Diabetes in CKD

Diabetes and CKD: two related diseases.

Diabetes, especially type 2, is the leading cause of CKD worldwide, responsible for 30-50% of cases. When CKD develops due to diabetes, it's called diabetic kidney disease (DKD), which significantly increases the risk of death and complicates treatment. We’re going to break down how diabetes contributes to CKD, its impact on health, and how a ketogenic diet may offer benefits.

How Common is Diabetes-Related CKD?

In high-income countries, diabetes accounts for about 44% of CKD cases, rising to 50-60% in places like the U.S. and Asia-Pacific. Indigenous populations face an even higher risk, with rates 4-5 times higher than non-Indigenous groups. Type 2 diabetes (T2DM) is the main driver, though type 1 diabetes (T1DM) contributes 5-10% of DKD cases.

How does diabetes lead to kidney disease?

High blood sugar (hyperglycemia) damages the tiny filtering units in the kidneys, leading to protein leakage in urine (proteinuria) and a slow decline in kidney function. Without proper control, 30-40% of diabetics develop CKD within 10-20 years.

How Does Diabetes Damage the Kidneys?

Diabetes harms the kidneys in different ways, some of which include:

➡ High Blood Sugar: Damages kidney cells, leading to scarring and protein loss in urine.

➡ Advanced Glycation End-Products (AGEs): Harm blood vessels, making the kidneys work harder. AGEs come from high-carb, processed foods, linking diet to kidney stress.

➡ Oxidative Stress & Inflammation: High blood sugar triggers chronic inflammation that worsens kidney damage.

➡ High Blood Pressure (hypertension): 70-80% of diabetics with CKD also have elevated blood pressure, further straining the kidneys.

➡ Dyslipidemia (abnormal blood lipids): Diabetes often causes high triglycerides and low HDL, which contribute to kidney disease progression.

How Diabetes Increases CKD-Related Death Risk

Diabetes doesn’t just cause CKD—it also makes it more dangerous.

Heart Disease (CVD): Diabetics with CKD are twice as likely to develop heart disease. 50-60% of CKD-related deaths in diabetics are due to heart disease.

Infections: Higher risk of sepsis and pneumonia due to weakened immunity from high blood sugar and kidney dysfunction. CKD patients with diabetes have 1.5-2 times higher infection-related death rates.

Diabetes Complications: Low blood sugar (hypoglycemia) and diabetic ketoacidosis (DKA) become more dangerous in advanced CKD because the kidneys struggle to clear medications and excess acids.

Overall Impact: Diabetics with CKD have a 1.5-2 times higher risk of death compared to non-diabetic CKD patients. Diabetes-related CKD ranks among the top 10 causes of disability worldwide.

Can a Ketogenic Diet Help?

A well-formulated ketogenic diet (low-carb, high-fat, moderate protein)  can offer several benefits for diabetes and CKD:

➡ Better Blood Sugar Control: Studies show ketogenic diets reduce HbA1c and fasting glucose, helping slow CKD progression. Many T2DM patients on keto can reduce or stop insulin, lowering the risk of hypoglycemia.

➡ Reduced Inflammation: Ketones, especially beta-hydroxybutyrate (BHB), have anti-inflammatory effects that may help protect kidney function.

 ➡ Heart Health Benefits: Keto improves lipid profiles, lowering triglycerides and raising HDL, which may reduce heart disease risk in CKD.

Potential Challenges for CKD Patients on Keto:

Traditional CKD diets restrict protein intake, but new research suggests moderate protein (1.0-1.3 g/kg) can be safe in CKD, especially with ketosis. A ketogenic diet includes moderate amounts of protein, but can be modified to fit physician's recommendations.

Electrolytes like potassium and phosphorus need careful monitoring, as CKD affects how the body handles them.

Lesser-Known Insights: Keto & CKD

Gut Health: Diabetes alters gut bacteria, increasing toxic byproducts that worsen CKD. Keto reduces processed carbs that fuel harmful gut bacteria.

Autophagy & Cellular Repair: Ketosis triggers autophagy, a process that removes damaged cells—potentially slowing CKD progression.

Conclusion: A New Approach for CKD & Diabetes?

Diabetes is a major cause of CKD, increasing mortality through heart disease, infections, and metabolic complications. A ketogenic diet offers promising benefits for blood sugar control, inflammation reduction, and heart health—but CKD-specific adjustments are essential.

As research evolves, keto may challenge outdated dietary restrictions and provide a powerful nutritional tool for CKD management.

Sources

USRDS stands for the United States Renal Data System Global Burden of Disease (GBD), KDIGO - Kidney Disease: Improving Global Outcomes, AIHW - Australian Institute of Health and Welfare