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Health A-Z

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Harvard Medical School

Treatment

If you have diabetes with high blood pressure, microalbuminuria or blood test evidence of kidney disease, it is important for you to take a medication from the ACE inhibitor or ARB group. These medications slow the progression of kidney disease in people with diabetes, although kidney disease continues to develop gradually. These two medicine groups are closely related, so the drugs usually are not combined with each other.

Reducing the amount of protein in your diet also may be helpful to slow progressing kidney disease.

Once nephropathy reaches advanced stages, you may need dialysis to remove waste products from the blood An alternative way to treat advanced kidney disease is with a kidney transplant. There are two types of dialysis, hemodialysis and peritoneal dialysis. Hemodialysis filters waste substances and excess fluid out of the blood. Hemodialysis usually is done at a dialysis center in three- to four-hour sessions three times a week. Peritoneal dialysis does not directly filter the blood. Instead, for this form of dialysis, sterile fluid is allowed to flow into the abdominal cavity through a catheter that is permanently placed through the skin. The fluid is then removed after it has absorbed waste substances. After practice, peritoneal dialysis can be done at home. It is a good alternative for some people, although it requires significant time and self-care.

Kidney transplants have allowed many people with severe kidney disease to avoid or discontinue dialysis. However, the donor and the recipient have to match genetically, or the body will reject the new kidney. The waiting period for a matching donated kidney is between two and six years. . Anti-rejection drugs that suppress the immune system help the body to accept the donated organ. An organ recipient can expect to take such medications as long as the transplanted kidney continues to function. A transplanted kidney is likely to function for at least 10 years if its genetics are closely matched. If a transplanted kidney stops functioning, dialysis or a new transplant is necessary.

In a person with type 1 diabetes and kidney failure, a kidney-pancreas transplant is another possible treatment. This option is available only for a small number of people because of the scarcity of organ donors, the risks of the surgery, and the need for lifelong immunosuppressive drugs. When it is successful, the transplanted pancreas begins producing insulin and may reverse diabetes.

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From Health A-Z, Harvard Health Publications. Copyright 2007 by the President and Fellows of Harvard College. All rights reserved. Written permission is required to reproduce, in any manner, in whole or in part, the material contained herein. To make a reprint request, contact Harvard Health Publications. Used with permission of StayWell.

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