Chronic kidney disease is becoming one of the world’s biggest health threats, yet millions of people who have it may not know anything is wrong.
A new series of research papers warns that many cases are being missed even though the condition can often be detected with simple blood and urine tests.
The papers were written by an international group of kidney experts and published in The Lancet. Researchers involved came from institutions including the University of Glasgow, SingHealth Duke-NUS Academic Medical Center, the University of Toronto and Peking University.
Chronic kidney disease, usually shortened to CKD, develops when the kidneys become damaged or gradually lose their ability to work properly. The condition can progress slowly over months or years.
The kidneys perform several jobs that are essential for life. They filter waste and extra water from the blood, help control blood pressure and keep important minerals in balance.
When kidney function falls, waste and fluid can begin to build up in the body. Severe kidney failure may eventually require dialysis, a treatment that removes waste from the blood, or a kidney transplant.
The major problem is that early kidney disease is often silent. People can lose a significant amount of kidney function without feeling obviously sick.
Symptoms such as severe tiredness, swelling, nausea, itching and changes in urination may become more noticeable only when disease is advanced. By that stage, opportunities to prevent serious damage may have been reduced.
Worldwide, CKD affects an estimated 844 million adults. It is currently ranked as the ninth-leading cause of death and is projected to rise to fifth place by 2040 if current trends continue.
Despite these numbers, researchers estimate that around 30% to 50% of cases may remain undiagnosed even in wealthy countries such as the United Kingdom. The problem may be even greater in countries with fewer health care resources.
Singapore provides another example of the hidden burden. About 14.9% of the population is reported to have CKD, and researchers estimate that as many as seven in ten affected people in the community may not know they have it.
The good news is that screening does not necessarily require expensive technology. Doctors can use a blood test to estimate how well the kidneys are filtering and a urine test to look for protein leaking from the kidneys.
Protein in urine can be an early warning sign because healthy kidneys normally keep most important proteins in the bloodstream. When the kidney’s filtering system is damaged, some protein can escape into urine.
Routine testing may be especially important for people at higher risk. These include people with diabetes, high blood pressure, obesity, heart disease or a family history of kidney problems.
Risk also increases with age. Certain ethnic populations have higher rates of kidney disease or kidney failure, although the reasons can involve a complex mix of medical, social, economic and access-to-care factors.
The Lancet papers also highlight differences in diagnosis between population groups. Women and some nonwhite populations may be more likely to have CKD that remains unrecognized.
Dr. Jennifer Lees of the University of Glasgow, who led the research series, said there is major potential to find disease earlier by routinely checking urine for protein in people at risk. Earlier diagnosis gives doctors more time to protect remaining kidney function.
This matters because treatment for CKD has improved. Depending on the cause and stage of disease, controlling blood pressure and diabetes, using kidney-protective medicines and making appropriate lifestyle changes can slow further damage.
People with CKD also have a higher risk of heart and blood vessel problems. In fact, many people with kidney disease are more likely to develop cardiovascular complications than to progress all the way to kidney failure.
CKD can also make hospital care more complicated. People with the condition are more likely to be admitted to hospital, experience complications during a hospital stay and return to hospital after discharge.
The researchers argue that kidney health needs to become a greater public health priority. In 2025, the World Health Assembly formally recognized kidney health as a global priority, but the authors say diagnosis and use of recommended treatments remain inadequate.
Clinical Professor Angela Wang of Singapore General Hospital and SingHealth Duke-NUS said rising rates of diabetes, high blood pressure, obesity and an aging population are helping drive kidney disease in Singapore. She emphasized screening, prevention and better use of proven treatments.
New technology may eventually make kidney care more precise. Researchers are studying blood and urine markers, genetic testing, kidney tissue analysis, digital health tools and artificial intelligence to better identify the cause and likely course of disease.
However, the central message of the Lancet series is much simpler than these advanced technologies. Many people at high risk are still not receiving basic tests that already exist.
The analysis is compelling because it brings together evidence about diagnosis, treatment and health inequalities from around the world. However, estimates of undiagnosed disease vary between countries and populations, so no single percentage applies everywhere.
Screening also needs to be targeted carefully. Testing people at higher risk is likely to provide more useful information than assuming every healthy person needs repeated kidney tests.
Overall, the research shows that CKD is both common and frequently hidden. Finding it before symptoms appear may give patients and doctors valuable time to slow kidney damage and reduce the risk of heart disease, kidney failure and early death.
Source: University of Glasgow.
