Health ConditionsDiabetes
Explore This Topic

What Is Diabetic Kidney Disease?

What Is Diabetic Kidney Disease?
Everyday Health
By
Published on April 17, 2025
by
Diabetic kidney disease refers to chronic kidney disease that occurs as a result of diabetes.

 Chronic kidney disease (CKD) involves a slow decline in the kidneys’ ability to function.

Hyperglycemia, or high blood sugar, is a significant risk factor for kidney damage in people with type 1 and type 2 diabetes, as are high blood pressure and obesity.

While there isn’t a cure for diabetic kidney disease, and kidney damage is irreversible, certain treatments can help slow the progression of kidney function decline, including blood glucose management, medications, and lifestyle modifications.

 However, diabetic kidney disease can lead to kidney failure, which must be treated with either dialysis to filter the blood or kidney transplants.

The Stages of Diabetic Kidney Disease

The progression of chronic kidney disease is categorized in five stages, each of which is defined by estimated glomerular filtration rate (eGFR), a measure of how well the kidneys filter blood. eGFR is measured in milliliters of cleansed blood per minute per body surface area, which reads as mL/min/1.73m2. Using this method, chronic kidney disease progresses through the following stages:

Graphic titled the stages of diabetic kidney disease, shows a table: Stage 1, Stage 2, Stage 3a, Stage 3b, Stage 4, and Stage 5. Everyday Health logo bottom middle.
Adobe Stock; Everyday Health
Healthcare providers also measure the levels of a protein called albumin present in the urine to assess the severity of chronic kidney disease, categorizing it in three levels. However, people with diabetic kidney disease don’t always present with albumin in the urine as an indicator of the condition.

Signs and Symptoms of Diabetic Kidney Disease

Early stages of diabetic kidney disease don’t typically present with clear symptoms, which is why it’s so important to test kidney function early and regularly when treating and managing diabetes.

People can experience the following symptoms in more advanced stages of chronic kidney disease:

  • Nausea and vomiting
  • Loss of appetite
  • Trouble sleeping
  • Signs of fluid buildup, such as shortness of breath from fluid in the lungs or swelling in the feet
  • Feeling weak and fatigued
  • Abnormal urine output, including very small amounts of urine
  • Itchiness
In advanced diabetic nephropathy, or diabetic kidney disease, people can also experience:

  • Fatigue
  • Swelling in the feet
  • Foamy urine
  • Symptoms related to diabetes, such as delayed wound healing and numbness or tingling
  • Nephrotic syndrome, excess protein in the urine that leads to other symptoms like fluid buildup (edema)

Causes and Risk Factors of Diabetic Kidney Disease

The main job of the kidneys is to filter the body’s accumulated waste products as well as salt and minerals your body needs — sodium, calcium, potassium, phosphorus — into tiny tubules where they are either reabsorbed into the blood or passed into urine.

Prolonged high blood sugar in diabetes can cause irreversible damage to the small blood vessels in the kidneys as well as the structures responsible for filtering waste. As a result, people with diabetes can experience hyperfiltration, which is indicated by an elevated GFR rate. This stress on the kidneys contributes to the development and progression of diabetic kidney disease.

When your kidneys aren’t able to filter waste products from the blood as well as they should, you can develop chronic kidney disease. Gradual loss of kidney function can worsen over time, eventually leading to kidney failure if left untreated.

Common risk factors for chronic kidney disease include:

Other risk factors that may contribute to diabetic kidney disease include:

  • Increased age
  • Duration of diabetes
  • Being a man or a postmenopausal woman
  • Dyslipidemia (abnormal lipid levels)
  • Smoking
  • Sedentary lifestyle
  • A diet high in animal protein
  • High salt intake

How Is Diabetic Kidney Disease Diagnosed?

Doctors use a few different tests to determine whether someone has chronic kidney disease:

  • Measurement of Urine Albumin-to-Creatinine Ratio This urine test assesses how much albumin protein is present in the urine, an indication of kidney dysfunction.

  • Measurement of the Estimated Glomerular Filtration Rate (eGFR) This measurement of kidney function uses data from a person’s bloodwork to estimate how well the kidneys are filtering blood.

  • Kidney Imaging Ultrasounds and computerized tomography can help identify kidney changes and problems.

To determine whether diabetes is the cause of chronic kidney disease, healthcare providers can perform a kidney biopsy, although this procedure isn’t as common as other diagnostic tests. 

