Diabetes and Kidney Disease: Why Your Annual Screening Just Got More Important

If you have diabetes, your kidneys are silently at risk. Between 20% and 40% of people with diabetes will develop chronic kidney disease (CKD) at some point in their lives, according to the American Diabetes Association's updated 2026 Standards of Care in Diabetes. The good news? Catching it early with the right screening can change everything. The bad news? Many people don't know they're at risk until significant damage has already occurred.

What Exactly Is Kidney Disease in Diabetes?

When you have diabetes, high blood sugar levels can damage the tiny blood vessels in your kidneys that filter waste from your blood. Over time, this damage reduces your kidneys' ability to do their job, leading to chronic kidney disease. For people with type 1 diabetes, this typically develops after about 10 years of living with the condition (though it can appear anywhere from 5 to 15 years after diagnosis). For those with type 2 diabetes, kidney disease can actually be present at the time of diagnosis, catching many people off guard.

The stakes are high. Kidney disease in people with diabetes doesn't just affect kidney function—it dramatically increases your risk of heart disease and stroke, and it's the leading cause of kidney failure requiring dialysis or transplantation in the United States.

How Should You Be Screened for Kidney Disease?

The American Diabetes Association now recommends a specific screening approach based on your diabetes type and how long you've had the condition. The key is consistency and the right tests.

• Type 1 Diabetes: Get screened at least once per year if you've had diabetes for 5 years or longer, using two specific measurements: a urine albumin-to-creatinine ratio (UACR) and an estimated glomerular filtration rate (eGFR).
• Type 2 Diabetes: Get screened at least once per year regardless of how long you've had diabetes or what treatment you're taking, using the same UACR and eGFR tests.
• If You Already Have CKD: Monitoring becomes more frequent—anywhere from 1 to 4 times per year depending on how advanced your kidney disease is and your individual risk factors.

The urine albumin-to-creatinine ratio (UACR) is the preferred screening method because it's simple and reliable. A random spot urine sample is collected and tested in a laboratory—no 24-hour collection needed. This matters because it removes barriers to screening. The test measures how much protein (albumin) is leaking into your urine, which is an early warning sign of kidney damage.

Why Does the Timing and Frequency of Screening Matter So Much?

The new guidelines emphasize that screening frequency should match your risk level. If your initial screening shows no signs of kidney disease, annual screening is sufficient. But if kidney disease is detected, your doctor will monitor you more closely—potentially 4 times per year (roughly every 3 months) if you have advanced disease with high risk of progression.

This tiered approach matters because kidney disease progresses at different rates in different people. Some people's kidney function declines slowly over decades, while others experience rapid decline. By monitoring more frequently when risk is highest, doctors can catch dangerous changes early and adjust treatment before serious complications develop.

One important note: because albumin levels in urine naturally vary from day to day (with variations exceeding 20% between measurements), the guidelines recommend that two out of three urine samples collected within a 3- to 6-month period should show abnormal results before a diagnosis of kidney disease is confirmed. This prevents false alarms and unnecessary worry.

The bottom line is straightforward: if you have diabetes, don't skip your annual kidney screening. It's one of the most powerful tools available to catch kidney disease early, when treatment options are most effective and your kidneys can still be protected from further damage.