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Screening for Early Diabetic Kidney Disease (DKD)

diabetic kidney disease

Initiating early screening measures for Diabetic Kidney Disease (DKD) is paramount in the comprehensive care of individuals with diabetes. The timely identification of kidney dysfunction at its early stages empowers healthcare professionals to implement effective interventions, potentially slowing down or preventing the progression of DKD.

Early detection is crucial for identifying and treating Diabetic Kidney Disease (DKD) promptly. Here are recommendations for DKD screening:

It is advised to conduct kidney disease screening for T1DM patients within 5 years of diagnosis and for T2DM patients immediately upon diagnosis, with a minimum of once a year (strong recommendation, level A).

Regarding the frequency and methods of early DKD screening, both domestic and international guidelines and consensus generally agree. Organizations such as KDOQI, ADA, the Canadian Diabetes Association (CDA), and the Chinese Society of Endocrinology recommend screening for T1DM patients within 5 years of diagnosis and immediate screening for T2DM patients upon diagnosis.

Research indicates that proteinuria often occurs within 5 years of diagnosis in T1DM patients, while the onset time for T2DM is difficult to determine, with some patients exhibiting proteinuria at the time of diagnosis. Additionally, if microalbuminuria is not detected, it is still recommended to screen T1DM and T2DM patients annually.

It’s strongly recommended to use the urinary albumin/creatinine ratio (UACR) test to check the levels of albumin in the urine for individuals with diabetes (DM) and Diabetic Kidney Disease (DKD) (strong recommendation, level A).

Checking both urinary albumin and estimated glomerular filtration rate (eGFR) is crucial for screening DKD. Domestic guidelines, the 2020 APSN, and KDOQI all suggest using random UACR tests as a method for early DKD screening. However, it’s important to note that UACR can sometimes show significant fluctuations, and in necessary cases, the screening for DKD can also involve measuring the 24-hour urinary albumin excretion.

It is recommended to use the CKD-EPI method, which includes creatinine and cystatin C, to estimate the glomerular filtration rate (eGFR) in patients. This method is a crucial assessment for the kidney function of patients (recommended level: Grade A, strongly recommended).

eGFR is a key indicator reflecting the patient’s kidney function. Previously, the assessment of kidney function was typically done by measuring blood creatinine and using the MDRD formula. However, in recent years, both domestically and internationally, there has been a recommendation to use the CKD-EPI formula to calculate eGFR. The 2012 KDIGO guidelines emphasize the use of eGFR calculation formulas based on both serum creatinine and cystatin C (such as CKD-EPI cystatin C formula and CKD-EPI creatinine-cystatin C formula) to assess patient kidney function.

Foreign studies show that compared to the MDRD method, CKD-EPI is more sensitive and reliable in assessing eGFR in patients with normal albuminuria and high filtration. Additionally, cystatin C can freely pass through the glomerulus, undergo reabsorption by renal tubular epithelial cells, and degrade within the cells. It is not influenced by factors such as age, height, diet, malignant tumors, etc. Its sensitivity and specificity are superior to blood creatinine.

Research confirms that the CKD-EPI method is more sensitive to mild decreases in kidney function with GFR between 60-90 mL/min/1.73m². Compared to other GFR assessment methods such as Cockcroft-Gault and solely creatinine-based CKD-EPI formulas, the CKD-EPI method incorporating creatinine and cystatin C more accurately evaluates patient kidney function. It can identify whether T2DM patients have kidney impairment and is particularly suitable for the Chinese population. The 2021 Clinical Diagnosis and Treatment Guidelines for Diabetic Kidney Disease in China also recommend using the CKD-EPI method, including creatinine and cystatin C, to estimate the glomerular filtration rate in patients.

Diabetic Kidney Disease

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Screening for Early Diabetic Kidney Disease (DKD).

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