Albuminuria in Type 2 Diabetes and Risk of Cardiorenal Outcomes- Insights from Latest JACC Advances Study Including >74,000 Patients

A recent study has found that 40% of patients with type 2 diabetes (T2D) have albuminuria and may benefit from cardiovascular and renoprotective drugs. The study also highlights that the remaining 60% with normoalbuminuria continue to experience a substantial risk of cardiovascular disease, warranting increased focus.

The findings are published in October, in the Journal of the American College of Cardiology (JACC) Advances.

Albuminuria is a well-established biomarker linked to cardiovascular and renal morbidity and mortality. Despite guidelines recommending annual screening for urinary albumin excretion in patients with T2D, real-world adherence appears suboptimal. At the same time, newer therapeutic classes—including SGLT2i, GLP-RAs, and nonsteroidal MRA—have shown benefits in individuals with elevated urinary albumin-to-creatinine ratio (UACR). Yet emerging evidence suggests that structural kidney and vascular damage may already be present even at UACR levels below 30 mg/g. Current guidelines do not fully incorporate this residual risk in normoalbuminuric patients, leaving clinicians without a clear framework to address risk that lies within the so-called normal range.

This study was therefore undertaken to determine the prevalence of albuminuria among patients with T2D in Denmark, identify those meeting inclusion criteria for cardiorenal-protective therapies, and evaluate the 4-year absolute risk of major cardiovascular and renal outcomes across the UACR spectrum.

Using Danish nationwide registries, researchers identified adults aged > 18 years with prevalent T2D as of January 1, 2015. Patients were included if they had a recorded UACR and creatinine measurement within the preceding year. Those with cancer within one year before index, known HF, eGFR <25 mL/min/1.73 m², or ESRD were excluded. The final study population comprised 74,014 patients, drawn from four of the five Danish regions where laboratory data were available. Patients were categorized into albuminuria (UACR ≥30 mg/g) and normoalbuminuria (UACR <30 mg/g) groups. Baseline characteristics, comorbidities, and medications were extracted from validated national registries. The primary outcome was a composite of heart failure (HF) hospitalization, myocardial infarction (MI), stroke, or all-cause death. The secondary outcome included ESRD or a sustained ≥50% decline in estimated glomerular filtration rate (eGFR). Absolute risks over a four-year period were estimated using Kaplan–Meier and Aalen–Johansen methods.

Of the 74,014 patients, 29,581 (40%) had albuminuria and 44,433 (60%) had normoalbuminuria. Those with albuminuria were older, more often male, and had longer T2D duration, higher HbA1c, and lower eGFR. Comorbidities and use of cardiovascular medications were more frequent in this subgroup. The 4-year absolute risk of the primary composite outcome was 28.6% in patients with albuminuria compared with 18.7% in those with normoalbuminuria. Risks of individual outcomes—including HF (7.0% vs 4.0%), MI (4.4% vs 3.2%), and stroke (7.6% vs 5.5%)—were consistently higher in the albuminuric group. All-cause mortality was also substantially elevated (16.6% vs 9.3%). Renal outcomes demonstrated an even sharper gradient of risk: the secondary composite occurred in 8.7% of those with albuminuria and 2.9% with normoalbuminuria. ESRD risk was 2.5% versus 0.4%, respectively.

Overall, the study reinforces albuminuria as a strong marker of cardiorenal vulnerability, while revealing that individuals with normoalbuminuria remain at meaningful cardiovascular risk. Despite these implications, only 49% of all Danish patients with T2D had UACR measured within a year, reflecting major gaps in guideline implementation. With 40% of tested patients eligible for newer cardiorenal-protective therapies, routine screening and earlier intervention are needed to mitigate progressive cardiorenal decline in T2D.

*SGLT2i- Sodium glucose cotransporter 2 inhibitors, GLP-RAs-Glucagon like peptide 1 receptor agonists, MRA- Mineralocorticoid receptor antagonists, ESRD- End stage renal disease

Reference: Parveen S, Malmborg M, Arulmurugananthavadivel A, Carlson N, Andersson C, Andersen CF, Jensen J, Anjum DZ, Elmegaard M, Eroglu T, Fosbøl E, Gislason G, Køber L, Schou M. Albuminuria in Type 2 Diabetes and Risk of Cardiorenal Outcomes. JACC Adv. 2025 Oct 23;4(11 Pt 1):102254. doi: 10.1016/j.jacadv.2025.102254. Epub ahead of print. PMID: 41135384; PMCID: PMC12593582.