Screening
Chronic kidney disease (CKD) screening is reported to be cost-effective in patients with diabetes and hypertension.[62]
Reason for screening for DKD:
Detecting moderately increased albuminuria (previously known as microalbuminuria) is important because interventions such as intensive glucose and blood pressure control (including renin-angiotensin system inhibition) and use of medications such as sodium-glucose cotransporter-2 (SGLT2) inhibitors and nonsteroidal mineralocorticoid receptor antagonists (e.g., finerenone) can prevent progression to severely increased albuminuria (previously known as macroalbuminuria), which is associated with significantly greater morbidity, mortality, and progression to end-stage renal disease (ESRD).[34][63]
Advanced DKD is more resistant to treatment, is associated with greater cardiovascular (CV) morbidity and mortality, and is more likely to progress to ESRD and dialysis. However, patients with DKD are likely to die of CV causes before they progress to kidney failure; myocardial infarction and stroke are approximately twice as common in those with DKD than in those with diabetes without renal disease, and patients with ESRD carry a CV risk that is at least ten times greater again.[34]
Populations to screen for DKD:[1]
People with type 1 diabetes - 5 years after diagnosis and at least annually thereafter
People with type 2 diabetes - at the time of diagnosis and at least annually thereafter.
Screening tests for DKD:[1]
Urinary albumin (e.g., spot urinary albumin to creatinine ratio [ACR]) at least annually in patients with type 1 diabetes with duration of ≥5 years and in all patients with type 2 diabetes regardless of treatment.
Estimated glomerular filtration rate (eGFR) at least annually in patients with type 1 diabetes with duration of ≥5 years, and in all patients with type 2 diabetes regardless of treatment.
For information on screening for type 2 diabetes, please see Type 2 diabetes mellitus in adults.
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