Screening for Kidney Disease in Adults With Diabetes

Abstract

Screening programs are generally aimed at conditions with a substantial public health impact and which benefit from early interventions. Chronic kidney disease (CKD), especially CKD attributed to diabetes, certainly fits this criterion. Diabetes remains the leading cause of end-stage renal disease (ESRD) in most countries in the world, accounting for 40–50% of incident ESRD cases (1–4). Due to the epidemic of diabetes secondary to obesity and the aging of the population, rates of kidney disease secondary to diabetes are on the rise. Within the past 2 decades, the incidence of ESRD secondary to diabetes in the U.S. has doubled while the prevalence of CKD among general Medicare patients diagnosed with both diabetes and hypertension has increased fourfold (1). Annual expenditures are highest for patients with ESRD secondary to diabetes compared with all other primary ESRD diagnoses (1). Thus, the epidemic of diabetes will certainly drive up health care costs for ESRD, which in the U.S. are projected to exceed $28 billion by 2010 (5). To prevent ESRD in individuals with diabetes, we must first do an adequate job of screening and detecting CKD. Unfortunately, the enormous burden of CKD remains undetected among adults with diabetes. The early detection of CKD among patients with diabetes has primarily involved the measurement of urinary albumin excretion. A timed urine collection confirmed on at least two of three occasions over a 6-month period was the initial method of screening. The acceptance of the use of the albumin (in milligrams)-to-creatinine (in grams) ratio measured in a random urine specimen has greatly expanded screening efforts due to the test’s convenience for both patients and physicians. Persistently increased levels of urine albumin excretion ≥30–299 mg/24 h or spot urine albumin-to-creatinine ratios ≥30–299 mg/g indicate the presence of microalbuminuria while urine albumin excretion levels higher than …