If you have diabetes, check the urine albumin-to-creatinine ratio and serum creatinine once a year; if you have hypertension, check them too, to find chronic kidney disease early

Among adults in China who have chronic kidney disease, only about a tenth know they have it. A yearly urine and blood test in people with diabetes can find it earlier. Once urine protein is high, a drug such as dapagliflozin cuts the combined chance of kidney function failing, dialysis, or death by about 40%, and cuts death by about 30%.

Cost

Give a urine sample for the urine albumin-to-creatinine ratio, and have blood drawn for creatinine; ask the doctor to order both at a follow-up. The hard part is remembering to check when the kidneys feel fine.

Benefit

China's national chronic-disease surveillance for 2018 to 2019 tested blood and urine in 176874 adults. About 8.2% had chronic kidney disease, about 82000000 people. Of them, 73.3% were still in early stage 1 to 2. Only 10.0% knew they had it. Another survey in 45 hospitals nationwide tested 9672 people with type 2 diabetes; 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 be tested for both urine albumin and glomerular filtration rate (how much blood the kidney filters per minute). The first priority is people with hypertension, diabetes, or cardiovascular disease. The 2026 standards of the American Diabetes Association say that people with type 2 diabetes, whatever the treatment, should have the urine albumin-to-creatinine ratio and the estimated glomerular filtration rate checked at least once a year. The same applies to type 1 once the disease has lasted 5 years. For diabetes plus hypertension with urine albumin moderately raised (30 to 299 mg/g), a pril-class or sartan-class blood-pressure drug is recommended. Once it is found, there are drugs that can be used. A randomized trial enrolled 4304 people with chronic kidney disease, glomerular filtration rate between 25 and 75, and urine albumin-to-creatinine ratio 200 to 5000. Over a median of 2.4 years, 9.2% of the dapagliflozin group had any of these: kidney function falling by more than half, end-stage kidney disease, or death from kidney disease or cardiovascular disease. The placebo group 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 similar with or without diabetes

Notes

B only, because no randomized trial has directly compared whether "checking once a year" itself makes people die less. The figures for fewer deaths come from people who already had high urine protein and then took the drug. The size of the benefit is therefore set to medium by judgment, and was not slotted as large from the drop in deaths. A single high result is not a diagnosis; KDIGO requires a repeat to confirm. How often people with hypertension should be checked is not given as a fixed interval in the guideline; follow the doctor. The doctor chooses the drug; do not buy it yourself. The eye and the foot that diabetes needs checked: see item 7 (have the back of the eye checked). The person who benefits is mainly you.

Sources · 5

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. 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. 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. 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. 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. doi.org/10.1056/NEJMoa2024816