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Up to 50% of people living with chronic kidney disease (CKD) may be unaware they have the condition [1], according to a major series of papers published in The Lancet by an international team of researchers.
The analysis highlights a growing global health burden, with CKD now the ninth leading cause of death worldwide and projected to become the fifth leading cause by 2040. Despite affecting an estimated 844 million adults, diagnosis rates remain low, particularly in early stages when symptoms are often absent.
Researchers say much of this under diagnosis could be addressed through wider use of a simple and inexpensive urine test that detects protein in the urine - an early indicator of kidney damage. However, testing is not consistently implemented across healthcare systems and is often only carried out once the disease has progressed.
The Lancet series, led by Dr Jennifer Lees at the University of Glasgow, brings together evidence on the scale of the condition, disparities in diagnosis, and advances in treatment strategies. It also highlights significant inequalities in detection, with women and non-white populations more likely to remain undiagnosed.
In high-income countries, it is estimated that 30–50% of CKD cases are not diagnosed by a clinician, while even among those with a recorded diagnosis, the vast majority are unaware of their condition. In low- and middle-income settings, the proportion of undiagnosed cases is expected to be substantially higher.
Dr Jennifer Lees said early detection remains one of the most important opportunities for improving outcomes.
“There is huge potential to improve early diagnosis, treatment and healthy lifespan by testing urine for protein routinely across a range of healthcare settings. This may be particularly important in those most at risk of under diagnosis.”
The papers also emphasise that CKD is closely linked to conditions such as diabetes, hypertension, obesity and cardiovascular disease, with risk increasing significantly with age. Without intervention, progression to kidney failure can lead to dialysis or transplantation.
The authors argue that integrating routine screening into primary care for high-risk groups could significantly reduce late-stage diagnosis and improve long-term outcomes, alongside greater awareness of the condition’s silent progression.
Additional contributions from international experts underline the need for improved diagnostic infrastructure, including wider access to basic kidney function testing and emerging biomarker approaches that could help identify the cause of disease earlier.
The authors conclude that addressing the global gap in diagnosis is essential not only for improving patient outcomes, but also for reducing the long-term economic burden associated with advanced kidney disease.
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