Managed Diabetes Still Result in Kidney Failure?

Kidney failure is the final stage of chronic kidney disease, where the body loses its ability to rid itself of waste. When the kidneys fail, dangerous levels of toxins buildup in the body leading to death. Nearly 100,000 people are diagnosed in the United States every year with kidney failure (USRDS, 2007). According to the same data, diabetes accounts for a little under half of these new cases. Controlling diabetes is important and doctors are correct to express the importance of controlling diabetes to their patients. However, recent data suggests that even when diabetes is controlled, it can still lead to kidney failure. Nearly 24 million people in the United States have diabetes, and nearly 180,000 are living with kidney failure that is a direct result of diabetes (USRDS, 2007). This research will explore the connection between diabetes and kidney failure in connection with the importance of controlling diabetes.

Rationale

Many people believe that if they have diabetes and they manage it well, then it guarantees that they will be able to avoid chronic kidney disease. However, this is not always the case, particularly when several risk factors are combined such as high blood pressure and diabetes. Genetics can also play a role and minorities such as African-Americans, American Indians, and Hispanics have higher kidney failure rates than Caucasians do (USRDS, 2007). This study is based on research that indicates that not only must diabetes be controlled to avoid kidney failure, it must be eliminated.

Significance of the Study

Most U.S. citizens with kidney disease are eligible for some type of federally funded care. It is estimated at patients with kidney failure cost the United States nearly $32 billion annually (USRDS, 2007). The financial impact of the disease is devastating, as is the impact on individual lives and added stress to an already strained Health Care System. Heredity plays a role in kidney disease, but there are many more cases in which heredity does not play a factor than there are where it does. Kidney disease can be avoided, or the risk reduced of developing it, by taking simple steps such as proper diet and exercise. It is been suggested that controlling other risk factors, such as high blood pressure, can also have an impact on reducing the risk of kidney failure in those with diabetes (USRDS, 2007). Reducing incidences of kidney failure will have a significant impact not only on the patients and their families, but it will also have a major impact on the economy of United States.

Purpose of the study

The purpose of this study is two-fold. The first is to gain information that is based on evidence regarding the relationship between controlled diabetes, uncontrolled diabetes, and the chances of developing kidney failure. The second purpose is to allow health care professionals to use this information in the development of protocols to help give patients advice that will result in a reduction of chances for developing kidney failure. This research will benefit both doctors and patients alike.

Hypothesis

This research will focus on a single hypothesis. It will support the hypothesis that those with controlled diabetes are still at risk for the development of kidney failure. The null hypothesis home will state that control diabetes will significantly reduce the risk for the development of kidney failure.

Research Questions

In addition to the primary research hypothesis, the study will also attempt to answer several research questions that will provide greater insight into the issues surrounding the research hypothesis. The following research questions will also be addressed as a part of this research study.

1. How is diabetes related to kidney failure, regardless of whether it is controlled or uncontrolled?

2. Once a person has diabetes, is there anything they can do to reduce their risk of developing kidney failure?

3. Is the presence of high blood pressure more important in the development of kidney failure and diabetes?

4. Does controlling diabetes alone reduce the risk of the development of kidney failure?

These four central research questions will help in the development of a greater understanding of the connection between diabetes and kidney failure. They will aid physicians & medical professionals in advising their patients as to what they can do to reduce their chances of developing kidney failure.

Literature Review

Kidney disease is a progressive and fatal condition. The filtration system begins to fail slowly, resulting in a small amount of protein leaking into the urine. As the disease progresses, more protein begins a leak into the urine in the kidney’s filtering function begins to drop. As result the body retains high levels of waste. The disease rarely occurs in the first 10 years of diabetes and it is usually 15 to 25 years before kidney failure occurs (USRDS, 2007). The longer person has diabetes, the greater the risk of developing it.

Current wisdom holds that controlling diabetes can help reduce the risk of developing kidney failure. However, many people with well controlled diabetes still develop kidney disease and eventually kidney failure. High blood sugar levels cause damage to the kidneys. The longer a person goes without being diagnosed with diabetes, the more likely damages are to have already occurred. A 20-year study by de Boer, Rue, & Hall et al. (2011) found that the incidence rate of diabetes kidney disease increased from 1988 to 2008, despite increased use of glucose lowering medications and medications designed to lower factors involved with the development of kidney disease.(Koro, Lee, & Bowlin, 2009).

Newman, Mattock, & Dawnay et al. (2005) explored the effectiveness of early testing in the detection of diabetic complications. They explored factors other than microalbuminuria in the diagnosis of diabetic complications. They also examined whether improved glycemic or blood pressure control had a greater influence on the development of diabetic complications and those with detected microalbuminuria than in those with normal albuminuria. This study found that glycemic control had little benefit in the prevention of kidney disease in those that already had microalbuminuria. Those that had normal albuminuria appeared to benefit from glycemic control in the development of kidney disease. The study would suggest that once the disease has started, glycemic control does not play a role in the ongoing development of the disease. This study suggests that control prior to the development of the disease can have an impact on the prevention of developing the disease. Watanbe, Fujii, & Aoki, et al. (2009) found that obesity contributed to the development of kidney disease in patients with diabetes.

Information in the literature presents conflicting information on the connection between control diabetes and the development a kidney disease. Several other factors have been implicated in the development of kidney disease in patients with diabetes. High blood pressure and obesity may be contributing factors that place persons with diabetes at a greater risk of developing kidney disease. Studies also suggest that once kidney disease has started, controlling blood sugar levels will not reverse its effects or slow its progression. This study will help to resolve some of the issues found in previous research studies.

Methodology

This study will use a comparative quantitative method using historical records of patients with both kidney disease and diabetes. Demographic information will be collected to rule out sample bias as a potential reason for the results found. The study will divide patients into those with a history of controlled diabetes, uncontrolled diabetes, and those with other complicating factors such as high blood pressure or obesity.

The groups in this study will be compared using descriptive statistical techniques. Correlational statistics will be performed both within and between the various patient groups. Crushed tabulation will be used to detect the presence of bias in the sample population and to determine the relationships that exist between the groups. The study will determine what factors have the greatest impact on reducing the chances for development of kidney disease among various study groups.

Conclusion

This study will examine the connection between diabetes and kidney disease in a detailed manner. The purpose of the study is to determine whether controlling diabetes has an effect on the development or progression of kidney disease. The literature suggested that once a person develops kidney disease that controlling diabetes has no affect. The presence of microalbuminuria will be used to classify those that already have early stages of the disease in to separate them from those that have not yet developed the disease. The study will play an important role and prevention of kidney disease as a complication of diabetes.

References

de Boer, I., Rue, T., & Hall, Y et. al. (2009). Temporal trends in the prevalence of diabetic kidney disease in the United States. JAMA. 305(24), 2532-9.

Koro, C., Lee, B., & Bowlin, S.(2009). Antidiabetic medication use and prevalence of chronic kidney disease among patients with type 2 diabetes mellitus in the United States. Clin Ther. (11):2608-17.

Newman, D., Mattock, M,., & Dawnay, A.,et al. (2005) Systematic review on urine albumin testing for early detection of diabetic complications. Health Technol Assess. 9(30):iii-vi, xiii-163.

United States Renal Data System. USRDS 2007 Annual Data Report. Bethesda, MD: National

Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health,

U.S. Department of Health and Human Services.

Watanabe, Y., Fujii, H., & Aoki K, et. al. (2009). A cross-sectional survey of chronic kidney disease and diabetic kidney disease in Japanese type 2 diabetic patients at four urban diabetes clinics. Intern Med. 2009;48(6):411-4.