People with type 1 diabetes should be screened annually for diabetic kidney disease after they’ve had diabetes for five years.

 Meanwhile, people with type 2 diabetes should get their eGFR and urine albumin levels tested at least once a year, starting when they are first diagnosed. If you already have a low stage of chronic kidney disease, your healthcare team may ask to run these tests one to four times per year.

Treatment and Medication Options for Diabetic Kidney Disease

Because it’s not possible to repair kidney damage, chronic kidney disease treatment prioritizes slowing the progression of kidney damage. Strategies can involve medication, blood pressure and diabetes management, and lifestyle changes.

Medication Options

Several medications can help manage kidney disease. Some may help slow or halt the progression of kidney disease, while others address additional issues like blood pressure or diabetes.

  • ACE Inhibitors These medications help decrease protein in the urine and can slow declines in kidney function as well as reduce blood pressure.

  • Angiotensin Receptor Blockers ARBs also help reduce protein in the urine, slow declines in kidney function, and decrease blood pressure.

  • Diuretics These medications allow more fluid to leave the body via urine.

  • GLP-1 Receptor Agonists By supporting weight loss and blood sugar management, these medications can reduce risk of kidney disease, slow its progression, and improve outcomes in those with kidney dysfunction.
  • Mineralocorticoid Receptor Antagonists These medications help the kidneys remove excess water and salt via urine without depleting potassium levels, lowering blood pressure as a result.

  • SGLT-2 Inhibitors These medications can help decrease blood sugar by allowing more sugar to leave the body via urine when someone’s kidney function is normal. When kidney function is reduced, SGLT-2 inhibitors can help decrease risk of further kidney disease progression.

Once you lose kidney function, you cannot restore it with medication.

 At the most advanced stage of kidney disease, there are only two ways to restore fluid and waste product filtration from your blood: dialysis and kidney transplantation. Usually, a healthcare provider discusses these options when diabetic kidney disease reaches stage 4.

Dialysis

Dialysis is usually recommended when around 90 percent of kidney function is lost. There are two types of dialysis: hemodialysis and peritoneal dialysis.

  • Hemodialysis This involves going to a dialysis center three times a week for several hours, where your blood is pumped through a machine that filters out waste products and excess fluids and then returned to your body. Sometimes hemodialysis can be done at home, but such treatment may need to occur more frequently and can take longer to complete.
  • Peritoneal Dialysis This is a self-administered procedure performed at home and involves putting a dialysis solution in your abdomen through a catheter placed surgically near your navel. The solution remains in your abdomen for several hours before being drained and replaced with fresh dialysis solution. This process can be done manually throughout the day or by machine at night.
Peritoneal dialysis may be the better option for people who want to continue to live an active lifestyle. However, it can require setting up the equipment yourself, which can be challenging for people with vision or dexterity problems.

Kidney Transplant

A kidney transplant may help improve life expectancy and is often a better option than dialysis. A person with kidney disease might receive dialysis while waiting for a kidney transplant.

Kidney transplants are major surgeries performed under general anesthesia that do carry a number of risks, including blood clots and bleeding, infection, and failure or rejection of the donated kidney. Following the procedure, most people spend several days to a week recovering in the hospital and require close monitoring and frequent checkups for several weeks to make sure the new organ is functioning properly.

After a person receives a new kidney, they must take certain medications for the rest of their life to ensure their body doesn’t reject the new organ.

Not everyone is eligible for a kidney transplant, such as people who have had cancer recently, people with severe obesity, or those who haven’t adhered to recommended dialysis or medication treatments.

Prevention of Diabetic Kidney Disease

The best way to prevent chronic kidney disease if you have diabetes is to carefully manage your blood sugar as well as treat associated conditions like high blood pressure and abnormal cholesterol levels. Managing these conditions effectively often involves using medications with the supervision of your healthcare provider. Lifestyle changes, such as maintaining a healthy weight, not smoking, and getting enough exercise, can also help decrease your risk for chronic kidney disease.

 
Talk with your doctor about your goals and how you can work to decrease your risk for chronic kidney disease. Diagnosing chronic kidney disease and getting treatment early can play a significant role in helping to improve outcomes.

 For people with type 1 and type 2 diabetes, annual screenings for chronic kidney disease are recommended. It’s easier to prevent the development of advanced kidney disease if the condition is identified early.

