Contact Us

CKD Associated With T2D

Understanding Albuminuria

For many patients with T2D, albuminuria may be the earliest sign of CKD before eGFR declines and it is an important marker for the early diagnosis of CKD associated with T2D.^1-3

Watch this 2 minute video to learn about the cardiorenal risks linked to albuminuria and the impact albuminuria can have on patient outcomes.

Watch video

Early Diagnosis

Albuminuria is a crucial component of early identification and diagnosis of CKD associated with T2D.³

Clinical Diagnosis of CKD in a patient with T2D

Persistent change in either or both of the following for ≥ 3 months¹

Elevated Albuminuria ¹

UACR ≥ 30mg/g
Marker of kidney damage²

Reduced eGFR¹

< 60mL/min/1.73m²
Measure of kidney function²

and/or

For complete patient care, both UACR and eGFR are necessary³

Albuminuria is an early marker of kidney damage and cardiorenal risk^3,6
Measuring eGFR alone may miss earlier stages of CKD³
Patients with normal eGFR are still at increased risk of CV events and CKD progression if albuminuria is present³

Click to enlarge

Cardiorenal Outcomes

Testing and Guidelines

Both UACR and eGFR should be used to guide CKD identification, monitoring, and appropriate management.⁴

Guidelines recommend UACR to test for albuminuria in addition to eGFR at least annually in all patients with T2D starting at diagnosis^3-5,11

Risk of CV outcomes are higher in patients with T2D and albuminuria, regardless of eGFR level

There are multiple tests to measure albuminuria, but UACR is the preferred test^3,12

Testing for albuminuria can be most easily performed by UACR in a random spot urine collection.

Limitations exist when using methods other than UACR (such as AER, UPCR, and urine dipstick) for detection of CKD in patients with T2D.

Click to enlarge

UACR is a predictor of CV mortality and ESKD

Albuminuria and eGFR are predictive of CKD progression and risk for CV events and both should be used to guide CKD monitoring and appropriate management⁴

The KDIGO 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.

Click to enlarge

Albuminuria in patients with T2D is strongly associated with CKD progression

ADA guidelines recommend reducing albuminuria levels to slow CKD progression³

ADA Treatment Recommendation: Aim to reduce urinary albumin by ≥30% in people with CKD and albuminuria ≥300 mg/g to slow CKD progression.

Click to view ADA Guidelines

Click for more information on impact of albuminuria reduction on outcomes

Burden

Abbreviations

AACE, American Association of Clinical Endocrinology; ADA, American Diabetes Association; AER, albumin excretion rate; CI, confidence interval; CKD, chronic kidney disease; CV, cardiovascular; CVD, cardiovascular disease; DKD, diabetic kidney disease; DP, dipstick proteinuria; eGFR, estimated glomerular filtration rate; ER, emergency room; ESKD, end-stage kidney disease; GFR, glomerular filtration rate; HF, heart failure; HR, hazard ratio; KDIGO, Kidney Disease Improving Global Outcomes; T2D, type 2 diabetes; UACR, urine albumin-to-creatinine ratio; UAE, urine albumin excretion; UPCR, urine protein-to-creatinine ratio.

References

1. Afkarian M. Pediatr Nephrol. 2015;30(1):65-74. 2. Pugliese G. Acta Diabetol. 2014;51(6):905-915. 3. American Diabetes Association. Section 11. Diabetes Care. 2025;48(Suppl 1):S239-S251. 4. de Boer IH, et al. Consensus report. Diabetes Care. 2022;45(12):3075-3090. 5. Kidney Disease Improving Global Outcomes. Kidney International. 2024;105(Suppl 4S):S117-S314. 6. Looker HC, et al. J Am Soc Nephrol. 2019;30(6):1049-1059. 7. Matsushita K, et al. Lancet. 2010;375(9731):2073-2081. 8. Jin Q, et al. Am J Kidney Dis. 2022;80(2):196-206. 9. Gansevoort RT, et al. Kidney International. 2011;80(1):93-104. 10. Nichols GA, et al. BMC Nephrology. 2020;21(1):167. 11. Blonde L, et al. Endocr Pract. 2022;28(10):923-1049. 12. Kidney Disease Improving Global Outcomes. Kidney Int Suppl. 2013;3(1):1-150. 13. Shlipak MG, et al. Kidney Int. 2021;99(1):34-47. 14. Zhou Z et al. Diabetes Ther. 2017;8(3):555-571. 15. Vassalotti JA, et al. Am J Manag Care. 2019;25(11):e326-e333.

