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6 things you must know about Diabetic Kidney Disease

6 things you must know about Diabetic Kidney Disease

Diabetic Kidney Disease (DKD), also known as diabetic nephropathy, is a serious complication of both type 1 and type 2 diabetes. In the United States, approximately one-third of diabetes patients have diabetic kidney disease.

DKD affects the daily functioning of the kidneys, impairing their ability to remove waste and excess fluids from the body. Maintaining a healthy lifestyle and effectively managing diabetes and high blood pressure are the best ways to prevent and delay the onset of diabetic kidney disease.

Over time, diabetic kidney disease gradually damages the intricate kidney filtration system. Early treatment can prevent or delay the progression of the disease and reduce the risk of complications.

Kidney disease can progress to kidney failure, also known as end-stage renal disease. Kidney failure can be life-threatening. If kidney failure occurs, treatment options include dialysis or kidney transplantation.

One crucial task of the kidneys is to clean the blood. As blood circulates in the body, it absorbs extra fluids, chemicals, and waste products. The kidneys are responsible for separating these substances from the blood and excreting them through urine. If the kidneys cannot function properly and go untreated, it can lead to severe health problems, ultimately resulting in death.

Diabetic Kidney Disease symptoms

In the early stages of diabetic kidney disease, it is unlikely to notice any signs or symptoms. Late-stage signs and symptoms may include:

  • 1. Worsening blood pressure control
  • 2. Urine containing protein
  • 3. Swelling in the feet, ankles, hands, or eyes
  • 4. Increased need for frequent urination
  • 5. Reduced need for insulin or diabetes medications
  • 6. Confusion or difficulty concentrating
  • 7. Shortness of breath
  • 8. Loss of appetite
  • 9. Nausea and vomiting
  • 10. Persistent itching
  • 11. Fatigue

Diabetic Kidney Disease causes

Diabetic kidney disease occurs when diabetes damages the blood vessels and other cells in the kidneys. The kidneys consist of millions of tiny clusters of blood vessels (glomeruli) that filter waste from the blood. Severe damage to these blood vessels leads to diabetic kidney disease, a decline in kidney function, and eventually kidney failure.
A normal kidney has approximately 1 million filtering units. These filtering units are called nephrons, and each nephron is connected to a small tube that collects urine. Conditions such as high blood pressure and diabetes can damage these filtering units and collecting tubes, leading to scarring and impairing kidney function.

Healthy kidneys and diseased kidneys

The kidneys clear waste and excess fluids from the blood through structures known as “nephrons.” Each nephron contains a filter called the glomerulus, which consists of a network of tiny blood vessels (capillaries). When blood enters the glomerulus, small molecules (water, essential nutrients, and waste) pass through the capillary walls, while larger molecules (such as proteins and red blood cells) do not. The filtered fluid then enters another part of the nephron, known as the renal tubule. Essential water, nutrients, and minerals needed by the body are reabsorbed into the bloodstream, while excess water and waste become urine, which flows to the bladder.

kidney cross section

The pathogenesis of Diabetic Kidney Disease

Molecular Mechanisms

In cases where patients have reduced insulin secretion or abnormal insulin activity within their bodies, it can lead to kidney damage. This is because insulin not only effectively regulates glucose metabolism in the body but also influences the insulin sensitivity of podocytes and renal tubular epithelial cells.

When insulin sensitivity is impaired, the glucose metabolism within kidney cells undergoes changes, leading to abnormal vascular responses that hinder blood vessel formation. Furthermore, insulin also plays a role in regulating the flexibility of podocytes, which can affect proteinuria and renal dysfunction resulting from changes in the permeability of the glomerular basement membrane.

In the progression of diabetic kidney disease, inflammation is a significant influencing factor. Downstream signals within kidney cells can be activated in a high-glucose environment, triggering a cascade of reactions that lead to the generation of inflammation in the body. This, in turn, causes glomerular hypertrophy, deposits of collagen type IV and fibronectin, and ultimately activates signaling pathways, resulting in the infiltration of inflammatory cells in the circulation, thereby amplifying and sustaining the inflammatory state of the kidneys.

