In the United States, about one in ten people have diabetes, and 40% of these develop chronic kidney disease (CKD), increasing their cardiovascular disease risk. Despite American Diabetes Association (ADA) recommendations for managing type 2 diabetes (T2D) with CKD, adherence is under 50%. Screening with spot urine albumin-to-creatinine ratio and estimated glomerular filtration rate at diagnosis and annually helps in early CKD detection and timely interventions. ADA advises good glycemic and blood pressure control and the use of renin–angiotensin system inhibitors, SGLT-2 inhibitors, GLP-1 receptor agonists, and non-steroidal mineralocorticoid receptor antagonists.

Early CKD detection and intervention are crucial as the disease is asymptomatic, initially. Intensive glycemic control can reduce CKD development in patients with T2D but is less effective for advanced CKD. Dietary and blood pressure control also play critical roles. Effective medications like angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, sodium–glucose cotransporter-2 inhibitors, and glucagon-like peptide-1 receptor agonists help slow CKD progression and reduce cardiovascular risks. However, usage rates are low, underscoring the need for better guideline implementation and collaboration between primary care providers and nephrologists.

Reference: Skolnik NS, Style AJ. Importance of Early Screening and Diagnosis of Chronic Kidney Disease in Patients with Type 2 Diabetes. Diabetes Ther. 2021;12(6):1613-1630. doi: 10.1007/s13300-021-01050-w.