Kidney disease is often a metabolic disease in disguise
On March 12, 2026the world marks World Kidney Day— a global initiative dedicated to raising awareness about kidney health and preventing kidney disease.
Kidneys rarely fail suddenly. More often than not, the process unfolds quietly for decades. Long before symptoms appear, subtle metabolic disturbances may already be putting pressure on the delicate filtering system that keeps our internal environment stable.
Today, chronic kidney disease affects hundreds of millions of people around the worldand its primary cause is no longer infection or injury. It is diabetes and metabolic dysfunction.
However, an important question is increasingly being asked in the medical community:
Is Diabetic Kidney Disease Really Just About Blood Sugar?
Information from Dr. Yvo SijpkensNutrition Network lecturer and pathologist and vascular medicine specialist from the Netherlands, suggest that the answer may be much more complex. His lecture on diabetic kidney disease, presented at Basic Food Web Science Trainingoffers a powerful framework for understanding why kidney disease can actually begin years before diabetes is diagnosed.
The Kidney: A Metabolic Powerhouse
The kidneys are among the most valuable organs of the human body. They filter vast amounts of blood every day, removing waste, balancing fluids and electrolytes, regulating acid-base status, and producing hormones involved in blood pressure control.
Inside each kidney are about a million microscopic filtration units called nephrons. At the center of each nephron sits the glomerulusa tiny capillary network that filters the blood while preventing essential molecules such as proteins and red blood cells from escaping in the urine.
When these filtration units are healthy, they perform their job with excellent efficiency. But when exposed to prolonged metabolic stress, the system begins to falter.
The growing burden of diabetic kidney disease
According to Dr. Sijpkens, diabetic kidney disease (DKD) it has been done leading cause of kidney failure worldwide. The condition is usually diagnosed when two clinical indicators appear: leakage of protein into the urine (albuminuria) and a decrease in the filtration capacity of the kidneys, measured by glomerular filtration rate (GFR).
Roughly one third of people with diabetes will develop diabetic kidney disease during their lifetime.
But when clinicians take a closer look at these patients’ histories, a striking pattern often emerges. Hypertension, fatty liver, cardiovascular disease and insulin resistance often occur years before the official diagnosis of diabetes.
In other words, the metabolic disturbances that cause kidney damage may be present long before blood glucose levels cross the threshold for diabetes.
The hidden role of hyperinsulinemia
One of the most important ideas highlighted in Dr. Sijpkens is his role hyperinsulinemia—chronically elevated insulin levels—in the development of kidney disease.
In many patients, insulin resistance gradually causes the pancreas to produce greater and greater amounts of insulin in order to keep blood glucose within normal limits. At this stage, laboratory glucose levels may still appear relatively normal, but insulin levels may be dramatically elevated.
Over time, this metabolic state contributes to multiple processes that stress the kidneys. High insulin levels can promote sodium retention, raising blood pressure. They can impair the function of the endothelium, destroying the lining of the blood vessels. They may also contribute to inflammation, fibrosis and metabolic stress in kidney tissue.
The result is a slow cascade of vascular and metabolic damage that eventually manifests as diabetic kidney disease.
Hyperfiltration: The kidney is working too hard
One of the first detectable changes in diabetic kidney disease is something known as glomerular hyperfiltration. At first glance, the kidneys may appear to be performing well—sometimes even filtering more efficiently than normal.
But this apparent increase in filtration reflects a state of physiological stress. The increased pressure within the glomerulus forces the filtration system to work harder, gradually damaging the delicate structures that form the filtration barrier.
Over time, this excessive workload leads to leakage of protein into the urine and progressive loss of kidney function.
Hyperfiltration appears to be caused by a variety of metabolic factors, including chronic hyperglycemia, hypertension, inflammation, and insulin resistance. These processes disrupt the delicate balance of blood flow entering and exiting the glomerulus, increasing pressure within the filtration unit and accelerating structural damage.
