Prediabetes and chronic kidney disease: a comprehensive review of association and clinical implications

Prediabetes affects nearly one-third of adults in the United States and is increasingly recognized as a contributor to early chronic kidney disease (CKD). This review summarizes current evidence linking prediabetes with early kidney changes, including albuminuria, glomerular hyperfiltration, and mild renal impairment, as well as its association with increased cardiovascular risk. Large observational cohorts, such as the Chronic Renal Insufficiency Cohort, suggest an association between prediabetes and progression of proteinuria, although its independent contribution to advanced CKD remains variable. We review proposed mechanisms, including insulin resistance, low-grade hyperglycemia, altered tubulo-glomerular feedback mediated by sodium-glucose cotransporter 2 activity, inflammation, and endothelial dysfunction. Variability in diagnostic thresholds across major guidelines complicates risk stratification. Emerging biomarkers may facilitate earlier detection but require further validation. Early identification and guideline-directed lifestyle and pharmacological interventions may help mitigate CKD progression and related cardiovascular outcomes. These insights inform population-level screening, prevention, and decision-making.