Lifestyle Changes for Diabetic Kidney Disease

Many of the healthy habits that can help you manage diabetes, such as eating a balanced diet and exercising regularly, can also help keep your kidneys healthy and slow the progression of chronic kidney disease.

Eat a Healthy Diet

Following a balanced diet that prioritizes whole, unprocessed food can help improve both blood sugar and blood pressure.

 A healthy diabetes diet may involve monitoring carbohydrate intake, choosing nonstarchy vegetables, and limiting processed foods and sugary snacks. Similarly, if you have high blood pressure, eating a diet high in fruits and vegetables while limiting added sugar, salt, alcohol, and red meat can be helpful.

If you have diabetic kidney disease, you may be asked to eat a specialized diet, which could include:

  • Limiting salt and sodium consumption
  • Limiting potassium or phosphorous intake
  • Detailed protein goals and limits
Create an individualized dietary plan with your healthcare team, and ask questions when you aren’t sure which food options are appropriate.

Watch Your Protein and Salt Intake

Limiting salt in your diet can help decrease blood pressure and reduce fluid buildup. To limit salt:

  • Season foods with sodium-free herbs and spices.
  • Avoid packaged food, fast food, and salty snacks.
  • Check all food labels for sodium content.
Consult your healthcare provider before using salt substitutes. Some contain high levels of potassium, and people with chronic kidney disease may also need to limit their intake of this mineral.

A protein-heavy diet may make your kidneys work harder. Talk to your doctor about how much protein you should eat, and opt for lean sources like fish or chicken.

It’s important to ask about dietary restrictions and create a plan that works for your specific kidney function and needs. As chronic kidney disease progresses, the specifics of diet can become more meticulous, and it may help to work with a nutrition specialist.

 For example, if you’re on dialysis, you might need more protein in your diet. Ask your doctor about what your protein, salt, and other food intake should look like to best manage your condition.

Get Regular Exercise

Exercise can help you manage your weight, improve your mental health, and achieve your blood sugar and blood pressure goals.

The American Diabetes Association and the World Health Organization recommend adults with diabetes aim for 150 to 300 minutes of moderate-intensity aerobic physical activity per week and engage in strength or resistance training at least twice a week.

For those with kidney dysfunction, the National Kidney Foundation stresses the importance of prioritizing aerobic activities like walking, biking, and swimming, sticking with lower weights and higher repetitions when resistance training, and gradually working up to exercise sessions lasting 30 minutes each. Exercising at least three times a week is ideal.

For people with diabetes or diabetic kidney disease, lower-intensity exercise may be best. Consult your healthcare provider prior to exercising to create a fitness plan that is safe for your condition and tailored to your specific goals.

Address Your Sleep and Stress Issues

Stress can raise blood sugar and blood pressure levels as a result of the body’s release of the hormone cortisol. In addition to everyday stress, you may also experience stress specifically related to managing your diabetes.

A wide range of stress management strategies, including limiting your caffeine consumption, spending time with people you love, and going outside, can help provide relief. Techniques like meditation that allow you to practice mindfulness can also be helpful.

Sleep is another important component of stress management, and getting enough sleep may also help reduce your risk of diabetes complications like kidney disease. Sleeping less than six hours a night is associated with a higher risk of developing chronic kidney disease than sleeping between six and eight hours per night.

Adequate sleep can also support weight management and heart health, decreasing your risk of developing high blood pressure and heart disease.

Diabetic Kidney Disease Prognosis

Early diagnosis and proper management of diabetic kidney disease can help you live longer and extend your quality of life. In fact, only a small percentage of people experience the advanced stages of chronic kidney disease.

However, chronic kidney disease remains a leading cause of death worldwide.

 Heart disease, a complication of the condition, is the most common cause of death for individuals with chronic kidney disease.

Continue working with your healthcare provider to explore care options relevant to your situation to best manage your chronic kidney disease.

Complications of Diabetic Kidney Disease

Chronic kidney disease doesn’t just affect the kidneys. It can also lead to a number of complications that may require specialized treatment, such as:

Research and Statistics: How Many People Have Diabetic Kidney Disease?

About 35.5 million people in the United States have chronic kidney disease.

 Worldwide, more than 840 million people have chronic kidney disease.

However, not everyone with chronic kidney disease has diabetes.

In the United States, almost 30 million people are diagnosed with diabetes.

 About half of the people with type 2 diabetes, as well as one in three people with type 1 diabetes, will also experience diabetic kidney disease.

