[건강한 가족] “Type 2 diabetes causes rapid damage to the kidneys… You need to check not only your blood sugar but also your kidneys regularly.”

an interview Byeong-Wan Lee, professor of endocrinology at Scarry Hospital

Type 2 diabetes, a chronic chronic disease, is accompanied by various complications. A representative example is chronic kidney disease accompanied by diabetes, a microvascular problem. In Korea, the rate of increase in the number of patients with end-stage renal failure requiring dialysis or kidney transplantation due to chronic kidney disease caused by diabetes is the fastest in the world. This is why it is emphasized that if you have diabetes, you should monitor the signs of kidney damage such as albuminuria and estimated glomerular filtration rate every year. On the occasion of World Diabetes Day (November 14), I heard about chronic kidney disease associated with type 2 diabetes from Professor Byeong-Wan Lee (Diabetes Association practice director) from Dept. Endocrinology at Scarry Hospital.

Q: There are many people diagnosed with diabetes who suffer from major and minor problems.

A: “It’s not because I can’t control my blood sugar. The reason is that, as the average life expectancy increases, the time after being diagnosed with diabetes has extended. If the duration of diabetes is more than 10 years, problems arise due to chronic inflammation in all the large and small blood vessels in the body. If the large blood vessels (macrovascular) connected to the brain and heart are blocked, a stroke or myocardial infarction can occur, and if the small blood vessels (microvessels) that make up the eyes and the blocked kidneys, vision may decrease and renal replacement therapy. such as dialysis may be required. Large blood vessels are directly related to life, but small blood vessels affect the quality of life. “If you are diagnosed with diabetes, you need to not only control blood sugar but also monitor target organs such as the cardiovascular system and the kidneys.”

Q: Are there signs of suspected kidney disease associated with diabetes, a microvascular problem?

A: “As a result of edema, the body swells up and a lot of foam appears in the urine. Even diabetic patients have difficulty recognizing changes in their body as their kidney function deteriorates over a long period of time. When the kidney’s glomerular filtration rate decreases, the amount of filtered waste slows down and foamy urine appears as a result of albuminuria, in which albumin (protein) is excreted in the urine. Although the treatment environment has improved compared to before, there are still cases where emergency dialysis is still performed after it is discovered too late that the kidney is damaged. A high incidence of kidney disease, a microvascular problem, occurs in 3 out of 10 diabetic patients aged 30 or older (30.3%) in Korea. In particular, type 2 diabetes requires caution as kidney damage occurs at a rapid rate. Kidney function should be checked annually by testing for albuminuria and monitoring the estimated glomerular filtration rate. This information is also specified in the treatment guidelines of the Korean Diabetes Association.”

Q: Some diabetic patients eat brown rice only to control blood sugar levels.

A: “It is true that brown rice is beneficial for controlling blood sugar levels. However, if you have chronic kidney disease with diabetes, you should prioritize protecting your kidneys more than controlling your blood sugar levels. As kidney function declines, the ability to remove proteins weakens. Brown rice has more protein than rice. If you have reduced kidney function due to chronic kidney disease associated with diabetes, brown rice can be toxic. The same goes for vegetables. Potassium rich in vegetables can also stress the kidneys. Therefore, diabetic patients with poor kidney function should reduce the amount of brown rice and vegetables to protect their kidneys, even if they suffer a loss in blood sugar control. ”

Q: What should I do if proteinuria is detected in a urine stick test?

A: “The detection of proteinuria is a sign that there is a problem with the kidneys. A stick-type urine test can check for proteinuria at home by changing color, but it cannot determine specific values. It is used only to refer to a rough standard. If the duration of type 2 diabetes is long, microvascular problems can occur. Therefore, if proteinuria is detected, it is recommended that you meet your doctor and undergo additional professional blood and urine tests to check kidney function for an accurate diagnosis. It is unfortunate that in Korea, the level of monitoring of kidney function is low even in people with diabetes. If you are diagnosed with diabetes, not only your blood sugar but also your kidney function will be checked regularly. It is important to take preemptive measures to prevent the condition from worsening into end stage kidney failure requiring dialysis treatment. For reference, patients with chronic kidney disease accompanied by diabetes are a high-risk group for dialysis and kidney transplantation. The kidney’s glomerular filtration rate decreases rapidly, and the damaged kidney has difficulty recovering, eventually requiring dialysis or a kidney transplant. “To break this vicious cycle, a new drug (pinerenone) is needed that protects the kidney function from the beginning. ”

Q: It seems important to prevent progression to end-stage renal failure.

A: “That’s right. Previously, it was treated indirectly by controlling blood pressure and blood sugar to maintain kidney function. Recently, it has been able to prevent the progression of chronic kidney disease slow it down with finerenone, a treatment that works directly on the kidneys to suppress kidney inflammation and fibrosis. Finerenone, which is attracting attention as a new treatment strategy for the treatment of chronic kidney disease diabetes, has proven to be effective in reducing the risk of dialysis by 20% by stopping the progression of kidney disease associated with type 2 diabetes through clinical studies such as FIDELIODKD, FIGARO- DKD, and FIDELITY. It has been prescribed as a health insurance benefit since February this year. In clinical practice, many people report a reduction in foam in the urine after ordering finerenone. From the point of view of the medical staff, this in itself is interpreted as an improvement in the work of the kidneys and a reduction in proteinuria. “From a long-term perspective, it is expected to be able to reduce the possibility of stroke and myocardial infarction due to its protective effect on the kidneys as well as the cardiovascular system.”

Q: What would you like to advise diabetic patients?

A: “Diabetes is the leading cause of chronic kidney disease. You must be aware of this clearly and check your kidney function regularly. In addition, due to the nature of diabetes, high blood pressure and hyperlipidemia are often accompanied. Not only blood sugar, but also blood pressure and cholesterol must be managed comprehensively. Also, don’t compare yourself to the past when you were healthy. As you grow older, diseases increase one by one. The more you compare, the worse you get and it does not have a positive effect on the results of the treatment. “If you treat appropriately depending on the severity of the disease, you can maintain your quality of life.”

Seonmi Kwon (kwon.sunmi@joongang.co.kr)