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What This Means For You

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At Stage 2, some key health conditions may now be present—like high blood pressure, type 2 diabetes, high triglycerides, or early signs of kidney problems. These are more than just lab results—they’re signals that your heart, kidney, and metabolic systems are under stress and need attention. These conditions often appear together and can influence each other. For example:

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• Diabetes or high blood pressure can damage your kidneys.

• Kidney problems can cause blood pressure to rise.

• A cluster of issues like high blood sugar, large waist size, and high blood pressure is called metabolic syndrome, which increases your risk for heart and kidney disease.

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Why It Matters​

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Even if these conditions seem manageable right now, they tend to get worse if left untreated. That’s why this stage is a turning point—where early action can help slow or stop the progression to more serious health problems like heart attacks, strokes, or kidney failure. At this stage, your care team will likely focus on:

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• Improving your lifestyle (diet, physical activity, quitting smoking)

• Monitoring lab results regularly

• Using medications that treat more than one issue at once, like lowering blood pressure and protecting your kidneys​​

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Diabetes (Type 2)

In Stage 2, diabetes may be newly diagnosed or not yet well-controlled. It's one of the major drivers of kidney damage and heart disease, so getting your blood sugar into a healthy range is crucial.

 

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Why Your Diet Matters in Diabetes

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Fibre: Your Blood Sugar Regulator

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Fibre slows down the digestion and absorption of carbohydrates, helping to prevent sharp spikes in blood sugar levels. It also supports digestive health and can improve cholesterol levels, which is especially important for people with diabetes.

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Basic Carbohydrate Counting

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Understanding how many carbs are in your food helps you manage your blood sugar more effectively. Carb counting is a simple tool to track your intake and make informed food choices.

 

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Blood Sugar Targets and Monitoring

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Blood sugar targets vary depending on timing:

• Fasting (before meals): 4.0–7.0 mmol/L

• 2 hours after meals: 5.0–10.0 mmol/L

Monitoring your blood sugar regularly helps catch patterns and adjust your treatment accordingly.

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High Blood Sugar and Your Kidneys

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Prolonged high blood sugar can damage the kidneys' filtering system, leading to diabetic kidney disease. Over time, this can progress to kidney failure if not managed properly.

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High Blood Sugar and Your Eyes

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High blood sugar can harm the tiny blood vessels in the eyes, leading to diabetic retinopathy—a leading cause of blindness. Regular eye exams are essential for early detection and prevention.

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High Blood Sugar and Your Heart

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Diabetes increases your risk of heart disease by affecting cholesterol levels and damaging blood vessels. A healthy diet helps keep blood sugars and cholesterol in check, reducing this risk.

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Treating Highs and Lows

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Blood sugar can swing too high (hyperglycemia) or too low (hypoglycemia). Knowing how to recognize and treat these episodes can prevent complications and help you feel better day-to-day.

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Cholesterol

 

What is Cholesterol?

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Cholesterol is a waxy, fat-like substance found in your blood. While your body needs it to build healthy cells, too much cholesterol can lead to health problems—especially in people with diabetes or heart disease risk factors.

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HDL, LDL, and Triglycerides

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• HDL (High-Density Lipoprotein): Often called “good” cholesterol. It helps remove excess cholesterol from your arteries.

• LDL (Low-Density Lipoprotein): Known as “bad” cholesterol. High levels can lead to plaque buildup in arteries.

• Triglycerides: A type of fat found in your blood. High levels can increase your risk of heart disease, especially when combined with low HDL or high LDL.

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ApoB and Lp(a): The Hidden Risk Factors

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• ApoB (Apolipoprotein B): A protein found on harmful cholesterol particles (like LDL). High ApoB means more cholesterol particles damaging your blood vessels.

• Lp(a) (Lipoprotein(a)): A genetically determined type of LDL that increases risk for heart attack, stroke, and aortic valve disease, regardless of your other cholesterol numbers.

