In type 2 diabetes (T2DM) patients, long-term renal function deterioration can be independently predicted by visit-to-visit variability (VVV) in albuminuria.

• In this cohort study, the predictive ability of VVV in albuminuria was assessed for changes in renal function in patients with T2DM.

• A higher albuminuria variability score (AVS) was found to be linked with higher adjusted odds of having a declined or rapidly declined estimated glomerular filtration rate (eGFR) trajectory (1.84 and 5.70, respectively), a resultant eGFR <60 ml/min/1.73 m ² (2.61) and a >40% decrease in eGFR from baseline (6.44).

• In the validation cohort, a 5-year decrease of >40% in eGFR to <60 mL/min/1.73 m ² was shown to be independently predicted by a higher AVS (adjusted hazard ratio 3.33).

• AVS significantly improved the predictive ability of the models.