Oxidative stress is also one of the mechanisms underlying diabetic kidney disease. It induces the production of inflammatory cytokines, exacerbating the inflammatory response in the body. Typically, low levels of reactive oxygen species in the body help maintain the stability of hypoxia-inducible factors. However, when the reaction between reactive oxygen species and hypoxia-inducible factors becomes intense, it can weaken the body’s responsiveness to hypoxia, leading to hypoxic injury in the renal tubulointerstitium. When the body’s antioxidant capacity is insufficient to counteract the reactions of oxygen radicals, oxidative stress occurs.

On one hand, when glucose metabolism within the body is poorly regulated, it can stimulate the production of a large amount of reactive oxygen species, leading to changes in the permeability of glomerular blood vessels. Additionally, reactive oxygen species can directly or indirectly damage renal cells, resulting in renal fibrosis. On the other hand, a decline in the body’s ability to clear free radicals is detrimental to the effective metabolism and protection of kidney cells.

The pathogenesis of Diabetic Kidney Disease

Cellular Mechanisms

Podocytes play a critical role in maintaining the integrity of the glomerular filtration barrier in the kidney. As highly specialized cells, podocytes exhibit pathological characteristics such as podocyte hypertrophy, foot process effacement, and podocyte apoptosis.

Animal experimental studies suggest that various factors, including advanced glycation end products and increased oxidative stress in a high-glucose environment, can damage podocytes, leading to dysfunction of the glomerular filtration barrier.

Additionally, the dysfunction of mesangial cells in the glomerulus also has a significant impact on the development of diabetic kidney disease. Mesangial cells secrete extracellular matrix proteins, and when mesangial cell function is impaired, it can lead to the accumulation of extracellular matrix proteins, causing mesangial cell proliferation, a key pathological change in diabetic kidney disease.

Endothelial dysfunction is closely associated with the progression of diabetic kidney disease. Its main pathological features include increased endothelial permeability and decreased secretion of endothelial-derived vascular factors. When endothelial cells are activated by high glucose, advanced glycation end products, and oxidative stress, they recruit monocytes, activate macrophages, and initiate an inflammatory response, contributing to the development of diabetic kidney disease.

Risk Factors for Diabetic Kidney Disease

If you have diabetes, several factors can increase your risk of developing diabetic kidney disease. These factors include:

  • 1. Poorly controlled high blood sugar
  • 2. Poorly controlled high blood pressure
  • 3. Smoking
  • 4. High blood cholesterol levels
  • 5. Obesity
  • 6. A family history of diabetes and kidney disease

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What are the complications of Diabetic Kidney Disease?

Complications of diabetic kidney disease may gradually develop over months or years, and these may include:

  • 1. Fluid retention, which can lead to swelling in the arms and legs, high blood pressure, or pulmonary edema (fluid in the lungs).
  • 2. Elevated potassium levels in the blood (hyperkalemia).
  • 3. Heart and vascular diseases, which may lead to strokes.
  • 4. Damage to the blood vessels in the light-sensitive tissue at the back of the eyes (diabetic retinopathy).
  • 5. Reduced red blood cell count for transporting oxygen (anemia).
  • 6. Foot ulcers, erectile dysfunction, diarrhea, and other issues related to nerve and blood vessel damage.
  • 7. Skeletal and mineral imbalances due to the kidneys being unable to maintain proper blood calcium and phosphate balance.
  • 8. Complications during pregnancy that pose risks to both the mother and the developing fetus.
  • 9. Irreversible damage to the kidneys (end-stage kidney disease), eventually requiring dialysis or kidney transplantation for survival.

Medicine treatment of Diabetic Kidney Disease

LUCIFINE Finerenone Tablets Is a non-steroidal mineralocorticoid receptor antagonist (MRA) indicated to reduce the risk of sustained eGFR decline end stage kidney disease, cardiovascular death non-fatal myocardial infarction, and hospitalization for hear failure in adult patients with chronic kidney disease(CKD) associated with type 2 diabetes T2D)

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of a drug and may not reflect the rates observed in practice.

The safety of LUCIFINE was evaluated in 2 randomized, double-blind, placebo-controlled, multicenter pivotal phase 3 studies, FIDELIO-DKD and FIGARO-DKDin which a total of 6510 patients were treated with 10 or 20 mg once daily over a mean duration of 2.2 and 2.9 years, respectively.

LUCIFINE Finerenone Tablets
LUCIFINE Finerenone Tablets

Overall, serious adverse events occurred in 32% of patients receiving LUCIFINE and in 34% of patients receiving placebo in the FIDELIO-DKD study: the findings were similar in the FIGARODKD study. Permanent discontinuations due to adverse events also occurred in a similar proportion of patients in the two studies (6-7% of patients receiving LUCIFINE and in 5-6% of patients receiving placebo).

