Albuminuria is useful for early screening and diagnosis of kidney impairment, especially in people with pre-diabetes or
type 2 diabetes (T2D), which is the leading cause of
chronic kidney disease (CKD) and
end-stage kidney disease (ESKD), associated with increased mortality, poor cardiovascular outcomes, and high economic burden. Identifying patients with CKD who are most likely to progress to ESKD permits timely implementation of appropriate interventions. The early stages of CKD are asymptomatic, which means identification of CKD relies on routine assessment of kidney damage and function. Both
albuminuria and estimated glomerular filtration rate are measures of kidney function. This review discusses
albuminuria as a marker of kidney damage and cardiorenal risk, highlights the importance of early screening and routine testing for
albuminuria in people with T2D, and provides new insights on the optimum management of CKD in T2D using
albuminuria as a target in a proposed algorithm. Elevated urine
albumin can be used to detect CKD in people with T2D and monitor its progression; however, obstacles preventing early detection exist, including lack of awareness of CKD in the general population, poor adherence to clinical guidelines, and country-level variations in screening and treatment incentives. With
albuminuria being used as an entry criterion and a
surrogate endpoint for
kidney failure in clinical trials, and with novel treatment interventions available to prevent CKD progression, there is an urgent need for early screening and diagnosis of kidney function decline in people with T2D or pre-diabetes.