Diabetes and hypertension are the leading causes of kidney disease in India, accounting for nearly 60% of cases,  says Dr Vijay Kher. a noted nephrologist with over 40 years of experience. However, Dr Kher reassures that diabetic kidney damage typically develops gradually, providing opportunities for intervention.

"It usually takes 10 to 15 years for diabetes to cause kidney disease. It doesn't happen on day one by and large," he told First Check in an interview. "There is enough scope for prevention of diabetic kidney disease. Early diagnosis and new medications offer significant benefits, potentially extending kidney function by decades.”

Dr Kher, who works at Epitome Kidney Urology Institute & Lions Hospital, New Delhi, recommended regular monitoring for diabetic patients, calling on them to look for early signs of kidney disease and do some basic tests at least once a year. 

"Fortunately, over the last decade newer drugs for diabetes have come which can help prevent or slow down the rate of deterioration of kidney disease," he  explained. "If we make a diagnosis early and we start these drugs early, we can add up to about 27 years of life to the kidney, delaying  the start of dialysis or transplant."

Diabetes Capital of the World

India is now home to over 101 million diabetics, a recent Indian Council of Medical Research (ICMR) study has revealed. This has earned the country a title of the "Diabetes Capital of the World." With an additional 136 million people classified as pre-diabetic, the country faces a public health crisis that extends far beyond diabetes itself. Among the most serious complications arising from diabetes is kidney disease, a condition that puts at risk a large number of people particularly in the working age population.

According to Dr Kher, the earliest symptom patients might notice is "development of froth in the urine," but laboratory tests can detect problems sooner. 

"If you look for albumin in the urine and then do serum creatinine and urine and look for eGFR, we should be able to make a diagnosis of kidney disease very early," he said.

Treatment now involves multiple medication classes. "With the use of these SGLT2 inhibitors as well as the ACE inhibitors or angiotensin receptor blockers—these are a group of drugs which control blood pressure as well as reduce albumin excretion in the urine," Dr Kher said.

These medications, he said,  form "three pillars" of treatment of early diabetic kidney disease: "ACE and ARB as one pillar, SGLT2 as second pillar, then third pillar is finerenone or eplerenone," the nephrologist said.

Cardiovascular protection is equally important, as kidney disease increases heart risks, Dr Kher pointed out. "Patients developing kidney disease from diabetes commonly die of heart disease. Many patients with diabetes may not reach end-stage kidney disease requiring dialysis or transplantation but might have had a heart attack before."

But the latest medications offer dual benefits: "GLT2, fortunately, is also good for the heart. These angiotensin receptor blockers, ACE inhibitors, are good for the heart as well as kidneys," he said. 

Dr Kher noted that uncontrolled diabetes creates conditions favorable for infections: "If the diabetes is not well controlled, then that gives an environment for fungus and bacteria and other organisms to grow because they require sugar for their growth and energy."

He emphasized the importance of glucose control, monitored through regular testing. "Patients must get their blood sugars controlled effectively which can be monitored by checking hemoglobin A1C every 3 months which gives you an average of 3 months blood sugar."

Comprehensive care, the nephrologist stressed, includes multiple strategies. "Keep the blood pressure and blood sugar under control, monitor kidney disease and heart disease regularly and watch for symptoms of heart and kidney disease."

Dr Kher strongly advocated lifestyle modifications: "Keep your weight on the lower side, keep exercising, don't smoke," he advised. "Smoking is bad not only for the lungs and the heart but it is also bad for kidneys as well. Keep your salt intake on the lower side. This will keep the blood pressure also under control."

Also read: Early-life sugar restriction can protect against diabetes and hypertension later in life - First Check