ORLANDO — Every patient with type 1 or type 2 diabetes should be screened annually for the presence of diabetic kidney disease, according to comprehensive guidelines developed by the National Kidney Foundation as part of its Kidney Disease Outcomes Quality Initiative.
The clinical practice guidelines offer “simple, clear messages about managing risk factors not only for kidney disease but also for cardiovascular disease,” Dr. Katherine R. Tuttle said at a meeting that was sponsored by the National Kidney Foundation.
The working group that drafted the guidelines included representatives of the American Diabetes Association, the American Heart Association, and the American College of Physicians, as well as the NKF.
An estimated 21 million people in the United States have diabetes and over half of them have kidney damage. The incidence of diabetic kidney disease is expected to double by the year 2030.
The guidelines recommend measurements of urinary albumin-to-creatinine ratio in a spot urine sample, and measurement of serum creatinine to estimate the glomerular filtration rate.
“We recommended a spot urine sample rather than 24-hour urine collection so that this [measurement] can actually be done in an internist's or other primary care provider's office. Plus, it's cheap,” said Dr. Tuttle, who is the medical and scientific director of research at Providence Medical Research Center, Spokane, Wash.
Screening is essential because strategies that slow or prevent chronic kidney disease and its complications are available. “Simple, clear messages are very powerful. And that's what we're after,” she said.
The guidelines, under the title “KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease” (Am. J. Kidney Dis. 2007;49[2 suppl. 2]:S12–154) are available online at www.kdoqi.org
We recommended a spot urine sample that can be done in a provider's office. 'Plus, it's cheap.' DR. TUTTLE