Perspectives

Albuminuria in diabetes. How low should levels go?

Usha Panchapakesan, Carol Pollock

Figures

© RichLegg/istockphoto.com
© RichLegg/istockphoto.com

Abstract

Diabetic kidney disease, a main cause of end-stage kidney disease requiring renal replacement therapy, is associated with significant cardiovascular mortality. Reducing albuminuria confers cardiac and renal protection in the longer term.

Key Points

  • Albuminuria not only causes but also reflects structural damage to the kidneys.
  • Albuminuria and a decline in glomerular filtration rate are key prognostic markers in diabetic kidney disease (DKD).
  • Albuminuria is predictive not only of kidney function but also of cardiovascular risk and all-cause mortality.
  • Clinical studies use reductions in the level of albuminuria as a surrogate marker of renoprotection.
  • Current and future therapies for DKD aim to lower albuminuria and hence reduce the progression of kidney disease and minimise cardiovascular risk.
  • The two main classes of drugs shown to confer renoprotection and cardioprotection in DKD are the renin-angiotensin-aldosterone system blockers and the sodium-glucose cotransporter-2 inhibitors.
  • It is unclear whether aiming to lower albumin in the normoalbuminuric range translates to cost-effective benefit.