A new artificial intelligence-powered kidney test can predict which patients with diabetic kidney disease will experience serious decline over the next two years, and when used consistently, it changes how doctors prescribe treatment and improves patient outcomes. In a landmark study of 2,470 patients across two major U.S. health systems, the test, called KidneyIntelX.dkd, demonstrated sustained improvements in kidney function and meaningful reductions in disease progression over a full 24-month period.

How Does This Kidney Test Work Differently From Standard Care?

For years, doctors have relied on basic measurements to assess kidney disease risk: estimated glomerular filtration rate (eGFR), which measures how well kidneys filter waste; urine albumin-to-creatinine ratio (UACR), which detects protein in urine; and blood sugar control (HbA1c). These standard markers provide a snapshot, but they don't reliably predict who will decline rapidly and who will remain stable.

KidneyIntelX.dkd uses blood-based biomarkers and artificial intelligence to create a personalized risk profile. The test identifies which patients are at high risk for rapid kidney function decline, allowing doctors to target intensive treatment to those who need it most. This precision approach means lower-risk patients avoid unnecessary medication escalation, while high-risk patients receive aggressive, guideline-directed therapy from the start.

"These two-year data provide the clearest real-world picture yet of what risk stratification can do when applied consistently at scale in two large health systems. What we see is that a structured, biomarker-guided approach to prescribing translates into targeted therapy decisions,higher-risk patients receiving more intensive treatment, and lower-risk patients largely spared unnecessary escalation," said Dr. David Lam, Co-Principal Investigator and Endocrinologist with the Mount Sinai Health System.

Dr. David Lam, Co-Principal Investigator and Endocrinologist, Mount Sinai Health System

What Did the Two-Year Study Actually Show?

The study, published in the peer-reviewed journal Diabetes, Obesity and Metabolism, followed 2,470 patients with type 2 diabetes and early-stage chronic kidney disease (CKD) across Mount Sinai Health System in New York and Wake Forest/Atrium Health in North Carolina. The results revealed several striking findings:

• Risk Improvement: Nearly 29% of patients who were retested moved into a lower risk category, accompanied by measurable reductions in kidney disease biomarkers.
• Treatment Intensification: Use of SGLT2 inhibitors (a class of diabetes and kidney-protective drugs) increased substantially, reaching 56% in high-risk patients overall and 70% in high-risk patients at Mount Sinai. Combination therapy with both SGLT2 inhibitors and GLP-1 receptor agonists (another kidney-protective medication class) nearly tripled, rising from 12% to 32% over two years.
• Treatment Response: Patients who started SGLT2 inhibitors or GLP-1 receptor agonist therapies had nearly double the odds (1.93 times) of achieving risk reduction, demonstrating a direct link between test-guided treatment and patient benefit.
• Kidney Function Improvement: The rate of eGFR decline improved by 43%, protein in urine (UACR) decreased by 23%, and blood sugar control (HbA1c) decreased by 7.6% in high-risk patients over the two-year period.
• Prognostic Power: Patients designated as high-risk at baseline were 10.4 times more likely to experience significant kidney function decline or kidney failure than low-risk patients, even after accounting for standard clinical variables. No combination of standard markers achieves this level of risk separation.

These improvements represent a major shift in how kidney disease is managed. Prior studies showed the test influenced immediate clinical decisions and improved short-term kidney markers. But this two-year data proves those improvements translate into real, lasting benefits for patients.

"From a nephrology standpoint, what matters most is whether risk stratification translates into durable kidney protection,and that is what we are seeing here. The attenuation in eGFR decline rate sustained over two years, alongside reductions in UACR, reflects real change. The repeat testing data demonstrate nearly a third of high-risk patients moved to a lower risk category at one year, linked to measurable drops in kidney injury biomarkers and to initiation of therapy," explained Dr. Joji Tokita, Co-Principal Investigator and Nephrologist with the Mount Sinai Health System.

Dr. Joji Tokita, Co-Principal Investigator and Nephrologist, Mount Sinai Health System

How to Use This Test in Your Own Kidney Health Management

• Ask Your Doctor About Risk Stratification: If you have type 2 diabetes and early-stage chronic kidney disease, discuss whether precision kidney testing could help guide your treatment plan. The test is FDA-approved and covered by Medicare.
• Understand Your Biomarkers: Request regular monitoring of kidney function markers like eGFR and UACR, and ask your doctor how these numbers compare to your baseline. Improvement in these markers signals that treatment is working.
• Consider Guideline-Directed Therapy: If your doctor recommends SGLT2 inhibitors or GLP-1 receptor agonists based on your risk profile, these medications have strong evidence for slowing kidney disease progression. Discuss any concerns with your healthcare team.
• Plan for Repeat Testing: The study shows that nearly 30% of high-risk patients improved to lower risk categories when retested. Ask your doctor about follow-up testing to track your progress and adjust treatment as needed.

The significance of this research lies not just in the test itself, but in what it reveals about precision medicine in practice. When doctors have better information about individual patient risk, they make more targeted treatment decisions. Patients who truly need intensive therapy receive it early, while others avoid unnecessary medication burden. Over two years, this approach translates into measurable improvements in kidney function and disease progression.

For the roughly 37 million Americans with chronic kidney disease, many of whom don't know they have it, this kind of early risk identification and targeted treatment could be transformative. The test is particularly valuable for people with type 2 diabetes, since diabetes is the leading cause of kidney disease in the United States. By identifying high-risk patients in the earliest stages of kidney disease, before significant damage occurs, doctors have the best chance of slowing or even halting progression.