Background: Diabetic kidney disease (DKD) is a major cause of chronic kidney disease and end-stage kidney disease worldwide. Traditionally, albuminuria has been considered the earliest clinical marker of DKD. However, a significant proportion of patients with type 2 diabetes mellitus (T2DM) demonstrate declining renal function in the absence of albuminuria, referred to as non-albuminuric diabetic kidney disease (NA-DKD), which may remain undetected with conventional screening strategies.

Objectives: To determine the prevalence of NA-DKD in patients with T2DM, compare clinical and biochemical characteristics between albuminuric and non-albuminuric DKD, identify associated risk factors, and emphasize the importance of eGFR-based screening.

Methods: This cross-sectional observational study included 80 adult patients with T2DM attending a tertiary care center. Clinical evaluation, blood pressure measurement, and BMI assessment were performed. Laboratory investigations included serum creatinine, estimated glomerular filtration rate (eGFR) calculated using the CKD-EPI equation, urinary albumin-creatinine ratio (ACR), HbA1c, and lipid profile. Patients were categorized into albuminuric DKD and NA-DKD based on eGFR and ACR values. Statistical analysis was performed to compare clinical and biochemical parameters between groups.

Results: Among the study population, albuminuric DKD was present in 40%, NA-DKD in 22.5%, and no DKD in 37.5% of patients. NA-DKD patients were significantly older, had lower BMI, higher systolic blood pressure, and better glycemic control compared to albuminuric DKD patients, despite similar reduction in eGFR. NA-DKD was associated with higher LDL cholesterol levels and a greater prevalence of hypertension and cardiovascular disease, while diabetic retinopathy was less common compared to albuminuric DKD. Reliance on albuminuria alone would have missed 22.5% of patients with significant renal impairment.