Kidney Week

Abstract: SA-PO0447

Under the Radar: Gaps in Urine Albumin-to-Creatinine Ratio Testing and High-Risk Albuminuria in Type 1 Diabetes

Session Information

• CKM: Clinical - Screening, Population Management, Care Disparities, and Patient-Centered Outcomes
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Traill, Philippa Kirsten, University of Dundee, Dundee, Scotland, United Kingdom

Philippa Kirsten Traill, MBChB

• Arnold, Matthew, AstraZeneca R&D Cambridge, Cambridge, England, United Kingdom

Matthew Arnold, PhD

• Ambery, Philip D., Clinical Late Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden

Philip D. Ambery, MD, MBChB

• Bell, Samira, University of Dundee, Dundee, Scotland, United Kingdom

Samira Bell, MD, MBChB

Group or Team Name

• AZ/UoD Team

Background

Urine albumin-creatinine ratio (UACR) testing is essential for detection and risk stratification of chronic kidney disease (CKD) in type 1 diabetes (T1DM), but real-world testing patterns are poorly described. Albuminuria is an early marker of diabetic kidney disease and predicts increased risk of CKD progression, cardiovascular events, and premature mortality. Guidelines recommend regular UACR testing in diabetes to enable timely diagnosis and initiation of renal-protective therapies. However, testing uptake in routine practice may be suboptimal, resulting in missed opportunities for earlier intervention.

Methods

We conducted a retrospective population-based cohort study using linked laboratory data from 763,659 individuals in Tayside and Fife, Scotland (2008-2024). Adults with T1DM and Type 2 Diabetes Mellitus (T2DM) were identified and classified annually by creatinine-defined CKD stages 3-5 (≥2 eGFR <60 mL/min/1.73m² ≥90 days apart). The primary outcome was ≥1 UACR test per year. Secondary outcomes included UACR ≥100mg/mmol among those tested. A T2DM cohort was included as a comparator.

Results

6460 individuals with T1DM were included. UACR testing increased over time but remained incomplete. In 2024, 50.4% (258/512) of those with CKD underwent UACR testing compared with 38.3% (1861/4864) without CKD. Across the study period, testing was consistently higher in those with CKD, and peaked in 2014 at 68.4% (310/453). Among the albuminuria-tested T1DM population with CKD, the proportion with UACR ≥100mg/mmol increased from 9.5% in 2008 (n = 11/116) to 17.4% in 2024 (45/258), indicating a rising burden of high-risk albuminuria. Testing in individuals with T1DM without CKD remained substantially lower despite guideline recommendations.

Conclusion

In this population-based cohort, UACR testing in T1DM varied by CKD status and remained suboptimal, particularly in those without established CKD. These findings highlight missed opportunities for early kidney disease detection and risk stratification, with implications for improving delivery of guideline-directed care.

Acknowledgment

Dr Philippa Traill is undertaking a fully-funded PhD studentship and Clinical Research Fellowship with AstraZeneca.
University of Dundee Health Informatics Centre provided the linked population-based dataset; data access and linkage costs funded by AstraZeneca.

Funding

• Commercial Support – AstraZeneca