The Reason Optimal Medical Therapy is So Effective in Preventing Dialysis in Diabetic Patients
Chronic kidney disease requiring dialysis has doubled in the last two decades. Optimal medical therapy dramatically reduces the number of patients with diabetes who need dialysis. New science around diabetic kidney disease helps us understand why and to be certain of our recommendations.
There are nests of tiny arteries in the kidney called glomeruli. These very small vessels filter the blood and that is how the kidney gets rid of waste products. In diabetic kidney disease these vessels develop scarring that deforms these tiny nests slowly but finally destroying kidney function. The cells that grow to create the scars are called mesangial cells. The process of scarring the glomeruli is called glomerulosclerosis.
Fast food and processed foot that combine fat, salt, sugar, and carbs lead to excess abdominal fat accumulation and weight gain. That switches on genes that increase production of angiotensin II and aldosterone. These two molecules activate their respective receptors to increase oxidant production, growth factor signaling, and finally mTOR which causes mesangial cells to grow. That process results in scar formation leading to a shrunken kidney with reduced function. ACE inhibitors like lisinopril and ARBs like losartan precisely block the effects of angiotensin II. Medications like spironolactone or eplerenone precisely block the effects of aldosterone. These medications specifically block the mechanisms that cause chronic kidney disease. Metformin, empagliflozin, and statins impact the same pathways. Optimal medical therapy is precision medicine that protects every organ in the body in patients with type 2 diabetes. Primary care teams can deliver precision medicine for chronic disease in rural and disadvantaged communities now. Nurse practitioners, pharmacists, and physician assistants in outpatient clinics can make a big difference.
This is the best explanation I have seen explaining how diabetes causes kidney failure.