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Early Diagnosis and Management of CKD in Patients With T2D Offer the Potential to Reduce CV Events, Morbidity, and Mortality1
Early screening for CKD in patients with T2D is crucial because CKD often has no symptoms in its earlier stages, and early intervention can change the trajectory of patient outcomes1,2
What can you do in your practice to improve the uptake and efficiency of CKD screening and monitoring?
Some ideas to get started3:
Include UACR and eGFR alongside routine tests such as A1c
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Create EHR-based reminders for UACR screening tests
Stay informed on various resources
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Implement standing orders for clinical staff (eg, to collect urine specimens)
Use the KDIGO heat map to aid early diagnosis and intervention
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4 steps for early detection and management of CKD in patients with T2D2:
Screening
Screen all patients with T2D at least annually starting at diagnosis
Diagnosis
For ≥3 months:
UACR ≥30 mg/g
OR
eGFR <60 mL/min/1.73 m2
OR
Both
Monitoring
Monitor patients 1-4 times per year (based on CKD stage)
Intervention
Lifestyle modification, diabetes education, and medications to reduce cardiorenal risk
Early diagnosis and appropriate management of CKD associated with T2D offer the potential to1,4,5:
Reduce
CV events
Slow
CKD progression
Reduce
Healthcare costs
Guidelines recommend using both UACR and eGFR to guide CKD detection, monitoring, and treatment, with CKD screening starting at diagnosis of T2D2,4,6-8
Marker of kidney damage4
Measure of kidney function4
Expand to see screening and monitoring guidelines and recommendations:
- 11.1a: At least annually, urinary albumin (eg, spot UACR) and eGFR should be assessed in people with T1D with duration of ≥5 years and in all people with T2D regardless of treatment (B)
- 11.1b: In people with established CKD, urinary albumin (eg, spot UACR) and eGFR should be monitored 1-4 times per year depending on the stage of the disease (B)
UACR and eGFR should both be used to properly stage and monitor kidney health, as eGFR alone may miss the earlier stages of CKD6
When used together, UACR and eGFR are predictive of CKD progression and CV events in patients with CKD2
The heat map indicates the level of risk for CKD progression and CV events by color intensity, the recommended frequency for monitoring eGFR and UACR, and guidance for treatment and referral to nephrology care
Would you like to request a tearaway KDIGO heat map notepad?
For illustrative purposes only
Are you ready to take action?
Access resources created in partnership between the American Diabetes Association, Bayer, and other organizations to provide information on diabetic kidney disease.
View the infographics below to educate your team and patients.
Diabetic Kidney Disease
Understand the screening recommendations for identifying chronic kidney disease in your patients with diabetes.
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AACE, American Association of Clinical Endocrinology; ADA, American Diabetes Association; CKD, chronic kidney disease; CV, cardiovascular; CVD, cardiovascular disease; DCRM, Diabetes, Cardiorenal, and Metabolism; DKD, diabetic kidney disease; DM, diabetes mellitus; eGFR, estimated glomerular filtration rate; EHR, electronic health record; GFR, glomerular filtration rate; HF, heart failure; KDIGO, Kidney Disease Improving Global Outcomes; T1D, type 1 diabetes; T2D, type 2 diabetes; UACR, urine albumin-to-creatinine ratio.
1. Shlipak MG, et al. Kidney International. 2021;99(1):34-47. 2. de Boer IH, et al. Diabetes Care. 2022;45(12):3075-3090. 3. Goldman JD, et al. Clin Diabetes. 2024;cd230074. 4. Kidney Disease Improving Global Outcomes. Kidney International. 2024;105(Suppl 4S):S117-S314. 5. Yarnoff BO, et al. BMC Nephrology. 2017;18(1):85. 6. American Diabetes Association. Section 11. Diabetes Care. 2024;47(Suppl 1):S219-S230. 7. Blonde L, et al. Endocr Pract. 2022;28(10):923-1049. 8. Handelsman Y, et al. Metabolism. 2024;159:155931.
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