Routine Albuminuria Screening Improves Cardiovascular Outcomes in Diabetes Patients- A Single Centre Randomised Controlled Study

Background: Albuminuria is a well-established biomarker of chronic kidney disease (CKD) progression and a significant predictor of cardiovascular disease (CVD) risk, reflecting systemic vascular dysfunction, including myocardial capillary disease and arterial stiffness. Elevated urinary albumin excretion is linked to increased risks of coronary artery disease, stroke, heart failure, arrhythmias, and microvascular complications. Despite the availability of albuminuria-lowering therapies that reduce cardiovascular risk, screening remains underutilized. This study investigates the impact of routine albuminuria screening and targeted management on cardiovascular outcomes in a multidisciplinary diabetes care setting. Methods: This randomized controlled trial, conducted at Nidan Kutir Diabetes Care & Research Centre, Bhagalpur from 2022 to 2024, enrolled 735 patients with established CVD and no prior CKD diagnosis. Participants were randomized to either a structured albuminuria screening and management protocol (intervention group, n=368) or standard care (control group, n=367). The intervention group underwent quarterly urinary albumin-to-creatinine ratio (UACR) assessments, with albuminuria-lowering therapies (e.g., SGLT2 inhibitors, ACE inhibitors, or ARBs) initiated or optimized based on UACR levels. The primary endpoint was a composite of major adverse cardiovascular events (MACE), including myocardial infarction, stroke, heart failure hospitalization, and cardiovascular death, over the 2-year study period. Secondary endpoints included changes in UACR, estimated glomerular filtration rate (eGFR), and microvascular complications. Results: The intervention group demonstrated a significant reduction in MACE compared to the control group (hazard ratio [HR] 0.69, 95% CI 0.54–0.87, p=0.002). UACR levels decreased by 25% in the intervention group (p