Making an impact on kidney disease in people with type 2 diabetes: the importance of screening for albuminuria

Abstract

Albuminuria is useful for early screening and diagnosis of kidney impairment, especially in people with pre-diabetes or type 2 diabetes (T2D), which is the leading cause of chronic kidney disease (CKD) and end-stage kidney disease (ESKD), associated with increased mortality, poor cardiovascular outcomes, and high economic burden. Identifying patients with CKD who are most likely to progress to ESKD permits timely implementation of appropriate interventions. The early stages of CKD are asymptomatic, which means identification of CKD relies on routine assessment of kidney damage and function. Both albuminuria and estimated glomerular filtration rate are measures of kidney function. This review discusses albuminuria as a marker of kidney damage and cardiorenal risk, highlights the importance of early screening and routine testing for albuminuria in people with T2D, and provides new insights on the optimum management of CKD in T2D using albuminuria as a target in a proposed algorithm. Elevated urine albumin can be used to detect CKD in people with T2D and monitor its progression; however, obstacles preventing early detection exist, including lack of awareness of CKD in the general population, poor adherence to clinical guidelines, and country-level variations in screening and treatment incentives. With albuminuria being used as an entry criterion and a surrogate endpoint for kidney failure in clinical trials, and with novel treatment interventions available to prevent CKD progression, there is an urgent need for early screening and diagnosis of kidney function decline in people with T2D or pre-diabetes.

Meta-Analysis of the Effect of Nursing Intervention on Children with Type 2 Diabetes

“…In 2015, it was reported that 415 million people aged 20-79 have diabetes, which is expected to reach 642 million by 2040 [ 3 , 4 ]. Globally, the number of diabetes patients has quadrupled in the past few years, and 90% of diabetes patients are type 2 diabetes [ 5 ], which is mainly caused by insulin resistance due to various reasons [ 6 ]. Due to the change of dietary structure and the reduction of physical activity, obese children are gradually increasing, and the number of children and adolescents with type 2 diabetes is raising year after year [ 7 ], although type 1 diabetes is mostly in children.…”

Potential Involvement of LncRNAs in Cardiometabolic Diseases

“…The causes of T2D include obesity, physical inactivity, and genetic factors [79][80][81]. If left untreated, T2D can cause other health problems, including CVD [82], high blood pressure (hypertension) [83], vision loss (diabetic retinopathy) [84], and kidney disease [85]. Thus, intensive T2D research is ongoing to understand the impact of T2D to other health problems, including CMD.…”

Effect of tirzepatide on albuminuria levels and renal function in patients with type 2 diabetes mellitus: A systematic review and multilevel meta‐analysis

“…American Diabetes Association (ADA) and KDIGO have adopted a scheme incorporating both eGFR and UACR for CKD risk assessment in patients with T2DM 5 . Quantification of albuminuria with UACR is considered a powerful screening tool for the prompt identification of kidney damage in early, asymptomatic stages of diabetic kidney disease 6 . Of importance, it seems that albuminuria, as a marker of kidney damage in the context of T2DM, progresses irrespective of eGFR levels, emphasizing the absolute need for the meticulous, periodic evaluation of both parameters in clinical practice 7 .…”

“…5 Quantification of albuminuria with UACR is considered a powerful screening tool for the prompt identification of kidney damage in early, asymptomatic stages of diabetic kidney disease. 6 Of importance, it seems that albuminuria, as a marker of kidney damage in the context of T2DM, progresses irrespective of eGFR levels, emphasizing the absolute need for the meticulous, periodic evaluation of both parameters in clinical practice. 7 Besides its importance in the development and progression of CKD, albuminuria also appears to be a significant prognostic marker of all-cause mortality, cardiovascular morbidity and mortality, irrespective of the presence of baseline T2DM.…”