Diabetes and Kidney Disease: 12 Critical Steps

Updated on: October 18, 2026
Written by: Adel Galal
Medical review status: This article has not been medically reviewed by a nephrologist, endocrinologist, diabetes clinician, registered dietitian, pharmacist, or other licensed healthcare professional.

Diabetes and kidney disease are closely linked because high blood glucose can slowly damage the tiny blood vessels that filter your blood.

The problem is often silent. You may feel well while kidney damage is already developing.

That is why two tests matter so much: eGFR, which estimates kidney filtration, and UACR, which checks whether albumin is leaking into your urine.

Modern care goes far beyond simply lowering blood sugar. Blood pressure, kidney-protective medicines, urine albumin, heart risk, smoking, food choices, and regular follow-up all matter.

This article is for general information and education. It does not replace medical advice, diagnosis, or treatment.

For a broader diabetes guide, read Diabetes and Blood Sugar Management. For kidney focused information, see Chronic Kidney Disease, Chronic Kidney Disease Stages, and Kidney Disease Treatment.

How Does Diabetes Damage the Kidneys?

Your kidneys contain millions of tiny filtering units.

Over time, high blood glucose can damage the blood vessels inside these filters.

This may lead to:

• Albuminuria
• Loss of kidney filtration
• Higher blood pressure
• Progressive chronic kidney disease

This condition is often called diabetic kidney disease or diabetic nephropathy.

However, not every kidney problem in a person with diabetes comes from diabetes. Other kidney diseases can occur too.

12 Critical Steps for Diabetes and Kidney Disease

1. Check eGFR Regularly

eGFR means estimated glomerular filtration rate.

It estimates how well your kidneys filter blood.

People with type 2 diabetes should generally have kidney function checked at least once each year.

People with type 1 diabetes usually begin annual screening after diabetes has been present for about five years.

If CKD is already present, testing may be needed more often.

2. Check UACR Regularly

UACR means urine albumin to creatinine ratio.

It measures albumin leaking through the kidney filters.

This can detect kidney damage even while eGFR is still fairly high.

A UACR below 30 mg/g is generally classified as A1.

A UACR of 30 mg/g or more may indicate kidney damage and usually needs proper interpretation or confirmation.

3. Confirm Abnormal Results

One abnormal urine albumin test does not always mean permanent kidney damage.

UACR may temporarily rise with:

• Exercise
• Fever
• Infection
• Very high blood glucose
• Some acute illnesses

Repeat testing can help confirm whether the change is persistent.

Likewise, a temporary eGFR drop can occur with dehydration, acute illness, low blood pressure, urinary blockage, or certain medicines.

4. Manage Blood Glucose

Better glucose control can reduce the risk of developing or worsening diabetic kidney disease.

Your A1C goal should be personalized.

It may depend on:

• Age
• Duration of diabetes
• Kidney function
• Risk of low blood sugar
• Heart disease
• Other medical conditions

Do not assume that one A1C target fits every person.

5. Control Blood Pressure

Blood pressure control is one of the strongest tools for protecting kidneys.

High blood pressure can damage kidney blood vessels and speed CKD progression.

Current diabetes guidance commonly recommends a blood pressure below 130/80 mmHg for many people with diabetes and CKD when treatment can be used safely.

Some people may need a different goal based on age, symptoms, falls, medicine tolerance, and overall health.

6. Use an ACE Inhibitor or ARB When Appropriate

ACE inhibitors and ARBs can lower blood pressure and reduce albumin leakage.

They are especially important for many people with:

• Diabetes
• High blood pressure
• Albuminuria

Monitoring may include:

• Creatinine
• eGFR
• Potassium
• Blood pressure

ACE inhibitors and ARBs should generally not be combined together.

They are not automatically needed for primary kidney prevention in a person with normal blood pressure, normal UACR, and normal eGFR.

7. Use an SGLT2 Inhibitor When Appropriate

SGLT2 inhibitors have become a major part of modern diabetic kidney care.

For eligible people with type 2 diabetes and CKD, these medicines can reduce:

• CKD progression
• Kidney failure risk
• Heart failure hospitalization
• Cardiovascular events

Kidney benefits are not explained only by lower blood sugar.

