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Diabetic kidney disease (DKD) develops in 1 in 3 people with type 2 diabetes (T2D) and is the leading cause of end-stage renal disease (ESRD). DKD currently costs the US healthcare system USD 50 billion annually. PromarkerD is a simple biomarker-based blood test that can predict future renal function decline in T2D patients who have no or mild existing DKD (eGFR >30). This study estimated the net savings to US payers from covering the PromarkerD test versus current standard of care (SOC). Model inputs included costs and frequency of testing, costs associated with changes to patient medication strategies, and cost-savings from slowed DKD progression and averted ESRD interventions (dialysis and kidney transplants). All estimates and inputs for the model were collected from recent peer-reviewed literature, established insurance payment rates, and PromarkerD clinical studies. Results showed that over ten years the net savings for US payers by adopting PromarkerD testing for T2D patients (KDIGO DKD category G1-3b) would exceed USD 14 billion and the equilibrium point (costs equal savings) can be achieved after two years. Primarily, savings arise from slower DKD stage progression, with contributions from delayed dialysis and transplants, and also from fewer unplanned dialyses. This economic study demonstrates that improved management of T2D patients through the use of early, accurate and cost-effective prognosis with the PromarkerD test could result in substantial savings to US payers in the treatment of DKD. Employing this alternative PromarkerD testing regime over the current SOC would enable early interventions for at-risk patients, thereby decreasing the need for expensive interventions such as dialysis and transplants, or unnecessary adoption of new therapeutic treatments. Disclosure W. Burchenal: Research Support; Self; Proteomics International. M. Datar: Research Support; Self; Proteomics International. K. E. Peters: Employee; Self; Proteomics International, Stock/Shareholder; Self; Proteomics International. G. C. Fernandez: Employee; Self; Proteomics International, Stock/Shareholder; Self; Proteomics International. J. C. Morrison: Consultant; Self; Proteomics International. R. J. Lipscombe: Employee; Self; Proteomics International.