Type 2 Diabetes and chronic kidney disease are linked and have a significant impact on each other. Patients with chronic kidney disease can have their symptoms worsened by Type 2 Diabetes. Similarly, patients with no pre-existing kidney conditions can have them caused by diabetes type 2. This occurs through damage to the blood vessels, which accompanies the development of diabetes. This blood vessel damage extends to the kidney, where the kidney's vascularization is compromised as well. This damage to clusters of blood vessels within the kidney is known as diabetic nephropathy. This lowers the kidney's efficiency and performance. Thus, diabetes creates and/or exacerbates poor kidney function. Therefore, patients with Diabetes can experience kidney disease symptoms such as ankle swelling, weight gain, and hypertension. Diabetes also causes nerve damage, which affects waste removal through urine. The inability to empty the bladder properly that comes with diabetes-induced nerve damage can create infections that back up through the excretion system and damage one's kidneys. 10 to 40 percent of individuals that develop Type 2 Diabetes will end up suffering from kidney disease as a direct result of the negative health outcomes created for the excretory system by diabetes. Thus, kidney disease is something that should be screened regularly among patients with diabetes.
Symptoms of the development of kidney disease in diabetes patients begin with albumin in the urine. This is one of the earliest signs, and it is an important one to keep track of for patients with diabetes. Later signs include ankle swelling and frequent trips to the bathroom and high blood pressure. The development of kidney disease as a result of diabetes is so common that hypertension and diabetes are cited as the top causes of kidney disease among Americans (CDC, 2019). Likewise, research by Umanath, and Lewis cites diabetic nephropathy as the leading cause for end-stage kidney disease, and that it accounts for 30 to 50 percent of the cases within the borders of the United States (Umanath & Lewis, 2018).
Delegate your assignment to our experts and they will do the rest.
Diabetic nephropathy has been associated with an increase in mortality and morbidity among patients with diabetes, especially Type 2 Diabetes. Thus, diabetes is highly comorbid with kidney disease, and it is a cause for concern among patients with either.
Pharmacotherapy
Pharmacotherapeutic agents used for patients’ comorbid with diabetes and kidney disease fall into four kinds. These are agents used to manage hypertension, agents used to control protein levels in urine, agents used to manage high blood sugar, and agents used to manage cholesterol. The pharmacotherapeutic management of hypertension is necessary due to the increased risk of cardiovascular disease development within the population of people with diabetes and kidney disease (Patney et al., 2015) . The goal for physicians treating this specialized population is to reduce blood pressure levels until they reach 150 mmHg systolic (Patney et al., 2015). Previous clinical research shows that blood pressure above this level exacerbates kidney damage and increases the risk of cardiovascular episodes for patients struggling with diabetes (Patney et al., 2015). To achieve this goal, the patient must have their kidneys, blood sugar, and hypertension assessed first. If the patient has an organ injury, lifestyle modification and pharmacotherapy can begin for hypertension. This can be done in one of two ways. The first is with administering either angiotensin II receptor blockers – also known as ARBs – for use as RAAS inhibitors, which can reduce the amount of albumin in the urine, the cardiovascular risk, and the progression of kidney disease (Patney et al., 2015). The alternate way is the use of ACE inhibitors to achieve the same results. This particular course of pharmacotherapy addresses both the reduction of albumin in the urine and the reduction of hypertension. Overall, this will address albuminuria, cardiovascular risk, and hypertension in one move.
Another means of addressing hypertension and associated cardiovascular risk when treating comorbid diabetic nephropathy is to utilize calcium channel blockers (Patney et al., 2015). Calcium channel blockers, also known as CCBs, such as verapamil and diltiazem, are utilized specifically for diabetic patients experiencing kidney disease. They are effective alternatives to patients who react poorly to ARBs and ACE inhibitors (Patney, Whaley-Connell, & Bakris, 2015). Something to look out for with such patients is albuminuria, which will not be addressed by CCBs in the way that ARBs and ACE inhibitors would. It is also possible for these medications to fail in reducing peripheral edema. Thus their use should be accompanied by the administration of a RAAS blocker as well as the CCB (Patney et al., 2015). 
Laboratory Tests
Assessment of the development of comorbid diabetes and chronic kidney disease can begin as early as possible through screening for microalbuminuria. The presence of albumin in the urine is a sign of diabetic nephropathy, which would signal the beginning of diabetes-induced kidney disease. Laboratory test results that are positive for microalbuminuria two to three times are an indication that the patient is suffering from kidney damage. In this case, the results should show 30 to 300 milligrams of albumin present in the urine per gram of creatinine, over six months. The annual screening of diabetes patients for microalbuminuria should allow for it to be captured relatively early.
Another test is the estimated glomerular filtration rate. This test measures the rate at which the kidney filters serum creatinine, which is a muscular metabolite. The results of this test indicate how well the kidney is working, and can thus be used to assess diabetic nephropathy if it is present. A result showing a value of less than 60 mL/min/1.73 m 2 is an indication of chronic kidney disease. Results showing values of less than 15 mL/min/1.73 m 2 are an indication of kidney failure.
Education Strategies and Associated Outcomes
Two agencies materials' that I would use for patient education are the CDC and the WHO. I would utilize their resources as they are evidence-based, and these organizations represent respected experts in the field of health. Thus, its credibility is high.
The first education strategy would be fact-sheet summaries. Although patients are invested in their own health, sometimes the burden of researching vast amounts of data can negatively affect their ability to get all the pertinent information. Thus, I believe that providing information packets or links to resources is important to inspire patient autonomy and participation by providing a short fact-sheet summarizing the main points to take note of. In this case, a fact sheet would serve the double purpose of educating the patient and sensitizing them to issues that they can research further on, in a place that they can reference quickly. The CDC provides several fact sheets on chronic kidney disease, diabetes, and diabetic nephropathy. These fact sheets cover not only self-care strategies but also management options that can better their lifestyle management. I would create a fact sheet summarizing and combining these data with respect to the best collation of information for the patient in question. On the other hand, the WHO provides plenty of in-depth information on diabetic nephropathy, which encompasses the concerns that comorbid diabetes and kidney disease. Thus, I would include these resources in the more detailed information packet accompanying the fact sheet.
These strategies would contribute to positive patient outcomes by addressing both short and long-term patient education needs. The fact sheet would provide quick reference material and provide resources for patients unwilling to dive deep into research. On the other hand, the detailed information packet from WHO material will prove to be an important resource for patients willing to do in-depth research (Greer et al., 2012).
References
CDC. (2019). CKD Risk Factors. Retrieved from https://www.cdc.gov/kidneydisease/publications-resources/2019-national-facts.html#:~:text=Diabetes%20and%20high%20blood%20pressure,the%20kidneys%2C%20and%20older%20age.&text=blood%20pressure.,-Ways%20to%20Prevent
Greer, R. C., Crews, D. C., & Boulware, L. E. (2012). Challenges perceived by primary care providers to educating patients about chronic kidney disease. Journal of renal care , 38 (4), 174-181.
Patney, V., Whaley-Connell, A., & Bakris, G. (2015). Hypertension management in diabetic kidney disease. Diabetes Spectrum , 28 (3), 175-180.
Umanath, K., & Lewis, J. B. (2018). Update on diabetic nephropathy: core curriculum 2018. American Journal of Kidney Diseases , 71 (6), 884-895.