Current guidance supports starting an SGLT2 inhibitor with proven benefit in many people with type 2 diabetes and CKD when eGFR is at least 20.

Once started, it can often be continued at lower eGFR values until kidney failure, if it remains safe and tolerated.

8. Consider GLP 1 Therapy When Appropriate

GLP 1 based medicines can help reduce cardiovascular risk and can also slow kidney disease progression in selected people with type 2 diabetes and CKD.

Depending on the medicine and the individual, benefits can include:

• Lower blood glucose
• Weight reduction
• Lower cardiovascular risk
• Kidney protection

These medicines are not interchangeable, and the best option depends on kidney function and other health conditions.

9. Consider Finerenone in Selected People

Finerenone is a nonsteroidal mineralocorticoid receptor antagonist.

It can reduce kidney and cardiovascular events in selected people with:

• Type 2 diabetes
• CKD
• Persistent albuminuria
• Suitable eGFR
• Acceptable potassium

Potassium must be monitored because finerenone can raise it.

Current ADA guidance also allows selected simultaneous use of an SGLT2 inhibitor and finerenone in adults with persistent albuminuria who meet specific kidney function criteria.

10. Protect Your Heart Too

Diabetes plus CKD sharply increases cardiovascular risk.

Kidney care should therefore include attention to:

• Blood pressure
• Cholesterol
• Smoking
• Physical activity
• Weight when relevant
• Heart protective medicines when appropriate

Kidney protection and heart protection often overlap.

11. Review Food, Fluids, and Medicines

There is no single diabetic kidney diet for everyone.

Your plan depends on:

• eGFR
• UACR
• Potassium
• Phosphorus
• Blood pressure
• Blood glucose
• Dialysis status

Medicine review matters too because some drugs can become unsafe or need dose changes as kidney function falls.

12. Monitor Progression and Act Early

People with established CKD may need eGFR and UACR checked more than once per year.

Monitoring helps detect:

• Falling eGFR
• Increasing albuminuria
• High potassium
• Medicine effects
• Anemia
• Other CKD complications

Do not wait until kidney function becomes severely reduced before reviewing the treatment plan.

What Are the Symptoms of Diabetic Kidney Disease?

Early diabetic kidney disease often causes no symptoms.

As kidney disease becomes more advanced, possible symptoms include:

• Swollen feet or ankles
• Fatigue
• Poor appetite
• Nausea
• Itchy skin
• Muscle cramps
• Foamy urine
• Changes in urination
• Shortness of breath
• Difficulty concentrating

None of these symptoms proves diabetic kidney disease.

Can You Have Diabetic Kidney Disease Without Symptoms?

Yes.

This is common in early disease.

You can feel well while UACR is already elevated or eGFR is beginning to fall.

Regular testing matters more than waiting for symptoms.

What Are the Main Risk Factors?

Risk rises with:

• Longer duration of diabetes
• High blood glucose
• High blood pressure
• Smoking
• Cardiovascular disease
• Obesity
• Existing albuminuria
• Lower eGFR
• Family history of kidney disease

Type 1 vs Type 2 Diabetes Kidney Screening

Why Does Type 2 Diabetes Get Tested Earlier?

Type 2 diabetes can exist for years before diagnosis.

This means kidney damage may already be present when diabetes is first discovered.

Type 1 diabetes usually has a more clearly defined start, so kidney screening typically begins later.

What Does eGFR Tell You?

eGFR estimates filtration.

G1 and G2 do not prove CKD by themselves. Another marker of kidney damage is needed.

What Does UACR Tell You?

Why eGFR and UACR Must Be Read Together

A person can have normal looking eGFR but significant albumin leakage.

Another person can have low eGFR with little albuminuria.

The combination helps estimate:

• Kidney progression risk
• Cardiovascular risk
• Monitoring frequency
• Treatment intensity

Can Diabetes Cause Kidney Disease Without Albuminuria?

Yes.

Some people with diabetes develop reduced eGFR without major albumin leakage.

This is another reason both tests are necessary.

When Might Kidney Disease Have Another Cause?

Do not assume every kidney abnormality in diabetes is caused by diabetes.

