Over Half of People with Diabetes Aren’t Getting Kidney Screenings
By April Hopcroft
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Less than half of the adults with diabetes are getting recommended annual kidney screenings, according to research by the National Kidney Foundation. Learn how you can take care of your kidneys through annual eGFR and uACR tests, diabetes management, and medications.
New research shows that adults with diabetes are not receiving necessary kidney screening tests, despite recommendations from the ADA and National Kidney Foundation (NKF). Screening is essential to diagnose chronic kidney disease (CKD), which affects up to 20-40% of people with diabetes.
The ADA Standards of Care recommends that people with diabetes undergo two screening tests each year to monitor kidney health:
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Estimated glomerular filtration rate (eGFR). eGFR indicates kidney function – how well your kidneys are filtering waste products out of your blood – and is measured by a blood test.
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Urinary albumin creatinine ratio (uACR). uACR indicates how much protein (albumin) is spilling from your kidneys into your urine. There shouldn’t be any protein in your urine. It is measured by a urine sample.
According to a 2023 study, only 40% of people with diabetes get recommended kidney health testing. Without timely diagnosis and treatment, people who have both diabetes and CKD have a high risk of developing kidney failure and cardiovascular complications, such as heart failure.
What were the key findings from this study?
A study conducted by the NKF and the National Committee for Quality Assurance examined kidney screening rates in over 7 million adults with diabetes, including people on Medicare and with commercial insurance.
Broadly, the analysis showed that a sizable portion of adults with diabetes are not receiving recommended screenings. Screening rates were especially low among Black Americans and other minority groups.
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Fewer than 40% of adults with diabetes received recommended testing for CKD in 2017. This was largely due to not enough people receiving uACR testing.
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Black Americans and people with lower income, lower education, and dual Medicare-Medicaid enrollment had lower rates of kidney screening. Asian Americans had the highest rates of screening.
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Receiving the recommended kidney screening tests was (unsurprisingly) linked to a diagnosis of CKD. People who received both eGFR and uACR tests were also more likely to be on evidence-based medications for kidney disease, receive care from multiple specialists, and have better diabetes care.
These findings show the importance of screening to diagnose and properly treat CKD, as people who received adequate screening were more likely to have the necessary treatment. Based on this data, it’s clear that healthcare providers need to prioritize kidney screening for people with diabetes.
How can you take care of your kidneys?
Know your risk through annual screenings
First and foremost, ask your healthcare provider to measure eGFR and uACR every year. It’s also a good idea to recognize the risk factors for CKD – this is something else you can discuss with your healthcare provider. People with any of the following conditions have a greater chance of developing CKD:
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High blood sugar over a long period of time
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High blood pressure
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High cholesterol
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Heart disease
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Obesity
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Family history of kidney disease
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Black or African American, Hispanic or Latino, American Indian or Alaska Native, Asian American, or Native Hawaiian or Other Pacific Islander ancestry
Practice good diabetes self-management
Maintaining good glycemic control is a key part of preventing diabetes complications. Heart disease, CKD, eye disease, neuropathy and other complications are caused by damage to the blood vessels from high blood sugar levels, so it’s important to maximize your time in range.
The ABCDES of diabetes care are a simple way to remember how to prevent complications as well as maintain kidney health:
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A1C targets – Manage your blood glucose levels and keep them in-range (70-180 mg/dl).
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Blood pressure targets – Keep blood pressure at target range (aim for at or below 130/80 mm Hg).
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Cholesterol targets – Reduce LDL-cholesterol and non-HDL-cholesterol.
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Drugs for cardiovascular risk reduction – Ask your doctor about taking an SGLT-2 inhibitor or GLP-1 receptor agonist if you’re not already taking one.
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Exercise – Exercise regularly and eat a healthy, balanced diet – Minimizing salt, eating smaller portions of protein, reducing carbohydrates, and opting for foods that are low in phosphorus and potassium are especially important.
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Smoking cessation – Do not smoke (if you do smoke, talk to your healthcare professional about a plan to quit).
Seek out medications that protect the heart and kidneys
Today, people with type 2 diabetes have several medications available to reduce the risk of heart and kidney disease. SGLT-2 inhibitors – medications approved for type 2 diabetes and those without diabetes that includes Jardiance, Farxiga, Invokana, and Brenzavvy – have been shown to slow the progression of CKD while also protecting against heart failure. Kerendia (finerenone) has also been approved to slow the progression of CKD associated with type 2 diabetes. And GLP-1 receptor agonists, a class of medications approved for type 2 diabetes and obesity that includes semaglutide and tirzepatide, have been shown to lower uACR levels and benefit the heart.
While these medications have yet to be approved for people with type 1 diabetes, researchers are investigating treatment options for this population. The FINE-ONE trial, slated to begin in 2024, will investigate Kerendia in people with type 1 diabetes. Another study is currently recruiting participants with CKD due to type 1 or type 2 diabetes and will test an investigational medication, INV-202, which is designed to improve regulation in the kidney, liver, and pancreas.
For more on kidney health and diabetes, read:
