetes. Regular monitoring of kidney function through blood tests (creatinine, eGFR) and urine tests (albumin-to-creatinine ratio) is essential for people with diabetes, as early detection can help prevent or slow the progression of kidney disease 1.

Management and Prevention

The use of newer classes of glucose-lowering agents, such as sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists, has changed the therapeutic landscape for patients with diabetic kidney disease, offering unprecedented opportunities to reduce the risk for progression of kidney disease and the risk of death 1. Medications like ACE inhibitors or ARBs are often prescribed to protect kidney function by reducing pressure within the kidney's filtering units and decreasing protein leakage. An integrated approach to patient care with a multidisciplinary focus can help achieve the necessary shift in clinical care of patients with diabetic kidney disease.

From the Research

Mechanisms of Diabetes-Induced Chronic Kidney Disease

  • Diabetes can cause chronic kidney disease (CKD) through several mechanisms, including injury to both glomerular and tubular compartments of the kidneys, leading to kidney dysfunction over time 2.
  • Persistent high blood glucose levels can damage the small blood vessels in the kidneys, impairing their ability to filter waste and fluids from the blood effectively 2.
  • Other factors like high blood pressure (hypertension), genetics, and lifestyle habits can also contribute to the development and progression of diabetic kidney disease (DKD) 2.

Key Features of Renal Complications of Diabetes

  • The key features of renal complications of diabetes include morphological and functional alterations to renal glomeruli and tubules, leading to mesangial expansion, glomerulosclerosis, and homogenous thickening of the glomerular basement membrane (GBM) 2.
  • Albuminuria, tubulointerstitial fibrosis, and progressive decline in renal function are also characteristic of DKD 2.

Treatment and Management of Diabetic Kidney Disease

  • Tight glycaemic control is the most powerful approach to decrease the chances of developing diabetic nephropathy, but having an HbA1c < 7% does not completely suppress the risk of kidney disease 3.
  • Recently, two classes of drugs, i.e., glucagon-like peptide (GLP) 1 receptor agonists and sodium-glucose transporter 2 inhibitors, have shown a renoprotective effect, well-beyond their glucose-lowering properties 3.
  • Early detection and proactive management of diabetes and its complications are crucial in preventing DKD and preserving kidney function 2, 4.

Epidemiology and Burden of Diabetic Kidney Disease

  • Diabetes is a major public health challenge, and DKD is the leading cause of chronic kidney disease and end-stage kidney disease in the United States and worldwide 4.
  • The global health burden of DKD is significant, making it essential to prioritize prevention, early recognition, referral, and aggressive management of DKD in the primary care setting 4, 5.
  • All-cause mortality in individuals with DKD is approximately 30 times higher than that in diabetic patients without nephropathy, and a great majority of patients with DKD will die from cardiovascular disease before they reach end-stage renal disease (ESRD) 6.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.