Preventing diabetic kidney disease through comprehensive testing and early detection
Reena Cholera, CardioRenal Business Manager
| Bayer
Bayer's CardioRenal Business Manager, Reena Cholera, explains how our health services can improve the prevention of diabetic kidney disease.
This article has been initiated and funded by Bayer plc who are fully responsible for the content. This article will be reviewed in June 2025.
Type 2 Diabetes (T2D) is the leading cause of chronic kidney disease (CKD).1 Referred to as the ‘silent killer’2 since the early stages of CKD are asymptomatic3, many people living with diabetes do not know how to take care of their kidneys and further damage can occur if their symptoms are unaddressed4. It is therefore extremely important for health services to prevent these patients from developing CKD.
Around 4m people in the UK have T2D (7% in the total population) and of those numbers, 1.6m are believed to have CKD5.
Over the summer of 2022, Bayer funded a survey and report in collaboration with the European Kidney Patients Federation to understand the daily challenges those with T2D and CKD face. 500 patients with T2D and CKD from France, Germany, Italy, Spain, and the UK were surveyed, and their views make for interesting comparisons between countries in areas like unmet need and health provision.6 This article will focus on the results from the UK.
45% of UK respondents that took part in the survey said they experienced symptoms for more than six months while 27% reported having symptoms for more than a year before they were diagnosed with CKD.
The most common symptoms were tiredness/fatigue followed by itchy skin and changes to the frequency of urination. The most cited emotional responses to a CKD diagnosis were feeling anxious (39%), depressed (36%) and stressed (34%). The report also highlighted that 66% of the respondents agreed that CKD had affected their working lives including having to reduce their working hours (24%).
A CKD diagnosis can have a profound impact on a person’s quality of life which carry over into their personal and social relationships. If left untreated, these patients may require further support from both mental health services and/or social care. The results of this survey point to the need for improved early identification and treatment intensification to prevent patients from progressing to the later stages of CKD.
We need pragmatic solutions and actions that make a difference.
As recommended by international guidelines7,8, people living with T2D should get the urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) tests every year to monitor their kidney health and pick up on the early indicators of cardiovascular complications.
Credit: Peter Ginter (photographer/producer)
NICE has noted that the UACR test can help detect diabetic kidney disease9 and recommended its use in the annual screening of children and young adults with T2D10. Despite clinical support for the UACR test, this currently isn’t on the Quality Outcomes Framework (QOF) which means not all in primary care are testing T2D patients and therefore people are slipping through the net.
As noted in the survey, awareness of the associated risks of CKD is low across all countries – many people just didn’t know anything about the importance of kidney health before their diagnosis. 50% UK respondents knew nothing about CKD prior to diagnosis, and 32% had heard of it but knew nothing about it.
We need better communications between clinicians and patients. Regular UACR testing by healthcare professionals (HCPs) in primary care will ensure that T2D patients are screened, diagnosed and optimally treated in a timely manner. Patients can then be referred to more specialist services where needed. Regular testing will provide HCPs with the opportunity to educate people with T2D about kidney health, empowering patients to take proactive measures to protect their kidneys from further damage.
To save lives, we need our health services to provide an annual UACR test for people with T2D by reintroducing it in the QOF.
Job bag number: PP-PF-OTH-GB-0043. Date of publication: May 2023
1. McGill JB, Haller H, Roy-Chaudhury P, Cherrington A, Wada T, Wanner C, Ji L, Rossing P. Making an impact on kidney disease in people with type 2 diabetes: the importance of screening for albuminuria. BMJ Open Diabetes Res Care. 2022 Jul;10(4):e002806. doi: 10.1136/bmjdrc-2022-002806. PMID: 35790319; PMCID: PMC9258490 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9258490/
2. https://www.kidneycareuk.org/news-and-campaigns/news/world-kidney-day-impact-kidney-disease/
3. Nicholas SB, Wright EE, Billings LK, Ambriz E, Gee P, Peeler T. Living with Chronic Kidney Disease and Type 2 Diabetes Mellitus: The Patient and Clinician Perspective. Adv Ther. 2023 Jan;40(1):1-18. doi: 10.1007/s12325-022-02325-9. Epub 2022 Oct 25. PMID: 36282450; PMCID: PMC9592880. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9592880/
4. https://www.diabetes.org.uk/guide-to-diabetes/complications/kidneys_nephropathy
5. EKPF (2023) The realities of living with CKD: Report sponsored by People with T2D and CKD speak up EKPF-Designed-Patient-Insights-Report_FINAL.pdf (Sponsored by Bayer)
6. Ibid.
7. KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (kidney-international.org)
8. Standards of Medical Care in Diabetes—2020 Abridged for Primary Care Providers | Clinical Diabetes | American Diabetes Association (diabetesjournals.org)
9. Chronic kidney disease: assessment and management (nice.org.uk)
10. Diabetes (type 1 and type 2) in children and young people: diagnosis and management (nice.org.uk)
End of Bayer plc funded article
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