Metabolic Dysfunction: A Broader Perspective
Rather than seeing diabetic kidney disease purely as a complication of diabetes, Dr. Sijpkens suggests a broader framework: metabolic dysfunction.
This concept recognizes that a wide range of chronic diseases—including obesity, hypertension, fatty liver disease, cardiovascular disease, and chronic kidney disease—often share the same underlying metabolic factors.
Patients with metabolic dysfunction often have early warning signs long before overt disease occurs. An increase in waist circumference, an increase in blood pressure, increased triglycerides, a decrease in HDL cholesterol, and subtle changes in liver enzymes or uric acid levels can all signal underlying insulin resistance. Renal markers such as a decrease in GFR or an increase in urinary albumin may appear later as the disease progresses.
This perspective redefines kidney disease not as a single organ problem but as part of a systemic metabolic disorder.
Treatment revisited: Beyond symptom management
For decades, the medical approach to diabetic kidney disease has largely focused on controlling risk factors. Doctors prescribe drugs to lower blood glucose, lower blood pressure, or manage cholesterol levels.
In recent years newer drugs such as e.g SGLT2 inhibitors, GLP-1 receptor agonistsand mineralocorticoid receptor antagonists have shown promising benefits for cardiovascular and renal outcomes. These drugs are a major advance and may provide substantial protection for many patients.
However, Dr. Sijpkens argues that drugs alone cannot fully address the root cause if the metabolic dysfunction remains uncorrected. Without addressing the upstream drivers of insulin resistance, patients may accumulate an increasing number of medications while the underlying metabolic disorder persists.
The role of nutrition in kidney health
One of the most debated questions in nephrology concerns the effect of dietary protein and carbohydrate intake on kidney health.
For many years, clinicians feared that higher protein intake—especially in the context of a low-carbohydrate diet—could accelerate kidney damage by increasing glomerular filtration pressure. This concern has shaped dietary guidelines for decades.
However, research examining this issue has produced more mixed findings. A two-year randomized clinical trial comparing a low-carbohydrate, high-protein diet with a conventional low-fat diet no evidence of deleterious effects on renal filtration, albuminuria, or electrolyte balance was found in obese adults.
These findings suggest that, at least in people with healthy kidneys, carbohydrate restriction does not appear to harm kidney function.
In fact, dietary approaches that lower insulin levels and improve metabolic health may reduce several of the factors that cause kidney damage.
Prevention starts earlier than diagnosis
Perhaps the most powerful message from the work of Dr. Sijpkens is its meaning early recognition of metabolic dysfunction.
Kidney disease rarely comes on suddenly. Instead, it develops gradually as metabolic stress accumulates over years or decades. During this time, there are many opportunities for intervention – long before irreversible kidney damage occurs.
Lifestyle measures that improve metabolic health, such as nutrient-dense whole foods, reduced intake of refined sugars and ultra-processed carbohydrates, regular physical activity, adequate sleep, and stress management, may help reduce the burden of metabolic disease and its downstream complications.
These fundamental interventions not only affect blood glucose levels, but also influence insulin sensitivity, vascular function, inflammation, and energy balance—factors that collectively shape kidney health.
A new way of thinking about kidney disease
World Kidney Day offers an opportunity to rethink how we think about chronic disease.
If kidney disease is often the result of long-term metabolic dysfunction, then preventing it requires more than simply managing blood sugar or prescribing additional medications. It requires a deeper understanding of how diet, lifestyle and metabolic health interact to affect the body’s most vital organs.
As Dr. Sijpkens points out, early treatment of metabolic dysfunction can help prevent not only kidney disease, but also many of the chronic diseases that accompany it.
Learn more
The full lecture of Dr. Yvo Sijpkens, “Diabetic Kidney Disease: Evaluation and Treatment”, available within it Basic Food Web Science Trainingwhere clinicians and health professionals explore the physiological foundations of metabolic health and therapeutic nutrition.
On this World Kidney Day, the message is clear: protecting kidney health begins long before kidney disease occurs. By focusing on metabolic health today, we may be able to change the trajectory of chronic disease for generations to come.