Doctors may look for another cause when there is:

• Blood in the urine
• Rapid kidney decline
• Very sudden protein leakage
• An unusual urine sediment
• Signs of autoimmune disease
• An atypical clinical pattern

Blood Pressure and Diabetic Kidney Disease

High blood pressure and diabetes can damage the same small kidney blood vessels.

This makes blood pressure treatment especially important.

Helpful steps include:

• Taking prescribed medicines
• Reducing excess sodium
• Physical activity
• Weight management when needed
• Home blood pressure monitoring

Why Albumin Reduction Matters

Albuminuria is more than a diagnostic marker.

Lowering very high urine albumin can also reflect a useful treatment response.

Current diabetes guidance aims for a meaningful reduction in UACR in people with severely increased albuminuria.

SGLT2 Inhibitors and the Initial eGFR Dip

SGLT2 inhibitors can cause a small early fall in eGFR after treatment begins.

This does not automatically mean the medicine is damaging the kidneys.

A modest early change can reflect the medicine's effect on pressure inside the kidney filters.

Long term, the medicine can slow kidney function loss in eligible patients.

Kidney function and clinical status still need monitoring.

ACE Inhibitors, ARBs, and Creatinine

A small rise in creatinine can occur after an ACE inhibitor or ARB is started.

This does not always mean treatment should stop.

Clinical guidance allows continuation with some mild to moderate creatinine increases when there is no significant dehydration or another safety problem.

Potassium and kidney function still need monitoring.

Can ACE Inhibitors and ARBs Be Used Together?

Usually no.

Combining them can raise the risk of:

• High potassium
• Low blood pressure
• Acute kidney injury

A healthcare professional should choose one approach rather than routine dual therapy.

Metformin and Kidney Function

Metformin is commonly used for type 2 diabetes.

Kidney function affects whether it can be started or continued safely and whether closer monitoring is needed.

Do not stop metformin because of one kidney result without discussing it with your clinician.

Low Blood Sugar Risk in CKD

As kidney function declines, some glucose lowering medicines stay in the body longer.

This can increase the risk of hypoglycemia.

Insulin requirements may also change.

That is why diabetes medicine doses often need review as eGFR falls.

Diabetes, CKD, and Protein Intake

More protein is not always better.

For many people with nondialysis CKD, very high protein intake is discouraged.

Current diabetes guidance commonly uses around 0.8 grams of protein per kilogram of body weight per day for people with stage G3 or higher CKD who are not receiving dialysis.

Dialysis often increases protein needs.

A renal dietitian can help prevent both excess intake and malnutrition.

Should Everyone With Diabetic Kidney Disease Avoid Potassium?

No.

Potassium restriction should depend on:

• Blood potassium
• eGFR
• Medicines
• Dialysis status
• Other medical conditions

Do not automatically remove bananas, potatoes, beans, tomatoes, oranges, or avocados simply because CKD is present.

Should Everyone Restrict Phosphorus?

No.

Phosphorus restriction becomes more important when advanced CKD causes mineral balance problems or laboratory tests show a reason for restriction.

Processed foods with phosphate additives can be especially relevant.

How Much Water Should You Drink?

There is no universal amount for diabetes and kidney disease.

Fluid needs depend on:

• Kidney function
• Urine output
• Swelling
• Heart health
• Dialysis
• Weather and activity

Drinking excess water does not flush diabetic kidney damage away.

Why Salt Substitutes Can Be Risky

Some salt substitutes replace sodium with potassium.

This can be a problem for people whose potassium is already high or whose medicines increase potassium.

Check the label and ask your healthcare team before using potassium based salt substitutes.

NSAIDs and Diabetic Kidney Disease

NSAID pain medicines can reduce blood flow through the kidneys.

Examples include:

• Ibuprofen
• Naproxen
• Diclofenac

The risk rises with:

• CKD
• Dehydration
• Heart failure
• Older age
• Some blood pressure medicines
• Diuretics

Ask a healthcare professional about safer pain options if you have kidney disease.

Smoking and Kidney Risk

Smoking damages blood vessels and increases cardiovascular risk.

Stopping smoking is an important part of protecting both the kidneys and the heart.

Physical Activity

Regular activity can support:

• Blood glucose
• Blood pressure
• Heart health
• Weight management
• Fitness
• Mental health

People using insulin or medicines that can cause low blood sugar should learn how exercise affects glucose.