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Statins: Cholesterol-Lowering Medication

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Statins are medications that lower LDL cholesterol by blocking the liver’s ability to make cholesterol. They also reduce inflammation and lower your risk of heart attack and stroke. Common statins include atorvastatin, rosuvastatin, and simvastatin.

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Cholesterol and Blood Pressure

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High cholesterol can lead to plaque buildup in blood vessels, making them stiffer and narrower. This forces the heart to work harder, raising your blood pressure over time—a major risk factor for stroke and heart disease.

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Cholesterol and Kidney Health

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Cholesterol can damage the blood vessels in your kidneys, just like it does in the heart. This reduces blood flow and can worsen or even cause chronic kidney disease, especially in people with diabetes or high blood pressure.

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Vascular Risks: Heart and Peripheral Arteries

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• Coronary Artery Disease (CAD): When LDL builds up in the coronary arteries, it reduces blood flow to the heart muscle, leading to chest pain or heart attacks.

• Peripheral Artery Disease (PAD): Cholesterol plaque in arteries of the legs or arms causes poor circulation, pain while walking, and increases risk of amputation.

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Hypertension

High blood pressure is a key cause of both heart disease and kidney failure. Even "mild" elevations increase your long-term risk. And in Stage 2, high blood pressure often coexists with other issues like diabetes or high cholesterol.

 

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Chronic Kidney Disease (CKD)

In Stage 2, CKD may already be showing up in blood or urine tests—like a lower eGFR or protein in your urine. Even a small decline in kidney function is a red flag that your body needs support.​​​​​​​​​​​

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How Do the Kidneys Work?

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Your kidneys filter waste and extra fluid from your blood, control blood pressure, balance minerals, and produce hormones. They’re vital to your overall health—especially if you have diabetes or heart issues.

 

 

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Living with Kidney Disease

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From diagnosis to lifestyle changes and treatments, living with kidney disease requires knowledge, planning, and support. These resources guide you through every step:

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What Are Creatinine and eGFR?

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• Creatinine is a waste product made by muscles. High levels in your blood may mean your kidneys aren't working well.

• eGFR (estimated Glomerular Filtration Rate) is a calculation based on your creatinine, age, sex, and race to estimate kidney function. A lower eGFR means decreased kidney function.

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What is the Urine Albumin-to-Creatinine Ratio (uACR)?

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This test checks for albumin, a type of protein, in your urine. Healthy kidneys should not let albumin pass into urine. A high uACR indicates early kidney damage, even if eGFR is normal.

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Stages of Chronic Kidney Disease (CKD)

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Kidney disease is categorized in stages based on eGFR and uACR:

• Stage 1: eGFR ≥ 90 + signs of kidney damage

• Stage 2: eGFR 60–89 + signs of damage

• Stage 3a/b: eGFR 45–59 (3a), 30–44 (3b)

• Stage 4: eGFR 15–29

• Stage 5: eGFR <15 or dialysis (kidney failure)
  High uACR levels can indicate worsening disease even at higher eGFRs.

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How Cholesterol Affects Kidney Health

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High LDL cholesterol damages blood vessels—including those in the kidneys—causing narrowing and poor blood supply. This can worsen CKD or increase the risk of developing it.

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Blood Pressure and the Kidneys

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High blood pressure puts extra strain on kidney blood vessels, leading to scarring and reduced function over time. It’s both a cause and result of CKD—managing BP is key to kidney protection.

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ACE Inhibitors and ARBs: Kidney Protectors
 

ACE inhibitors (e.g., ramipril) and ARBs (e.g., losartan) lower blood pressure and reduce protein leakage into urine. These medications are especially protective in people with diabetes or proteinuria.

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SGLT2 Inhibitors and Kidney Protection

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Originally for diabetes, SGLT2 inhibitors (like empagliflozin or dapagliflozin) also protect kidneys by lowering pressure in kidney filters, reducing proteinuria (protein in urine), and slowing kidney decline, even in non-diabetic CKD.

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