Individuals in the denominator who underwent testing for microalbuminuria, proteinuria, urine albumin-to-creatinine ratio, or urine protein-to-creatinine ratio during the measurement year.
Diabetic patients aged 18 to 84
20%-40% of diabetes patients will develop kidney complications (1). Diabetes is the most common cause of kidney damage, progressing to end-stage renal failure, a condition that requires dialysis or a kidney transplant. The most essential laboratory test for early detection of kidney damage in diabetic patients is monitoring the levels of albumin excreted in the urine. When kidney function begins to deteriorate, urinary albumin levels gradually increase. Albumin excretion of over 300 mg/day is a marker of kidney disease progression and the development of end-stage renal failure. In addition, albuminuria indicates a patient is at high risk for cardiovascular disease. Tests to detect albuminuria (increased excretion of the protein albumin in the urine) should be performed at least once a year. However, some patients may develop diabetic kidney damage characterized by a decline in GFR (Glomerular Filtration Rate) without elevated protein excretion. In such cases, regular monitoring of GFR is essential for detecting kidney damage. Additionally, tracking GFR is important for assessing the severity of renal failure, identifying and treating patients at risk for complications of kidney failure (such as electrolyte imbalances or bone metabolism disorders), and referring patients with advanced kidney failure for nephrology evaluation and dialysis preparation. Therefore, annual monitoring of renal function is recommended for all diabetic patients, with more frequent assessments for those experiencing a decline in kidney function. This monitoring is critical due to the availability of effective therapeutic interventions that can slow the progression of kidney damage once detected. These include angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), particularly in diabetic patients presenting with hypertension and proteinuria, as well as sodium-glucose co-transporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists. Optimal management of blood pressure and glycemic control also plays a pivotal role in mitigating renal disease progression (1)(2).
1. American Diabetes Association. Standards of Medical Care in Diabetes – 2017. Am Diabetes Assoc. 2017;40.
2.Davies MJ, D’Alessio DA, Fradkin J, Kernan WN, Mathieu C, Mingrone G, et al. Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the european association for the study of diabetes (EASD). Diabetes Care. 2018;41(12):2669–701.
