If you have diabetes, get a urine albumin-to-creatinine ratio and a blood creatinine test every year, and do the same if you have high blood pressure, to catch chronic kidney disease early

Cost

Leave one urine sample for the albumin-to-creatinine ratio and have blood drawn for creatinine; ask your doctor to order them together at a follow-up visit. The hard part is remembering to get checked when your kidneys don't bother you.

What you get

China's national chronic disease surveillance in 2018 to 2019: 176874 adults all had blood and urine tests. About 8.2% had chronic kidney disease, about 82,000,000 (8200万) people. Of these, 73.3% were still in the early stages 1 to 2. Only 10.0% knew they had it. Another survey tested 9672 patients with type 2 diabetes in 45 hospitals across the country, and 31% had chronic kidney disease. Of these 2997 people, only 27% had been checked for kidney disease before. The 2024 KDIGO kidney guideline says people at risk should have both urine albumin and the glomerular filtration rate (how much blood the kidneys filter per minute) tested. The first priority is people with high blood pressure, diabetes and cardiovascular disease. The American Diabetes Association's 2026 Standards say that people with type 2 diabetes, whatever their treatment, should have the urine albumin-to-creatinine ratio and the estimated glomerular filtration rate checked at least once a year. The same goes for type 1 once the disease has lasted 5 years. For people with diabetes plus high blood pressure and moderately raised urine albumin (30 to 299 mg/g), it recommends a blood pressure drug of the "-pril" (ACE inhibitor) or "-sartan" (ARB) type. Once it is found, there are drugs to use. A randomized trial enrolled 4304 patients with chronic kidney disease whose glomerular filtration rate was between 25 and 75 and whose urine albumin-to-creatinine ratio was 200 to 5000. Over a median of 2.4 years, 9.2% of the group taking dapagliflozin had one of these events: kidney function falling by more than half, reaching end-stage kidney disease, or death from kidney or cardiovascular disease. In the placebo group it was 14.5%. HR 0.61 (95% CI 0.51–0.72), about 39% lower. Deaths were 4.7% versus 6.8%, HR 0.69 (0.53–0.88), about 31% lower. The effect was about the same whether or not people had diabetes

Notes

Only rated B, because no randomized trial has directly compared whether "checking once a year" itself means fewer deaths. The figures for fewer deaths come from people who had already been found to have high urine protein and then took the drug. So the size of the benefit is set at medium by judgment, and not scaled up to large from the drop in deaths. One high result is not a diagnosis; KDIGO requires a repeat test to confirm. For people with high blood pressure, the guideline sets no fixed interval, so follow your doctor. Your doctor decides which drug to take; don't buy it yourself. For the eye-ground and foot checks that diabetes needs, see §16.7 (get an eye-ground exam once). The beneficiary is mainly you.

Evidence grade

B : Supported by research but without a precise number, or based on small or single studies.

Sources

1. Wang L, Xu X, Zhang M, et al. (2023). Prevalence of Chronic Kidney Disease in China: Results From the Sixth China Chronic Disease and Risk Factor Surveillance. JAMA Internal Medicine, 183(4), 298-310. https://doi.org/10.1001/jamainternmed.2022.6817
2. Shi L, Xue Y, Yu X, et al. (2024). Prevalence and Risk Factors of Chronic Kidney Disease in Patients With Type 2 Diabetes in China: Cross-Sectional Study. JMIR Public Health and Surveillance, 10, e54429. https://doi.org/10.2196/54429
3. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group (2024). KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney International, 105(4S), S117-S314，Practice Point 1.1.1.1、1.1.1.2. https://doi.org/10.1016/j.kint.2023.10.018
4. 美国糖尿病学会 (2026). 糖尿病诊疗标准 2026·第 11 章 慢性肾病与风险管理. Diabetes Care, 49(Suppl 1), S246-S260，推荐 11.1a、11.6a. https://doi.org/10.2337/dc26-S011
5. Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al. (2020). Dapagliflozin in Patients with Chronic Kidney Disease. New England Journal of Medicine, 383(15), 1436-1446. https://doi.org/10.1056/NEJMoa2024816

Translated from the Chinese original. Original book, section 16, tip 13. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer