with those who were normoglycaemic at baseline. CVD risk factors explained much of the relationship between prediabetes and the development of CKD. In a recent cross-sectional survey [3], using data from NHANES III, 33% of diabetic adults with a GFR < 60 ml/min per 1.73 m 2 did not have evidence of either microalbuminuria, macroalbuminuria or retinopathy. Taken together, these data suggest that CKD in the setting of prediabetes might be thought of as an additional complication of macrovascular atherosclerosis. Findings obtained from T2DM patients with nonalbuminuric renal insufficiency [4] suggest that patients with T2DM can commonly progress to a significant degree of renal impairment while remaining normoalbuminuric. Focusing solely on urine albumin excretion to screen for CKD may therefore miss a substantial number of cases in adults with T2DM. The latter consists of a more heterogeneous group of patients, who are in general older and have more comorbid conditions at diagnosis compared with adults with T1DM. Thus, screening for diabetic renal disease should include an estimation of glomerular filtration rate (GFR) in addition to measuring AER. This will allow for the detection of subjects who follow either an albuminuric or non-albuminuric pathway to renal impairment.