Diabetes is the leading cause of renal failure and need for dialysis. In diabetes, early renal function loss is characterised by a long, clinically silent period, which typically occurs prior to the development of either chronic renal failure, or premature death from cardiovascular disease. Current estimates of glomerular filtration rate (GFR) are inaccurate in patients with diabetes who have hyperfiltration or early renal function loss. Lack of availability of simple and accurate methods of assessing renal function has lead to inability to optimally identify those with early renal function loss, until almost half of renal function has already been lost.
There is a need to accurately identify early decline in renal function in people with diabetes because unlike other forms of chronic kidney disease, improved methods to detect early deterioration in GFR will allow targeting of novel therapies at an earlier stage when progressive renal injury may be slowed or even reversed. These therapies include SGLT2 inhibitors (including canagliflozin and empagliflozin), GLP1 agonists (including liraglutide, semaglutide and dulaglutide), anti-inflammatory and anti-fibrotic agents.