Protecting Kidney Function When You Have Diabetes

Diabetic kidney disease usually progresses silently. By the time symptoms appear, two-thirds of kidney function is gone. The good news: modern medications dramatically slow it down when started early.

Annual screening — non-negotiable

• Urine albumin-to-creatinine ratio (UACR) once a year for every diabetic.
• Serum creatinine + estimated GFR.
• Blood pressure at every visit; target generally below 130/80.
• HbA1c every 3 months; individualized target (often 6.5–7.5%).

What protects the kidney

• ACE inhibitors or ARBs — first-line for any diabetic with albuminuria or hypertension.
• SGLT2 inhibitors (empagliflozin, dapagliflozin) — reduce kidney decline and cardiovascular events even at moderate eGFR.
• GLP-1 agonists for weight and HbA1c control.
• Finerenone in selected cases of persistent albuminuria.

Lifestyle elements

• Lower-sodium diet (under 5 g salt / day).
• Adequate but not excessive protein.
• Hydration appropriate to climate and activity (heatwave risks dehydration AKI).
• Avoid chronic NSAID use; verify any new medication or contrast scan with your nephrologist if eGFR is reduced.

When to see a nephrologist

eGFR consistently below 60, UACR above 300 mg/g, persistent haematuria, or rapidly declining function — all warrant referral. Earlier referral allows planning for renal replacement therapy (transplant or dialysis) if needed.

Coverage in Lebanon

Dialysis is covered by NSSF, MoPH and other public schemes for eligible patients in contracted centres. Kidney transplant is performed at major Lebanese academic hospitals; living-donor evaluation is the most common pathway.