Optimal Early Diagnosis and Monitoring of Diabetic Kidney Disease in Type 2 Diabetes Mellitus: Addressing the Barriers to Albuminuria Testing

Abstract

Chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) is associated with increased risk of end-stage renal disease (ESRD) and cardiovascular disease (CVD). Urine albumin-to-creatinine ratio (UACR) is a sensitive and early indicator of kidney damage, which should be used routinely to accurately assess CKD stage and monitor kidney health. However, this test currently is performed in only a minority of patients with T2D. Here, we review the importance of albuminuria testing and current barriers that hinder patient access to UACR testing and describe solutions to such testing in a community clinical setting.

Novel glucose-responsive nanoparticles based on p-hydroxyphenethyl anisate and 3-acrylamidophenylboronic acid reduce blood glucose and ameliorate diabetic nephropathy

“…In addition, the p(AAPBA-b-HPA)2 treatment improved renal function to a greater degree than the insulin treatment. Some studies have shown that the determination of urinary microalbumin can better predict the occurrence of early DN, and the determination of UTP has become the main index for the diagnosis of renal injury [ 54 ]. The UTP inspection results of each group of mice are shown in Fig.…”

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

“…The CREDENCE (CKD and T2D population) and DAPA-CKD (CKD and mixed T2D and non-T2D population) trials of SGLT2is have shown that the presence of high albuminuria at baseline is predictive of elevated risk for future hard kidney outcomes; 38 39 the Heart Outcomes Prevention Evaluation (HOPE) study identified albuminuria as a continuous risk factor for all-cause mortality and cardiovascular mortality; 59 and in a meta-analysis of clinical trial data, lowering of albuminuria with SGLT2is correlated with delayed onset of hard kidney outcomes such as kidney replacement therapy. 60 61 An increased focus on routine systematic testing for albuminuria in clinical practice is important to address the current suboptimal rates and overcome existing barriers for albuminuria testing. There has been a long-standing perception of no utility in screening for CKD.…”

Geographical variation in kidney function testing and associations with health care costs among patients with chronic kidney disease and type 2 diabetes

“…[3][4][5] The uACR is an important laboratory indicator of CKD, as it reflects underlying kidney injury at an early stage in patients with T2D, even if eGFR initially remains unaffected. [5][6][7] Thus, it is important to use both eGFR and uACR measurements to identify CKD and characterize disease severity.…”

“…The current treatment (referred to as background therapy, BT) of patients with CKD associated with T2D includes lifestyle modifications and pharmacotherapy, focusing on slowing progression of the disease, preventing ESKD, and reducing the risk of CV events and mortality. 6,7 Nonetheless, there are residual risks and an unmet clinal need. 8 Finerenone is a new, selective, nonsteroidal mineralocorticoid receptor antagonist (MRA) with higher antagonistic potency for mineralocorticoid receptor (MR) and lower relative affinity for other steroid hormone receptors than noted with other steroidal MRAs.…”