Kidney Health and Type 1 Diabetes

Understanding Risks, Screening, and Treatment

Adults living with Type 1 diabetes (T1D) are at increased risk for kidney complications, including chronic kidney disease (CKD). These issues can develop slowly over time, often without symptoms in early stages. Proactive screening, prevention, and treatment are essential to protect kidney function and prevent serious complications, including kidney failure.

Why Are Kidney Problems More Common in Type 1 Diabetes?

The kidneys filter waste and excess fluids from the blood. High blood sugar levels over time can damage the delicate blood vessels in the kidneys, leading to a condition known as diabetic kidney disease (DKD).

Key reasons for increased kidney risk in T1D include:

• Chronic high blood glucose, which damages kidney filtering units (glomeruli)
• High blood pressure, which increases pressure on kidney vessels
• Inflammation and oxidative stress, which contribute to scarring
• Genetic factors and coexisting conditions (like heart disease)

About 20–40% of people with Type 1 diabetes will develop kidney complications during their lifetime.

Types of Kidney Issues in T1D

1. Diabetic Nephropathy
   Progressive kidney damage caused by long-term hyperglycemia. It often begins with microalbuminuria (small amounts of protein in the urine) and can lead to kidney failure.
2. Chronic Kidney Disease (CKD)
   Loss of kidney function over time, which is categorized in stages (1 to 5). Stage 5 is end-stage kidney disease (ESKD), requiring dialysis or transplant.
3. Acute Kidney Injury (AKI)
   Sudden drop in kidney function, sometimes triggered by dehydration, illness, or certain medications. People with T1D are more vulnerable.
4. Electrolyte Imbalance
   Impaired kidneys may struggle to balance sodium, potassium, and calcium levels.

Screening Guidelines

Early detection is critical. The American Diabetes Association (ADA) recommends the following for adults with T1D:

• Annual urine test for albumin-to-creatinine ratio (UACR): Detects early protein leakage.
• Annual blood test for estimated glomerular filtration rate (eGFR): Measures kidney function.
• Blood pressure checks: Every diabetes visit.
• Begin screening 5 years after diagnosis, then annually—or sooner if at high risk.

Prevention and Treatment Options

Managing kidney health in T1D focuses on controlling blood sugar, blood pressure, and cholesterol:

Lifestyle and Medical Management

• Tight glucose control: Target A1C is often <7% (or individualized).
• Blood pressure control: Goal is usually <130/80 mmHg.
• Use of ACE inhibitors or ARBs: Medications that protect kidney function and reduce protein in urine.
• Healthy diet: Low in sodium and processed foods; moderate protein if CKD is present.
• Quit smoking: Smoking worsens kidney function.
• Limit NSAIDs: Overuse of ibuprofen or naproxen can harm kidneys.

Advanced Treatment Options

• Dialysis: A treatment for advanced kidney failure that removes waste from the blood
  • Hemodialysis (machine-based)
  • Peritoneal dialysis (home-based, uses abdominal lining)
• Kidney Transplantation: A long-term solution for kidney failure:
  • May come from a living donor or a deceased donor
  • Requires lifelong immunosuppressive medications to prevent rejection
  • People with T1D may receive combined kidney-pancreas transplants, which can eliminate the need for insulin and dialysis

Complications After Kidney Transplant

While transplants are often life-saving, potential complications include:

• Organ rejection
• Infections due to immunosuppressants
• Increased risk of cancer (rare)
• Medication side effects (e.g., high blood pressure, bone loss)
• Recurrence of diabetes-related complications in the new kidney if glucose control remains poor

Regular follow-up with transplant and diabetes specialists is essential.

Which Doctors Manage Kidney Health in T1D?

• Endocrinologist: Manages blood sugar and overall diabetes care.
• Nephrologist: Specializes in kidney function, CKD, dialysis, and transplantation.
• Primary Care Provider: Coordinates routine screening and referrals.
• Transplant Team: Includes surgeons, nephrologists, and transplant coordinators for advanced care.

Final Thought

Kidney disease is a serious complication of Type 1 diabetes. With regular screening, strong blood sugar and blood pressure control, and timely treatment, many people with T1D can protect their kidneys for life—or get access to advanced treatments like transplantation if needed. Stay informed, stay proactive, and work closely with your care team to safeguard your kidney health.

Last updated 09/14/2025.