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Screening for chronic kidney disease in patients with diabetes: are we missing the point?

Nature Clinical Practice Nephrology volume 4, pages 2–3 (2008)Cite this article

Screening for chronic kidney disease (CKD) should be an essential part of diabetes care. As an important health problem with high personal, social and financial costs, CKD meets any rational criteria for a screenable disease.1 The natural history of diabetic kidney disease is well understood, and measurement of urinary albumin excretion is a simple, safe, precise and validated means of screening that is acceptable and convenient for patients. Albuminuria offers a means of identifying patients who are at an early and treatable stage of disease, and who have increased risk of not just renal failure, but also of cardiovascular disease and premature mortality.

Screening does not end once a patient has been classified as likely or unlikely to develop complications, however. Fundamentally, screening encompasses not only the test, but also subsequent diagnostic procedures and interventions. Indeed, when physicians screen for disease (or risk of disease), they assume a substantial degree of responsibility to intervene or at least respond to the result. For example, detection of a breast lump should be followed by appropriate investigation and intervention. It would be malfeasance to do nothing but watch and wait, because the prognosis of unmanaged disease is worse than the risks associated with investigation and intervention. The same principles must be applied to screening for CKD in patients with diabetes. Indeed, untreated albuminuria might be substantially more costly to the healthcare service than an untreated breast lump.2

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Authors and Affiliations

  1. MC Thomas is a Research Fellow in the Diabetes and Metabolic Division at the Baker Heart Research Institute, Melbourne, Victoria, Australia,

    Merlin C Thomas

  2. G Viberti is Professor of Diabetes and Metabolic Medicine in the Cardiovascular Division at Guy's Hospital, King's College, London, UK,

    GianCarlo Viberti

  3. P-H Groop is Head of the Department of Diabetes Genetics at the Folkhälsan Research Center, University of Helsinki and Deputy Chief Physician in the Division of Nephrology, Department of Medicine, Biomedicum Helsinki, Helsinki University Central Hospital, Helsinki, Finland.,

    Per-Henrik Groop

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  1. Merlin C Thomas
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  2. GianCarlo Viberti
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  3. Per-Henrik Groop
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Correspondence to Merlin C Thomas.

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Thomas, M., Viberti, G. & Groop, PH. Screening for chronic kidney disease in patients with diabetes: are we missing the point?. Nat Rev Nephrol 4, 2–3 (2008). https://doi.org/10.1038/ncpneph0679

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