Do Kidney Detoxes Help?

No tea, juice, herb, powder, or supplement has been proven to reverse diabetic kidney disease.

Some supplements can actually:

• Damage the kidneys
• Raise potassium
• Interact with diabetes medicines
• Contain contaminants

Tell your clinician about every supplement you take.

How Often Should Kidney Tests Be Repeated?

When there is no known CKD, testing is commonly done once each year in people who meet diabetes screening criteria.

When CKD is present, eGFR and UACR may be monitored one to four times each year depending on:

• GFR category
• Albuminuria category
• Rate of progression
• Medicine changes
• Other health conditions

When Should You See a Nephrologist?

Kidney specialist referral becomes especially important when there is:

• eGFR below 30
• Continuously falling eGFR
• Continuously increasing albuminuria
• Rapid kidney decline
• An unclear cause
• Resistant blood pressure
• Repeated high potassium
• Complex CKD complications

When Is Diabetes and Kidney Disease an Emergency?

Seek urgent medical care for:

• Severe trouble breathing
• Chest pain
• Fainting or collapse
• Marked confusion
• Almost no urine
• Rapidly worsening swelling
• Persistent vomiting
• Severe weakness
• Symptoms of an abnormal heartbeat

Common Diabetes and Kidney Disease Myths

A Practical Kidney Protection Checklist

1. Know your eGFR.
2. Know your UACR.
3. Repeat abnormal tests when advised.
4. Know your personal A1C goal.
5. Know your blood pressure goal.
6. Take prescribed ACE inhibitor or ARB treatment correctly.
7. Ask whether an SGLT2 inhibitor is appropriate.
8. Ask whether GLP 1 therapy is appropriate.
9. Ask whether finerenone is appropriate if albuminuria persists.
10. Check potassium when medicines require it.
11. Avoid unnecessary NSAIDs.
12. Do not use kidney detox products.
13. Stop smoking.
14. Stay active as your health allows.
15. Review kidney tests regularly.

Conclusion: Protect Yourself From Diabetes and Kidney Disease

Diabetes and kidney disease often develop quietly, so waiting for symptoms can delay treatment.

Know your eGFR and UACR. Work with your healthcare team on glucose and blood pressure, and ask whether kidney protective treatments such as an SGLT2 inhibitor, ACE inhibitor or ARB, GLP 1 medicine, or finerenone fit your situation.

If kidney results are worsening, ask whether the pattern is truly from diabetes, whether another kidney disease needs to be ruled out, and how often testing should be repeated.

Early testing and modern treatment can make a meaningful difference in long term kidney and heart risk.

References and Sources

1. American Diabetes Association. Standards of Care in Diabetes 2026: Chronic Kidney Disease and Risk Management.
   Covers annual eGFR and UACR screening, blood pressure, ACE inhibitors, ARBs, SGLT2 inhibitors, GLP 1 therapy, finerenone, monitoring, and nephrology referral.
   https://diabetesjournals.org/care/article/49/Supplement_1/S246/163914/11-Chronic-Kidney-Disease-and-Risk-Management
2. National Institute of Diabetes and Digestive and Kidney Diseases. Diabetic Kidney Disease.
   Covers yearly kidney testing, blood glucose, blood pressure, diabetes related kidney damage, and prevention.
   https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/diabetic-kidney-disease
3. NIDDK. Quick Reference on UACR and GFR.
   Explains why eGFR and urine albumin are the two main markers used to detect and monitor kidney disease in diabetes.
   https://www.niddk.nih.gov/health-information/professionals/advanced-search/quick-reference-uacr-gfr
4. KDIGO. 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease.
   Covers CKD definition, staging, kidney protection, SGLT2 inhibitor use, monitoring, complications, progression, and referral.
   https://kdigo.org/guidelines/ckd-evaluation-and-management/
5. ADA and KDIGO. Diabetes Management in Chronic Kidney Disease Consensus Report.
   Covers SGLT2 inhibitors, GLP 1 therapy, finerenone, ACE inhibitor and ARB treatment, metformin, glucose care, and kidney monitoring.
   https://diabetesjournals.org/care/article/45/12/3075/147614/Diabetes-Management-in-Chronic-Kidney-Disease-A
6. NIDDK. Identify and Evaluate Patients With Chronic Kidney Disease.
   Explains why kidney disease in diabetes should not automatically be assumed to be diabetic kidney disease and describes further evaluation when the pattern is atypical.
   https://www.niddk.nih.gov/health-information/professionals/clinical-tools-patient-management/kidney-disease/identify-manage-patients/evaluate-ckd

