A Personalized Approach to Kidney Disease

Personalized kidney screening for people with type 1 diabetes (T1D) may reduce costs and help detect chronic kidney disease (CKD) earlier, according to a new analysis performed by the Epidemiology of Diabetes Interventions and Complications study group, funded by NIDDK.

The finding, published in Diabetes Care, provides the basis for the first evidence-based kidney screening model for people with T1D.

Current CKD screening recommendations include annual urinary albumin excretion rate (AER) testing for anyone who has had T1D for at least five years. Having too much albumin—a protein found in the blood—in urine is a sign of kidney disease. The new findings suggest that AER screening could be personalized to optimize testing frequency and early detection of CKD.  

People with T1D have an estimated 50% risk of developing CKD over their lifetime. CKD can progress to kidney failure, requiring dialysis or a kidney transplant. Using more than 30 years of participant data of AER and HbA1c (an integrated measure of blood glucose) from 1,334 participants in two NIDDK-funded clinical trials, the study group identified three levels of CKD risk that were associated with a later CKD diagnosis. They then developed a model to estimate optimal screening intervals.

According to the model’s findings, those at highest risk for developing CKD could be screened for urine albumin every six months so, if necessary, appropriate interventions could be instituted as early as possible. Those at lower risk, based on specific AER and blood glucose ranges, could be screened every two years, reducing patient burden and potentially saving millions of dollars compared to annual screening. All others with T1D could continue to be screened annually.

NIDDK studies continue to explore how diabetes affects the body over time and the long-term benefits of early and intensive blood glucose control.