With diabetes, check urine albumin-to-creatinine ratio and serum creatinine yearly (for type 1, start after 5 years of diabetes); people with hypertension should also be checked to detect chronic kidney disease early

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.

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%. hazard ratio HR 0.61 (95% CI 0.51–0.72), about 39% lower. Deaths were 4.7% versus 6.8%, hazard ratio HR 0.69 (0.53–0.88), about 31% lower. The effect was similar with or without diabetes

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. https://doi.org/10.1001/jamainternmed.2022.6817；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. https://doi.org/10.2196/54429；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. https://doi.org/10.1016/j.kint.2023.10.018；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. https://doi.org/10.2337/dc26-S011；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. https://doi.org/10.1056/NEJMoa2024816

The evidence grade is only B because no randomized trial has directly tested whether annual screening itself reduces deaths. The mortality figures come from people whose elevated urine protein had already been detected and who then received medication. The benefit is therefore rated medium as a judgment, rather than large based on the mortality reduction. A single elevated result does not establish a diagnosis; KDIGO requires repeat testing to confirm it. The guideline gives no fixed testing interval for people with hypertension; follow your doctor’s advice. Your doctor should choose the medication; do not buy it on your own. For eye and foot checks in diabetes, see Item 7 (have the back of the eye examined). If chronic kidney disease is diagnosed, see Section 34, Item 14 (impaired kidney function) on buying painkillers yourself and eating star fruit. The main beneficiary is you.