Introduction
Chronic kidney disease (CKD) is an important complication of type 2 diabetes and can progress even when glycaemic control appears satisfactory. Early identification of kidney involvement and appropriate risk-reduction strategies are therefore essential components of comprehensive diabetes care.
Why Is Early Detection Important?
CKD may remain clinically silent in its early stages. Assessment using estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) can help identify kidney abnormalities, inform risk stratification and guide treatment decisions.
Key Considerations for Clinical Practice
1. Assess both eGFR and albuminuria
Neither measure should be considered in isolation. Together, they provide complementary information about kidney function and kidney damage. Monitoring frequency should reflect the patient's clinical risk and disease status.
2. Look beyond glucose levels
For eligible patients with type 2 diabetes and CKD, SGLT2 inhibitors with proven benefit are recommended to reduce CKD progression and cardiovascular events. Selected GLP-1 receptor agonists with demonstrated benefit may also help reduce kidney and cardiovascular risk.
3. Individualise ongoing monitoring
Treatment decisions should account for kidney function, albuminuria, cardiovascular comorbidities, concomitant medications, tolerability and changes in clinical status. Follow-up should assess both treatment safety and the trajectory of kidney function.
Conclusion
Diabetes-related kidney protection requires more than monitoring HbA1c. Combining early detection, risk assessment and evidence-based therapies can support a more comprehensive approach to long-term cardiorenal health.
Clinical takeaway: Assess eGFR and UACR, stratify kidney risk and consider therapies with demonstrated kidney and cardiovascular benefits when indicated.
References
American Diabetes Association. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026. DOI: 10.2337/dc26-s011.
American Diabetes Association
Kidney Disease: Improving Global Outcomes (KDIGO). 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. KDIGO guideline resource.
KDIGO
Disclaimer: This article is intended for healthcare education and does not replace clinical judgement or locally applicable guidelines.