The most frequently reported (≥10%)adverse reaction in both studies was hyperkalemia [see Warnings and Precautions(5.1)]. Hospitalization due to Hyperkalemia for the LUCIFINE was 0.9% vs 0.2% in the placebo group across both studies. Hyperkalemia led to permanent discontinuation of treatment in 1.7% receiving LUCIFINE versus 0.6% of patients receiving placebo across both studies.

LUCIFINE is a CYP3A4 substrate. Concomitant use with a strong CYP3A4 inhibitor increases Finerenone exposure, which may increase the risk of LUCIFINE adverse reactions. Concomitant Use of LUCIFINE with strong CYP3A4 inhibitors is contraindicated see Contraindications (4) Avoid concomitant intake of grapefruit or grapefruit juice.

Moderate and Weak CYP3A4 Inhibitors LUCIFINE is a CYP3A4 substrate. Concomitant use with a moderate or weak CYP3A4 inhibitor increases Finerenone exposure, which may increase the risk of LUCIFINE adverse reactions. Monitor serum potassium during drug initiation or dosage adjustment of either LUCIFINE or the moderate or weak CYP3A4 inhibitor, and adjust LUCIFINE dosage as appropriate [(see Dosing and Administration (2.3) and Drug interaction (7 .2)]. Strong and Moderate CYP3A4 inducers.

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LUCIFINE is a CYP3A4 substrate. Concomitant use of LUCIFINE with a strong or moderate CYP3A4 inducer decreases Finerenone exposure. which may reduce the efficacy of LUCIFINE. Avoid concomitant use of LUCIFINE with strong or moderate CYP3A4 inducers.

It’s widely known that the treatment for type 2 diabetes, RYBELSUS® (semaglutide) tablets, comes with a high cost of up to $995 for 30 tablets. Similarly, the medication for treating diabetic kidney disease, Kerendia finerenone tablets, can be as expensive as $670 for 30 tablets. The exorbitant prices of these medications undoubtedly add to the challenges faced by patients in their daily lives.

Is there an equally effective but more affordable medication available? The answer is LUCIFINE finerenone tablets produced by Lucius Pharmaceuticals. LUCIFINE finerenone tablets are a diabetes kidney disease treatment that has received approval from the Laotian Ministry of Health and is manufactured in Lucius Pharmaceuticals’ GMP factory in Laos, as approved by the U.S. FDA.

LUCIFINE finerenone tablets are not only a legitimately authorized medication but also come at a very affordable price, being only one-third the cost of Kerendia finerenone tablets while delivering the same efficacy.

DKD Care Center serves as the authoritative global distributor for LUCIFINE finerenone tablets, and we possess the necessary authorization certificates from Lucius Pharmaceuticals. The introduction of this new medication comes with significant discounts. If you have been suffering from diabetic kidney disease for an extended period, please don’t hesitate to contact us promptly:

Phone: +852 6993858

Whatsapp: +856 2099383722


Prevention of Diabetic Kidney Disease

To reduce the risk of developing diabetic kidney disease, please consider the following:

  • 1. Manage Diabetes: Regularly monitor your diabetes management and have at least an annual check-up, or as advised by your healthcare team. Regular monitoring helps in screening for diabetic kidney disease and other complications.
  • 2. Treat Diabetes: Effective diabetes management can help prevent or delay the onset of diabetic kidney disease.
  • 3. Control High Blood Pressure or Other Conditions: If you have high blood pressure or any other condition that increases the risk of kidney disease, work with your doctor to manage these conditions effectively.
  • 4. Adhere to Over-the-Counter Medication Instructions: Follow the instructions on over-the-counter pain medications like aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) such as Aleve and Advil. Taking these medications improperly can lead to kidney damage in diabetic kidney disease patients.
  • 5. Maintain a Healthy Weight: If your weight is within a healthy range, engage in physical activity most days of the week to maintain it. If weight loss is necessary, consult your doctor for weight loss strategies, such as increasing daily exercise and reducing calorie intake.

Get rid of diabetic kidney disease

Contact our diabetic nephrologists

How to get rid of diabetic kidney disease, contact our online doctors to evaluate your condition.

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