Chronic kidney disease (CKD) is often accompanied by other serious conditions, the most common being diabetes, hypertension (high blood pressure), and cardiovascular disease (CVD). These conditions are deeply interconnected, and they must all be managed effectively in order to preserve kidney function.
The presence of multiple conditions creates a complex medical puzzle that requires careful, individualized management. With the right strategies, providers can help patients slow kidney disease progression and improve their quality of life.
How diabetes, hypertension, and CVD drive CKD progression
The National Institute of Diabetes and Digestive and Kidney Diseases states that diabetes and high blood pressure are the leading causes of CKD.1 In diabetes patients, prolonged high blood sugar levels (hyperglycemia) can damage the kidneys’ filtering units, leading to protein leakage and reduced kidney function. If left unchecked, this can eventually lead to kidney failure. For those with hypertension, if blood pressure is not controlled, the blood vessels and filtering units in the kidneys may be damaged, which can inhibit their function.
At the same time, CKD increases the risk of CVD. According to the U.S. Centers for Disease Control and Prevention (CDC), “When the kidneys don't work well, it puts stress on the heart. When someone has CKD, their heart needs to pump harder to get blood to the kidneys. This can lead to heart disease, the leading cause of death in the United States.”2
High blood pressure, often a cause and a consequence of CKD, further accelerates cardiovascular damage. This creates a dangerous cycle where heart disease worsens kidney disease, and vice versa.
Because these conditions are so tightly linked, treating each in isolation isn’t enough. Instead, a comprehensive, whole-patient approach is needed to manage risk factors and slow disease progression.
Managing blood sugar and kidney health
For patients with both CKD and diabetes, balancing blood sugar control with kidney protection is essential. Keeping blood sugar levels controlled can help prevent further kidney damage, while overly aggressive glucose control can lead to harmful low blood sugar, or hypoglycemia, particularly in patients with advanced CKD. The American Diabetes Association states that most adults with diabetes should aim for an A1C less than 7%, although target levels vary based on patients’ overall health and risk factors.3
Certain diabetes medications have proven to be especially beneficial for patients with CKD. SGLT inhibitors, for example, not only help control blood sugar but also protect kidney function and reduce cardiovascular risk. Similarly, GLP-1 receptor agonists offer additional cardiovascular benefits and are another good choice for CKD patients. On the other hand, some traditional diabetes medications, like metformin and sulfonylureas, are great choices in earlier stages of CKD, but may need to be stopped or used with caution in later stages of CKD due to the risks of lactic acidosis and hypoglycemia, respectively.
Diet also plays a critical role in managing CKD and controlling blood sugar. Carbohydrate management is important, but recommendations should be tailored to each patient’s dietary needs and preferences. Partnering with a registered dietitian can be invaluable in helping patients make sustainable, healthy food choices. Healthmap Solutions also recommends reviewing our “Kidney-Friendly Recipes” list for links to helpful meal planning ideas.
Keeping the heart and kidneys in sync
CVD is the leading cause of death in CKD patients. Therefore, protecting the heart is a top priority. Blood pressure control is a major part of this equation. According to the American Heart Association (AHA), blood pressure less than 120/80 mm Hg is considered normal, while blood pressure above 130/80 mm Hg is considered high and may require treatment.4 Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are considered first-line treatments due to their dual benefits for the heart and kidneys.
Lipid management is another key consideration. Statins, a type of medication to reduce cholesterol, are generally recommended for all CKD patients 50 years or older, as well as for those younger than 50 if they have diabetes or CVD, though decisions should be personalized based on the patient’s stage of kidney disease and overall health status. Lifestyle factors, including regular physical activity, weight management, and diet, also play a crucial role in lowering cardiovascular risk.
Patients with both CKD and heart failure must also pay close attention to fluid management. Patients may need to reduce their sodium intake, which helps control blood pressure and limits fluid retention. Diuretics can also help control fluid buildup, but they must be used cautiously to avoid worsening kidney function. The good news is that newer medications, like SGLT inhibitors, have shown promise in improving outcomes for patients with both heart failure and CKD. Healthmap offers more information for patients on ACE inhibitors, ARBs, statins, and SGLT inhibitors on our Patient Resources webpage.
Managing cardiovascular-kidney-metabolic syndrome risk
In 2023, the AHA formally defined cardiovascular-kidney-metabolic (CKM) syndrome as “a health disorder due to connections among heart disease, kidney disease, diabetes, and obesity leading to poor health outcomes.”5 This diagnosis includes those at risk for CVD and those with existing CVD. Because of the interconnectedness of these conditions and their risk factors, the AHA emphasizes the need for “a holistic, person-centered approach to CKM syndrome,” highlighting the importance of managing weight, blood pressure, lipids, and blood glucose to mitigate cardiovascular risk.
The role of coordinated patient-centered care
Managing CKD alongside diabetes, hypertension, and/or CVD isn’t a one-size-fits-all process. Each patient has unique needs. A collaborative, team-based approach has been shown to be the most effective way to provide comprehensive care. Coordination between nephrologists, endocrinologists, cardiologists, and primary care providers is needed to avoid potential treatment conflicts and duplication.
Healthmap Solutions supports this kind of integrated care through our Kidney Population Health Management program, which focuses on proactive population management, early risk identification, and personalized care strategies that address all comorbidities for CKD and end-stage renal disease (ESRD) patients. Our multidisciplinary Care Navigation team works with providers to support high-risk patients, improve adherence to treatment plans, and promote better overall health outcomes. Our goal is to help providers deliver efficient, patient-centric care that simultaneously reduces treatment costs while improving outcomes and quality of life for patients living with kidney disease.
1 https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/causes
2 https://www.cdc.gov/kidney-disease/risk-factors/link-between-diabetes-and-heart-disease.html
3 https://diabetes.org/about-diabetes/a1c
4 https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure
5 https://www.heart.org/en/professional/cardiovascular-kidney-metabolic-health
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