Ultimately, an estimated 750,000 people have stage 4 kidney disease, while approximately 325,000 people have stage 5 kidney disease, or kidney failure, in the United States.

Disparities and Inequities in Diabetic Kidney Disease

While diabetic kidney disease can affect anyone, some people are more likely to develop the condition or struggle to receive appropriate diagnosis and treatment.

People in low-income countries may have limited access to preventive care and are less likely to receive early treatment for chronic kidney disease.

Non-Hispanic Black adults have the highest rates of chronic kidney disease in the United States.

 Additionally, Native American and Hispanic adults in the United States have experienced increased rates of end-stage kidney disease from diabetic kidney disease.

 It’s possible that these disparities are due to inequalities in the social determinants of health, such as healthcare access and economic stability.
In the United States, people with financial insecurity, limited access to quality nutrition, limited access to green spaces, increased exposure to air and water pollution, limited access to medical care, and a lack of health insurance may also be at an increased risk for diabetic kidney disease.

Support for Diabetic Kidney Disease

Renal Support Network

This nonprofit assists people with kidney disease nationwide, helping connect them with others who are going through similar health experiences. It provides resources like virtual support groups, a peer support hotline, a blog, and a podcast all focused on providing support to people with chronic kidney disease.

American Association of Kidney Patients

Founded in 1969, AAKP serves as an advocate for people with kidney disease to help improve patients’ treatment. It provides educational resources and seeks to foster community among people with kidney disease by connecting them with renal support groups in five states as well as virtual support group options.

National Kidney Foundation

This group raises awareness of kidney disease and helps fund advancements in kidney disease research and treatment. It hosts a number of events in several states annually and provides a number of community resources, such as NKF Peers, which connects those affected by kidney disease with a mentor.

Common Questions & Answers

Can you reverse chronic kidney disease?

Chronic kidney disease cannot be reversed. However, treatments can help to slow or halt the progression. In severe situations, you need to use dialysis or receive a kidney transplant.

About half the people with type 2 diabetes and one-third of those with type 1 diabetes develop diabetic kidney disease. However, risk factors vary from person to person, and some of your lifestyle choices can help reduce your risk.

People with diabetes and kidney disease can protect their remaining kidney function by avoiding foods that are high in sodium, potassium, phosphorus, and sugar. Limiting your consumption of processed foods and alcohol can be helpful as well.

