Chronic Kidney Disease and Type 1 Diabetes: Why Earlier Action Matters

For people living with type 1 diabetes (T1DM), kidney health is an important part of lifelong care. Chronic kidney disease, or CKD, can develop gradually and may progress for years before symptoms become apparent. As CKD progresses, the risk of serious complications like kidney failure may increase. 

About 2 million people in the U.S. live with T1DM,iii and CKD remains a common long-term complication, with some studies estimating that the lifetime risk may exceed 70%.iv  This is because high blood sugar and, in many cases, high blood pressure, can damage the kidneys over time, which ultimately reduces their ability to effectively filter waste.v

Although advances in blood glucose management, blood pressure control and therapies have improved care, treatment options specifically aimed at slowing CKD progression in people with T1DM have remained limited for three decades. But the landscape is changing. As understanding of CKD continues to evolve, early detection and appropriate, proactive management may help clinicians assess risk, monitor disease progression and support kidney health. 

Why unmanaged CKD can become more serious over time

CKD can progress without obvious symptoms, which means kidney damage may occur without the person being aware. Over time, CKD may increase the risk of kidney disease progression and kidney failure.i

While there have been innovations for people with CKD and type 2 diabetes, treatment options specifically aimed at slowing CKD progression in people with T1DM have remained limited over the last 30 years.ii

The role of UACR

UACR stands for urine albumin-to-creatinine ratio. It is a urine test that measures the amount of protein (albumin) relative to waste (creatinine) in the urine. Elevated UACR can signal kidney damage.vi

Screening for UACR is important because it can identify asymptomatic CKD before clinically significant declines in estimated glomerular filtration rate (eGFR) are detected.vii,viii,ix 

Clinicians often use UACR and eGFR in tandem to get a complete picture of kidney health in people with T1DM, but UACR is particularly important as an early marker of kidney damage.x

For more information, learn about why UACR matters for cardiovascular risk for patients with CKD and type 2 diabetes.
 

Looking ahead

Routine UACR testing, clearer conversations about kidney risk and individualized care planning can help people living with T1DM better understand their risk and take a more proactive approach to managing CKD.

i Rossing P, Groop PH, Singh R, Lawatscheck R, Tuttle KR. Prevalence of chronic kidney disease in type 1 diabetes among adults in the U.S. Diabetes Care. Published online June 10, 2024. doi:10.2337/dc24-0335.
ii Heerspink H, et al. Rationale and design of a randomized phase III registration trial investigating finerenone in participants with type 1 diabetes and chronic kidney disease: The FINE-ONE trial Diabetes Research and Clinical Practice, 2023; 204
iii American Diabetes Association. Statistics about diabetes. American Diabetes Association. Accessed August 4, 2026. https://diabetes.org/about-diabetes/statistics/about-diabetes.
iv Perkins BA, Bebu I, de Boer IH, et al; Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group. Risk factors for kidney disease in type 1 diabetes. Diabetes Care. 2019;42(5):883-890. doi:10.2337/dc18-2062.
v Centers for Disease Control and Prevention. Diabetes and chronic kidney disease. CDC. Reviewed April 15, 2024. Accessed August 10, 2026. https://www.cdc.gov/diabetes/diabetes-complications/diabetes-and-chronic-kidney-disease.html.
vi Afkarian M, Sachs MC, Kestenbaum B, et al. Kidney disease and increased mortality risk in type 2 diabetes. Journal of the American Society of Nephrology. 2013;24(2):302-308. doi:10.1681/ASN.2012070718. 
vii American Diabetes Association Professional Practice Committee. Chronic kidney disease and risk management: Standards of care in diabetes—2024. Diabetes Care. 2024 Jan 1;47(Suppl 1):S219–S230. https://doi.org/10.2337/dc24-S011.
viii Alicic RZ, Rooney MT, Tuttle KR. Diabetic kidney disease: challenges, progress, and possibilities. Clinical Journal of the American Society of Nephrology. 2017;12(12):2032-2045. doi:10.2215/CJN.11491116.
ix Altemtam N, Russell J, El Nahas M. A study of the natural history of diabetic kidney disease (DKD). Nephrology Dialysis Transplantation. 2012;27(5):1847-1854. doi:10.1093/ndt/gfr561.
x Palmer BF. Change in albuminuria as a surrogate endpoint for cardiovascular and renal outcomes in patients with diabetes. Diabetes Obes Metab. 2023 Feb 21. https://doi.org/10.1111/dom.15030.