Diabetes-Related Kidney Health Assessments

Diabetes-related kidney disease represents a continuum of structural and functional changes in the renal system driven by chronic hyperglycaemia, haemodynamic alterations and metabolic derangements. Early damage is often silent and detected only through sensitive biomarkers such as urinary albumin excretion or subtle declines in glomerular filtration. Assessment strategies encompass laboratory measures of albuminuria and filtration rate, imaging modalities to detect anatomical changes and emerging biomarkers that reflect glomerular endothelial injury, tubular dysfunction and inflammatory pathways. The principal goal of screening is to stratify risk, guide timely intervention and prevent progression to end-stage renal disease. International guidelines advocate annual measurement of urinary albumin-to-creatinine ratio and estimated glomerular filtration rate in people with type 1 diabetes after five years of disease duration and from diagnosis in type 2 diabetes. Beyond traditional clinical indices, novel approaches address intra-individual variability of albuminuria, the role of intermediate hyperglycaemia and anthropometric markers to refine individual risk and improve prognostic accuracy. With the global burden of diabetes rising, standardised, accessible and cost-effective assessment tools are essential to reduce disparities in detection and management of diabetic nephropathy.

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Diabetes-Related Kidney Health Assessments publication trend

The graph below shows the total number of articles in diabetes-related kidney health assessments across all publications each year (not limited to Nature Index journals).

Technical terms

Estimated glomerular filtration rate (eGFR): A calculated index of kidney filtration function, usually expressed in millilitres per minute per 1.73 m², derived from serum creatinine, age, sex and race.

Urinary albumin-to-creatinine ratio (UACR): A measure of urinary albumin excretion adjusted for urine concentration, used to detect microalbuminuria and monitor progression of kidney damage.

Microalbuminuria: A moderate increase in urinary albumin excretion (usually 30–300 mg albumin per gram of creatinine) signalling early glomerular injury in diabetes.

Diabetic kidney disease (DKD): A clinical syndrome in diabetic patients characterized by persistent albuminuria, declining eGFR and elevated cardiovascular risk attributable to long-standing hyperglycaemia and associated metabolic abnormalities.

References

1. Neck-to-height ratio is positively associated with diabetic kidney disease in Chinese patients with type 2 diabetes mellitus. Frontiers in Endocrinology (2023).
2. Diabetes and chronic kidney disease in Chinese adults: a population-based cohort study. BMJ Open Diabetes Research & Care (2024).
3. Risk Factors of Microalbuminuria among Patients with Type 2 Diabetes Mellitus in Korea: A Cross-Sectional Study Based on 2019–2020 Korea National Health and Nutrition Examination Survey Data. International Journal of Environmental Research and Public Health (2023).
4. Long-term intra-individual variability of albuminuria in type 2 diabetes mellitus: implications for categorization of albumin excretion rate. BMC Nephrology (2017).