Keep Exploring

Pathophysiology

Explore mineralocorticoid receptor activation

Epidemiology

Find out about the burden of CKD associated with T2D

Screening and Diagnosis

Learn about the benefits of early screening and diagnosis

Podcast

Diabetes and Kidneys: Unraveling T2D's Silent Threat

Understanding Albuminuria

Understanding Albuminuria

Clinical diagnosis of CKD in patients with T2D

Clinical Diagnosis of CKD in a patient with T2D

For complete patient care, both UACR and eGFR are necessary³

Risk of CV outcomes are higher in patients with T2D and albuminuria, regardless of eGFR level⁸

UACR is a predictor of CV mortality and ESKD^7,9

Albuminuria in patients with T2D is strongly associated with CKD progression¹⁰

Guidelines recommend UACR to test for albuminuria in addition to eGFR at least annually in all patients with T2D starting at diagnosis^3-5,11

There are multiple tests to measure albuminuria, but UACR is the preferred test^3,12

Albuminuria and eGFR are predictive of CKD progression and risk for CV events and both should be used to guide CKD monitoring and appropriate management⁴

ADA guidelines recommend reducing albuminuria levels to slow CKD progression³

Patients with T2D and albuminuria have a high burden of disease and healthcare resource use¹⁴

Abbreviations

References

Pathophysiology

Epidemiology

Screening and Diagnosis

Podcast

Understanding Albuminuria

Understanding Albuminuria

Clinical diagnosis of CKD in patients with T2D

Clinical Diagnosis of CKD in a patient with T2D

For complete patient care, both UACR and eGFR are necessary​3

Risk of CV outcomes are higher in patients with T2D and albuminuria, regardless of eGFR level8

UACR is a predictor of CV mortality and ESKD7,9

Albuminuria in patients with T2D is strongly associated with CKD progression10

Guidelines recommend UACR to test for albuminuria in addition to eGFR at least annually in all patients with T2D starting at diagnosis3-5,11

There are multiple tests to measure albuminuria, but UACR is the preferred test3,12

Albuminuria and eGFR are predictive of CKD progression and risk for CV events and both should be used to guide CKD monitoring and appropriate management4

ADA guidelines recommend reducing albuminuria levels to slow CKD progression3

Patients with T2D and albuminuria have a high burden of disease and healthcare resource use14

Abbreviations

References

Pathophysiology

Epidemiology

Screening and Diagnosis

Podcast

For complete patient care, both UACR and eGFR are necessary³

Risk of CV outcomes are higher in patients with T2D and albuminuria, regardless of eGFR level⁸

UACR is a predictor of CV mortality and ESKD^7,9

Albuminuria in patients with T2D is strongly associated with CKD progression¹⁰

Guidelines recommend UACR to test for albuminuria in addition to eGFR at least annually in all patients with T2D starting at diagnosis^3-5,11

There are multiple tests to measure albuminuria, but UACR is the preferred test^3,12

Albuminuria and eGFR are predictive of CKD progression and risk for CV events and both should be used to guide CKD monitoring and appropriate management⁴

ADA guidelines recommend reducing albuminuria levels to slow CKD progression³

Patients with T2D and albuminuria have a high burden of disease and healthcare resource use¹⁴