The Takeaway

  • Diabetic kidney disease is chronic kidney disease that occurs as a complication of diabetes.
  • Early stages of diabetic kidney disease are often asymptomatic, but more advanced stages are typically marked by nausea, vomiting, fluid buildup, fatigue, and abnormal urine output.
  • While there isn’t a cure for diabetic kidney disease, blood glucose management, medications, and lifestyle modifications can all play a significant role in managing the condition and maintaining quality of life.
  • Early intervention is the best way to slow or halt the progression of diabetic kidney disease, so annual screenings for people with diabetes are critical.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Diabetic Nephropathy (Kidney Disease). Mayo Clinic. October 24, 2023.
  2. Vaidya SR et al. Chronic Kidney Disease. StatPearls. July 31, 2024.
  3. Hoogeveen EK. The Epidemiology of Diabetic Kidney Disease. Kidney and Dialysis. August 1, 2022.
  4. Forst T et al. New Strategies to Improve Clinical Outcomes for Diabetic Kidney Disease. BMC Medicine. October 10, 2022.
  5. Diabetic Kidney Disease. BMJ Best Practice. January 15, 2025.
  6. Chronic Kidney Disease. Mayo Clinic. September 6, 2023.
  7. Rout P et al. Diabetic Nephropathy. StatPearls. January 9, 2025.
  8. Tapia C et al. Nephrotic Syndrome. StatPearls. May 29, 2023.
  9. Chronic Kidney Disease Basics. Centers for Disease Control and Prevention. May 15, 2024.
  10. Pavkov ME et al. Kidney Disease and Diabetes. Diabetes in America. November 21, 2024.
  11. Testing for Chronic Kidney Disease. Centers for Disease Control and Prevention. May 15, 2024.
  12. Morales J et al. Perspectives on Chronic Kidney Disease With Type 2 Diabetes and Risk Management: Practical Viewpoints and a Paradigm Shift Using a Pillar Approach. Clinical Diabetes. Fall 2023.
  13. Living With Chronic Kidney Disease. Centers for Disease Control and Prevention. May 15, 2024.
  14. Glassock RJ. Patient Education: Diabetic Kidney Disease (Beyond the Basics). UpToDate. February 12, 2024.
  15. Chronic Kidney Disease. Cleveland Clinic. May 7, 2023.
  16. Aldosterone Antagonists. Cleveland Clinic. April 29, 2022.
  17. Berns JS. Patient Education: Dialysis or Kidney Transplantation — Which Is Right for Me? (Beyond the Basics). UpToDate. November 13, 2024.
  18. Kidney Transplant. Mayo Clinic. January 31, 2025.
  19. Healthy Eating. Centers for Disease Control and Prevention. May 15, 2024.
  20. Managing Blood Pressure With a Heart-Healthy Diet. American Heart Association. May 22, 2024.
  21. Diabetes and Kidney Disease: What to Eat? Centers for Disease Control and Prevention. May 15, 2024.
  22. Diet and Nutrition for Adults With Advanced Chronic Kidney Disease. National Institute of Diabetes and Digestive and Kidney Diseases. June 2022.
  23. Zhang C et al. Personalizing Physical Activity for Glucose Control Among Individuals With Type 2 Diabetes: Are We There Yet? Diabetes Care. February 2024.
  24. Staying Fit With Kidney Disease. National Kidney Foundation.
  25. How Stress and Depression Affect Diabetes. Cleveland Clinic. March 8, 2024.
  26. 20 Ways to Relieve Stress. Cleveland Clinic. October 2, 2024.
  27. Park S et al. Short or Long Sleep Duration and CKD: A Mendelian Randomization Study. Journal of the American Society of Nephrology. October 1, 2020.
  28. About Sleep. Centers for Disease Control and Prevention. May 15, 2024.
  29. Living With Chronic Kidney Disease. National Health Service. March 22, 2023.
  30. Kovesdy CP. Epidemiology of Chronic Kidney Disease: An Update 2022. Kidney International Supplements. March 18, 2022.
  31. Mineral and Bone Disorder. National Kidney Foundation.
  32. Chen TK et al. Chronic Kidney Disease Diagnosis and Management: A Review. JAMA. October 1, 2019.
  33. Hyperphosphatemia. Cleveland Clinic. October 14, 2022.
  34. Hyperkalemia (High Potassium). Cleveland Clinic. May 11, 2023.
  35. Chronic Kidney Disease in the United States, 2023. Centers for Disease Control and Prevention. May 15, 2024.
  36. National Diabetes Statistics Report. Centers for Disease Control and Prevention. May 15, 2024.
  37. CKD in the General Population. National Institute of Diabetes and Digestive and Kidney Diseases. 2022.
Meet Our Experts
See Our Editorial PolicyMeet Our Health Expert Network
igor-kagan-bio

Igor Kagan, MD

Medical Reviewer
Castle Connolly Top Doctor

Igor Kagan, MD, is an an assistant clinical professor at UCLA. He spends the majority of his time seeing patients in various settings, such as outpatient clinics, inpatient rounds, and dialysis units. He is also the associate program director for the General Nephrology Fellowship and teaches medical students, residents, and fellows. His clinical interests include general nephrology, chronic kidney disease, dialysis (home and in-center), hypertension, and glomerulonephritis, among others. He is also interested in electronic medical record optimization and services as a physician informaticist.

A native of Los Angeles, he graduated cum laude from the University of California in Los Angeles (UCLA) with a bachelor's in business and economics, and was inducted into the Phi Beta Kappa honor society. He then went to the Keck School of Medicine at the University of Southern California (USC) for his medical school education. He stayed at USC for his training and completed his internship and internal medicine residency at the historic Los Angeles County and USC General Hospital. Following his internal medicine residency, Kagan went across town to UCLA's David Geffen School of Medicine for his fellowship in nephrology and training at the UCLA Ronald Reagan Medical Center. After his fellowship he stayed on as faculty at UCLA Health.

See full bio

Jessica Freeborn

Author

Jessica Freeborn has worked as a health and wellness freelance writer since 2021. She is passionate about encouraging people to take control of their health and stay informed about the latest medical advancements. She has two nursing degrees and has used her healthcare experience to enhance her writing and research.

As someone with type 1 diabetes, she understands the complexities surrounding diabetes management and wants to provide people with accurate information and dispel misconceptions about diabetes treatment.

See full bio
See Our Editorial PolicyMeet Our Health Expert Network