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Diabetes · For patients and doctors

Heart and kidney risk in type 2 diabetes

Enter the numbers from your routine reports: HbA1c, blood pressure, cholesterol, creatinine and the urine albumin test. You get three risks together, heart attack, stroke and kidney failure, what is pushing each one up, and what would change if you fixed one thing. Doctors get the ESC risk category with the criteria met, the KDIGO grid, the kidney failure risk, and a checklist of what this patient should be on and is not.

A calculator, not a diagnosis. It is for adults with type 2 diabetes. The risks are estimates from population studies; your own risk also depends on things no score captures. If you have chest pain, sudden weakness of the face, arm or leg, or sudden trouble speaking, call 108 now. Nothing you enter leaves this page.

1. About you

Sex
Already happened or already diagnosed tick all that apply

2. Your numbers

Lab units: if your cholesterol report is in mmol/L, multiply by 38.7 for mg/dL. If creatinine is in µmol/L, divide by 88.4.

3. Medicines being taken now optional, for the checklist

Heart attack, 10 years
–
Stroke, 10 years
–
Kidneys
–

What is pushing your risk up

What would change if you fixed one thing

Each box changes one number and keeps the rest as you entered them. It shows the 10-year heart attack risk. The stroke risk moves the same way.

What to do next

Understanding the words

Why heart and kidney risk are shown together

In type 2 diabetes the same things damage the heart, the brain's blood vessels and the kidneys: high sugar over years, high blood pressure, cholesterol and smoking. A kidney that is leaking albumin is also a sign that the arteries are under strain, so kidney disease raises heart risk and heart disease raises kidney risk. The medicines that protect one usually protect the other. That is why one set of numbers gives all three risks here, and why the plan at the end is one plan.

What a 10-year risk means

A 10-year risk of 20% means that, of 100 people with the same numbers as you, about 20 would have a heart attack in the next 10 years and 80 would not. It is not a prediction about you personally. It is a way of seeing how much your numbers add up to, and how much they would come down if one of them changed.

The urine albumin test

Albumin is a protein that should stay in the blood. When the kidney filters are damaged, a small amount leaks into the urine years before the creatinine rises. The test is a spot urine sample, reported as the albumin-creatinine ratio (UACR). Below 30 mg/g is normal. 30 to 300 is early damage that can still be reversed. Above 300 is established damage. Every person with type 2 diabetes should have this test once a year.

eGFR

eGFR is the kidney number, worked out from your blood creatinine, age and sex. It estimates how much blood the kidneys filter each minute. 90 or above is normal. Below 60 for three months is chronic kidney disease. Below 15 is kidney failure. The kidney calculator goes into this in detail.

The medicines that protect both

Four groups of medicines lower the chance of heart attack, stroke, heart failure and kidney failure in type 2 diabetes, over and above their effect on sugar or blood pressure: SGLT2 inhibitors, GLP-1 medicines, ACE inhibitors or ARBs when there is albumin in the urine, and finerenone for diabetic kidney disease. Statins lower heart attack and stroke risk in almost everyone with type 2 diabetes over 40. The doctor's view lists which of these apply to you.

Sources

  1. Stevens RJ, Kothari V, Adler AI, Stratton IM. The UKPDS Risk Engine: a model for the risk of coronary heart disease in type II diabetes (UKPDS 56). Clin Sci 2001;101:671-9. Coefficients from the Oxford Diabetes Trials Unit equation sheet.
  2. Kothari V, et al. UKPDS 60: risk of stroke in type 2 diabetes estimated by the UK Prospective Diabetes Study risk engine. Stroke 2002;33:1776-81.
  3. Marx N, et al. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J 2023;44:4043-140. doi:10.1093/eurheartj/ehad192
  4. American Diabetes Association. Standards of Care in Diabetes 2026: Section 10, Cardiovascular Disease and Risk Management; Section 11, Chronic Kidney Disease and Risk Management. Diabetes Care 2026;49(Suppl 1).
  5. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of CKD. kdigo.org
  6. KDIGO 2022 Clinical Practice Guideline for Diabetes Management in CKD. kdigo.org
  7. Tangri N, et al. Multinational assessment of accuracy of equations for predicting risk of kidney failure. JAMA 2016;315:164-74.
  8. Inker LA, et al. New creatinine- and cystatin C-based equations to estimate GFR without race. N Engl J Med 2021;385:1737-49.
  9. Trials behind the checklist: EMPA-REG OUTCOME, CANVAS, DECLARE-TIMI 58, CREDENCE, DAPA-CKD, EMPA-KIDNEY (SGLT2 inhibitors); LEADER, SUSTAIN-6, REWIND, FLOW (GLP-1 receptor agonists); FIDELIO-DKD, FIGARO-DKD (finerenone); ASCEND (aspirin in diabetes); CTT meta-analysis (statins in diabetes).
  10. Validation of the UKPDS Risk Engine: Chamnan P, et al. Cardiovascular risk assessment scores for people with diabetes: a systematic review. Diabetologia 2009;52:2001-14. Read J, et al. Diabetologia 2021 (UKPDS-OM2 in contemporary cohorts).

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