This guideline topic has been taken from the NHMRC'National Evidence Based Guidelines for Diagnosis, Preven-tion and Management of CKD in type 2 diabetes' whichcan be found in full at the CARI website （http://www.cari.org.au）。 The NHMRC guideline covers issuesrelated to the assessment and prevention of CKD in indi-viduals with established type 2 diabetes.
The NHMRCguidelines do not address the care of people with diabeteswho have end-stage kidney disease （ESKD） or those whohave a functional renal transplant. In addition, the presentguideline does not provide recommendations regarding themanagement of individuals with established CKD, withrespect to the prevention of other （non-renal） adverse out-comes, including retinopathy, hypoglycaemia, bone diseaseand cardiovascular disease. It is important to note however,that in an individual with type 2 diabetes, the prevention ofthese complications may be a more important determinantfor their clinical care. Consequently, the recommendationsmade must be balanced against the overall managementneeds of each individual patient.
There is a high intra-individual variability in 24 halbumin excretion with a coefficient of variation of 40-50%,therefore a diagnosis of persistent microalbuminuria shouldbe based on repeated measurements, especially if long-termtreatment of normotensive individuals are being considered.While increasing albuminuria is a risk factor for both CVDand ESKD, cross sectional studies have also shown a highdegree of heterogeneity in people with type 2 diabetes com-pared with type 1 diabetes with respect to CKD. As such asignificant proportion of people with type 2 diabetes mayhave CKD and be normoalbuminuric.3,6,7In the recentlyreported ARIC study （a population based prospective bira-cial long-term observational study of 2187 individuals withpredominantly type 2 diabetes）， 30% of incident CKD（defined as eGFR < 60 mL/min per 1.73 m2or kidneydisease at hospitalization） did not have albuminuria（ACR 3 30 mg/g）。