Frequently Asked Questions
Frequently Asked Questions
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- More than 38 million (around 11.6%) Americans (of all ages) have diabetes1 and between 90-95% of them have type 2 diabetes (T2D).2
- Approximately 40% of adults with T2D develop chronic kidney disease (CKD).3
- Diabetes is a major cause of end-stage kidney disease (ESKD or kidney failure) in the United States.4
Clinical practice guidelines recommend screening for CKD at T2D diagnosis, with repeated screening at least once per year thereafter.5,6
- Clinical practice guidelines recommend screening for CKD by measuring both urine albumin (urine albumin-to-creatinine ratio or UACR) and the estimated glomerular filtration rate (eGFR) from a blood sample.5,6,7
- eGFR is a measure of kidney function: A persistent eGFR <60 mL/min/1.73 m2 for at least 3 months indicates reduced kidney function.5,6,7
- UACR is a measure of kidney damage: Kidney damage is indicated by abnormally high levels of certain proteins in urine (proteinuria). One such protein is albumin. A UACR ≥30 mg/g indicates increased levels of albumin in the urine (albuminuria).5,6,7,8
- A CKD diagnosis requires evidence of persistently abnormal eGFR (<60 mL/min/1.73 m2 ) and UACR (≥30 mg/g) (confirmed by repeat testing with or without other markers of kidney damage) for at least 3 months.5,7
- The American Society of Nephrology (ASN) and National Kidney Foundation (NKF) advocate using the 2021 CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation, which calculates eGFR without regard to race, to estimate glomerular filtration rate (GFR) from creatinine, age, and sex.5
- The preferred test for measuring albuminuria is UACR in single-voided spot urine sample. This is the most convenient way to measure albuminuria.5
- The albuminuria categories are as follows: 5,6,7
- Normal to mildly increased: <30 mg/g
- Moderately increased: 30-299 mg/g
- Severely Increased: ≥300 mg/g
- CKD is categorized into five stages, based on eGFR:5,6,7
- Stage 1: Normal or high kidney function (eGFR ≥90 ml/min/1.73 m2)
- Stage 2: Mildly decreased kidney function (eGFR 60–89 ml/min/1.73 m2)
- Stage 3a: Mildly to moderately decreased kidney function (eGFR 45–59 ml/min/1.73 m2)
- Stage 3b: Moderately to severely decreased kidney function (eGFR 30–44 ml/min/1.73 m2)
- Stage 4: Severely decreased kidney function (eGFR 15–29 ml/min/1.73 m2)
- Stage 5: Kidney failure or ESKD (eGFR <15 ml/min/1.73 m2)
- Studies have shown that the risk of CKD progression, cardiovascular events, and mortality all increase with categories of increasing albuminuria or decreasing eGFR5. .
- eGFR is an independent predictor of CKD progression. As eGFR decreases, the risk of CKD progression increases.5,6,7
- Data from a meta-analysis of 21 general population cohort studies involving 1,234,182 participants, showed that eGFR is an independent predictor of cardiovascular mortality and that an eGFR <60 mL/min/1.73 m2 is significantly associated with increased cardiovascular mortality.8
- In a summary of categorical meta-analyses for general population cohorts with UACR data, the adjusted relative risks for all-cause mortality, cardiovascular mortality, kidney failure, acute kidney injury, and CKD progression all increased when eGFR was <60 mL/min/1.73 m2.9
- UACR is an independent predictor of CKD progression, as UACR increases, the risk of CKD progression increases.5,6,7
- Results from meta-analysis of 21 general population cohort studies involving 1,234,182 participants showed that UACR is an independent predictor of cardiovascular mortality. As UACR increases, the risk of cardiovascular mortality increases.8
- In a summary of categorical meta-analyses for general population cohorts with UACR data, the adjusted relative risks for all-cause mortality, cardiovascular mortality, kidney failure, acute kidney injury, and CKD progression were higher across all eGFR categories (categories G1-G5 on the KDIGO heat map) when albuminuria was categorized as moderately or severely increased (categories A2- A3 on the KDIGO heat map).9
- Clinical practice guidelines recommend an holistic approach for improving outcomes in people with diabetes and CKD that involves lifestyle modifications (healthy diet, regular exercise, weight management and smoking cessation) and drug therapy.5,6,7
- Guideline-directed medical therapy (GDMT) for people with CKD associated with T2D include a renin-angiotensin-aldosterone system (RAS) inhibitor (either a angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB)), sodium-glucose co-transporter 2 (SGLT2) inhibitor, nonsteroidal mineralocorticoid receptor antagonist (nsMRA) and glucagon-like peptide 1 receptor agonist (GLP-1 RA). 5,6,7
- A maximally tolerated dose of a RAS inhibitor (either an ACEi or ARB) is recommended for non-pregnant people with diabetes and hypertension if they have moderately to severely increased albuminuria (UACR 30–≥300 mg/g)5,6,7 and/or eGFR <60 mL/min/1.73 m2 to prevent the progression of kidney disease and reduce cardiovascular events.6
- A SGLT2 inhibitor with demonstrated benefit is recommended for people with CKD associated with T2D with an eGFR ≥20 mL/min/1.73 m2 to reduce risk of CKD progression and cardiovascular events.5,6,7
- A nsMRA that has been shown to be effective in clinical trials is recommended in people with CKD and albuminuria (>30 mg/g) if eGFR is ≥25 mL/min/1.73 m2 to reduce cardiovascular events and CKD progression.5,6,7
- Patients initiating nsMRA treatment should have a normal serum potassium concentration/have their potassium levels monitored.5,6,7
- A GLP-1 RA with demonstrated benefit is recommended for people with CKD associated with T2D to reduce cardiovascular risk and kidney disease progression.6
- GLP-1 RAs are also recommended for adults with CKD associated with T2D who have not achieved individualized glycemic targets despite use of metformin and SGLT2 inhibitor treatment, or who are unable to use these medications.5,7
Reference List
- Centers for Disease Control and Prevention. National Diabetes Statistics Report. 2024. https://www.cdc.gov/diabetes/php/data-research/index.html. Accessed November 1, 2025.
- Centers for Disease Control and Prevention. Type 2 Diabetes. 2024. https://www.cdc.gov/diabetes/about/about-type-2-diabetes.html Accessed November 1, 2025.
- Bailey RA, et al. BMC Res Notes. 2014;7:415.
- Centers for Disease Control and Prevention. Kidney Failure and Diabetes. 2024. https://www.cdc.gov/diabetes/data-research/research/kidney-failure-diabetes.html. Accessed November 1, 2025.
- de Boer IH, et al. Diabetes Care. 2022;45(12):3075-3090.
- American Diabetes Association. Chapter 11. Diabetes Care. 2025;48(Suppl. 1):S239– S25
- Kidney Disease Improving Global Outcomes. Kidney Int. 2024:105(4S):S117-S314.
- Matsushita K, et al. Lancet. 2010;375(9731):2073-2081.
- Kidney Disease Improving Global Outcomes. Kidney Int Suppl. 2013;3:1-150.
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