Internal Links and Helpful NextFitLife Guides

• Diabetes and Blood Sugar Management
• Type 2 Diabetes
• Kidney Disease
• Chronic Kidney Disease
• Chronic Kidney Disease Stages
• Sign of Healthy Kidney
• Kidney Disease Symptoms
• Kidney Disease Treatment
• Kidney Healthy Foods
• Diet for Kidney Disease
• NextFitLife Health Hub

Frequently Asked Questions

How does diabetes damage the kidneys?

High blood glucose can damage the small blood vessels in the kidney filters over time, which can lead to albumin leakage and reduced filtration.

What tests check for diabetic kidney disease?

The two main tests are eGFR from a blood test and UACR from a urine sample.

How often should people with type 2 diabetes get kidney tests?

Current guidance recommends eGFR and UACR testing at least once each year from the time type 2 diabetes is diagnosed.

When should people with type 1 diabetes start kidney screening?

Kidney screening usually begins after type 1 diabetes has been present for at least five years.

Can diabetic kidney disease have no symptoms?

Yes. Early kidney disease often causes no symptoms, so regular blood and urine testing is important.

What is UACR?

UACR is the urine albumin to creatinine ratio. It measures albumin leakage and helps detect kidney damage.

What UACR level is abnormal?

A UACR of 30 mg/g or higher is considered increased and may indicate kidney damage when the finding is persistent.

What eGFR means chronic kidney disease?

An eGFR below 60 that persists for at least three months can meet CKD criteria. Higher eGFR can still occur with CKD when another marker of kidney damage is present.

Can diabetes cause kidney disease without protein in urine?

Yes. Some people with diabetes develop reduced kidney filtration without major albuminuria.

Does every kidney problem in diabetes come from diabetes?

No. People with diabetes can also develop other kidney diseases, particularly when the pattern of kidney damage is unusual.

Do SGLT2 inhibitors protect the kidneys?

Yes. In eligible people with type 2 diabetes and CKD, SGLT2 inhibitors can reduce CKD progression and cardiovascular events.

What eGFR is needed to start an SGLT2 inhibitor for CKD?

Current diabetes guidance recommends starting a proven SGLT2 inhibitor in many people with type 2 diabetes and CKD when eGFR is at least 20 mL/min/1.73 m².

Do GLP 1 medicines help the kidneys?

Selected GLP 1 medicines with proven benefit can reduce kidney disease progression and cardiovascular risk in people with type 2 diabetes and CKD.

What is finerenone?

Finerenone is a nonsteroidal mineralocorticoid receptor antagonist that can reduce kidney and cardiovascular events in selected people with type 2 diabetes, CKD, and albuminuria.

Are ACE inhibitors or ARBs used for diabetic kidney disease?

Yes. They are important treatments for many people with diabetes, high blood pressure, and albuminuria.

Should an ACE inhibitor and ARB be taken together?

Routine combination therapy is generally avoided because it can increase the risk of high potassium, low blood pressure, and acute kidney injury.

Should everyone with diabetic kidney disease avoid potassium?

No. Potassium restriction depends on blood potassium, kidney function, medicines, and individual needs.

How much water should someone with diabetic kidney disease drink?

There is no universal amount. Fluid needs depend on kidney function, urine output, swelling, heart health, activity, and dialysis status.

When should someone with diabetic kidney disease see a nephrologist?

Referral is especially important with eGFR below 30, continuously declining kidney function, rising albuminuria, rapid progression, difficult management, or an uncertain cause.

When is diabetes and kidney disease an emergency?

Seek urgent care for severe trouble breathing, chest pain, fainting, marked confusion, almost no urine, rapidly worsening swelling, persistent vomiting, severe weakness, or symptoms of an abnormal heartbeat.