Chronic kidney disease and type 2 diabetes: a urine test and three numbers to know

If diabetes runs in your family, there is a simple way to keep an eye on your kidneys: a urine test. A large study of adults with type 2 diabetes found that advanced chronic kidney disease was tied to several things you can work on, including blood sugar, weight and blood pressure.

The study also found that Asian adults had higher odds of advanced kidney disease than White adults. That is a good reason for everyone with diabetes, and especially people of Asian background, to get kidney checks early and keep them regular.

How the study worked

Researchers looked at primary care records for a large group of adults with type 2 diabetes in Lambeth, a diverse part of South London, between 2005 and 2021. The study was published on Oct. 20, 2026, in BMJ Public Health. Because it used routine records, ethnicity was self-reported and a few results, such as the one on LDL cholesterol below, are hard to explain.

What they found

The researchers looked at “advanced” kidney disease, meaning stages 4 and 5, when the kidneys filter at less than 30 on a standard measure called eGFR. They compared people who reached that point with those who did not.

Several things stood out, even after the researchers accounted for the other factors:

• Ethnicity. Asian adults had higher odds of advanced kidney disease than White adults.
• Age. Older adults were more likely to have advanced disease.
• Blood sugar. Higher HbA1c (the three-month blood sugar average) was linked to advanced disease.
• Weight. A higher body mass index (BMI) was linked to advanced disease.
• Blood pressure. Higher systolic pressure, the top number, was linked to advanced disease.
• Protein in the urine. Both moderate and high levels were linked to advanced disease.

There was one more finding. Adults who started the study with better kidney function were less likely to end up with advanced disease. That is a good reason to find out where you start.

Protein in the urine was common in every group. The share with the highest level was 25.6% in people of Mixed ethnicity, 24.6% in the Other group, 23.2% in White adults and 22.4% in Black adults. The researchers also noted that this highest level was most common in Asian adults, and said that makes early, proactive care and culturally tailored support important.

One result looks odd: higher LDL cholesterol was linked to lower odds of advanced disease. The researchers did not offer a clear explanation, so it is no reason to change anything about your cholesterol care.

The main takeaway is that blood sugar, weight and blood pressure are all things you and your care team can work on. Poor blood sugar control, obesity and high systolic blood pressure were the key factors the researchers pointed to.

What is the urine test?

It is called a urine albumin-to-creatinine ratio, or ACR. Albumin is a protein. Healthy kidneys keep it in the blood. When the kidneys are under strain, some leaks into the urine, often before you feel anything.

The test is just a small urine sample. It often goes along with a blood test for kidney function, which gives the eGFR number. Together, they show how your kidneys are doing and whether anything needs attention.

What you can do today

Log in to your patient portal, or call your doctor’s office, and look at your most recent diabetes lab results. See whether a urine albumin test is on the list. If it is not, ask for one at your next visit. It takes a few minutes, and it tells you where you stand.