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Diabetes mellitus is a disease in which the body does not make enough insulin or cannot use normal amounts of insulin properly. Insulin is a hormone that regulates the amount of sugar in the blood. A high blood sugar level can cause problems in many parts of the body.

Most common forms of diabetes are Type 1 and Type 2. Type 1 diabetes usually occurs in children. It is also called juvenile onset diabetes mellitus or insulin-dependent diabetes mellitus. The patient has to take insulin injections for the rest of his or her life or receive a panceas transplant.

Type 2 diabetes, which is more common, usually occurs in people over 40 and is called adult onset diabetes mellitus. It is also called non insulin-dependent diabetes mellitus. It is caused by reduced response to insulin and often associated with obesity.

With diabetes, small blood vessels in the body are injured. The kidneys are particularly vulnerable and when damaged cannot clean the blood properly. The body will retain more water and salt than it should, which can result in weight gain and ankle swelling. Diabetes also may cause damage to nerves in the body. This can cause difficulty in emptying the bladder. Pressure resulting from the full bladder can back up and injure kidneys.

About 30 percent of patients with Type 1 (juvenile onset) diabetes and 10 to 40 percent of those with Type 2 (adult onset) diabetes eventually will suffer from kidney failure: the most serious complication of the disease.

The earliest sign of diabetic kidney disease is an increased excretion of albumin in the urine. This is present long before the usual tests done in the doctor's office show a loss of kidney function. So it is important to have this test on a yearly basis. Maintaining control of the diabetes can lower the risk of developing both kidney failure and cardiovascular events (heart attack, strokes).

©2009 National Kidney Foundation www.kidney.org
For more information: International Diabetes Federation www.idf.org;

High Blood Pressure is another important risk factor in CKD patients. When people suffer from high blood pressure it puts more stress on blood vessels throughout the body, including the kidneys. When this happens kidneys cannot filter wastes from the blood properly.

High blood pressure is a global problem and the situation is projected to get worse. The world population is getting older and aging is the most common risk factor for the development of high blood pressure and diabetes as well as CKD. Nearly one billion people worldwide have high blood pressure, and that number is expected to increase to nearly 1.6 billion by 2025. The prevalence of high blood pressure is predicted to increase by 24 percent in developed countries and by 80 percent in developing regions such as Africa and Latin America.

High blood pressure is present in approximately 80 percent of patients with CKD. High Blood Pressure is related to CKD in a number of ways. High blood pressure can independently cause CKD, and CKD can cause high blood pressure. The treatment of high blood pressure has become the most important intervention in the management of all forms of CKD. Lowering blood pressure will reduce the risk of heart disease, which for most patients with CKD, is a more immediate threat than end-stage renal disease (ESRD). It will also reduce the chance of developing ESRD requiring dialysis or kidney transplantation

What can be done to control high blood pressure?
Lifestyle changes, regular exercise and diet can have a profound impact on blood pressure and overall health. Weight loss of as little as 8 to 10 pounds can have a dramatic impact on blood pressure. Reducing consumption of alcohol and cigarettes can also lower blood pressure.

Medications are essential in many patients and include the use of high blood pressure medicine, controlling cholesterol and the treatment of symptoms like anemia.

The kidney was designed to balance the salt intake naturally occurring in foods with normal body needs. Increased salt intake can lead to water retention. Eating as we do, many people accumulate more salt and water than their kidneys can handle. Excessive salt and water increases blood pressure and damages our heart and blood vessel walls. The higher the blood pressure, the more damage is done to kidney blood vessels and the more blood flow to the kidney is reduced, impairing the function of the kidney and ultimately leading to CKD.

A healthy diet with salt reduction to roughly less than five grams (100 mmols sodium) substantially lowers blood pressure. In addition, measuring blood pressure regularly and using medications when necessary are vital to reducing the incidence and risk of CKD.

For more information:
WHO Guidelines for assessment and management of cardiovascular risk http://www.ish-world.com/Documents/71665_71665_OMS_INT-RETIRATION.PDF
World Hypertension League www.worldhypertensionleague.org