Kidney Week

Abstract: SA-PO0446

Who Gets Missed During Kidney Disease Screening in Type 2 Diabetes? A Detection-Gap Analysis of Creatinine, eGFR, and Albuminuria

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

• Haider, Salar, Brigham and Women's Hospital, Boston, Massachusetts, United States

Salar Haider, MD

• Khan, Muhammad Arhum Hamid, Shifa College of Medicine, Islamabad, Islamabad Capital Territory, Pakistan

Muhammad Arhum Hamid Khan

• Mirza, Rida E Fatima, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan

Rida E Fatima Mirza, MBBS

• Batool, Alishba, Watim Dental College and Hospital, Islamabad, Islamabad Capital Territory, Pakistan

Alishba Batool, DrMed

Background

ADA and KDIGO recommend kidney screening in patients of type 2 diabetes mellitus (T2DM) with eGFR and urine albumin, but albuminuria testing remains incompletely implemented, especially in resource-limited primary care settings. We evaluated how creatinine, eGFR, and albuminuria perform as screening markers individually and together in a real-world T2DM cohort.

Methods

We performed a retrospective cross-sectional chart review of 624 patient records from adults with T2DM (HbA1c ≥6.5%) seen in a primary care clinic over 2 years. After exclusions, 441 patients were included. Detection-gap analyses used 308 complete cases with contemporaneous serum creatinine, eGFR, and dipstick albuminuria. Elevated creatinine was defined as >1.2 mg/dL in men and >1.0 mg/dL in women, reduced eGFR as <60 mL/min/1.73 m², and albuminuria as dipstick ≥1+.

Results

In the complete-case T2DM cohort, mean age was 53.3±10.6 years and mean HbA1c was 9.22±2.05%. Elevated creatinine was present in 12.0% of T2DM patients (37/308) [95% CI 8.8–16.1], reduced eGFR in 14.0% (43/308) [95% CI 10.5–18.3], and albuminuria in 23.1% (71/308) [95% CI 18.7–28.1]. Each marker identified a partially distinct patient subset. Among patients with reduced eGFR, 30.2% (13/43) [95% CI 18.6–45.1] had normal creatinine. Among patients with normal creatinine and preserved eGFR, 19.8% (51/258) [95% CI 15.4–25.1] still had albuminuria.

Conclusion

In this T2DM cohort, nearly 1 in 5 patients with normal creatinine and preserved eGFR had albuminuria and would have been missed without urine albumin testing, while nearly 1 in 3 patients with reduced eGFR had normal creatinine and would have been missed by creatinine-only screening. These findings quantify the real-world cost of incomplete kidney screening in T2DM and demonstrate why creatinine, eGFR, and urine albumin must be assessed together in these patients.