Up to half of people living with potentially deadly kidney disease are unaware of their condition, according to a new review. Approximately one in seven Americans—37 million—have been diagnosed with chronic kidney disease (CKD), meaning their kidneys cannot adequately filter waste from the blood, leading to a buildup of toxins in the body.
This condition causes dangerously high blood pressure and elevated levels of chemicals like potassium, which can trigger irregular heart rhythms and increase the risk of fatal heart attacks and strokes. Patients with CKD often require months or years of dialysis—a process that artificially filters waste from the blood—until they can receive a kidney transplant.
CKD is the ninth leading cause of death in the United States, killing 55,000 Americans annually. Early detection is crucial for preserving kidney function and avoiding the need for a transplant. However, a new review published in The Lancet found that up to 50 percent of CKD cases in high-income countries such as the US and UK go undiagnosed until they reach later, more difficult-to-treat stages.
The findings also revealed that minority populations and women are up to twice as likely as white men to have undiagnosed CKD. Furthermore, among those with a CKD diagnosis in their medical records, nine in ten were still unaware they had the condition.
Urgent Need for Early Diagnosis
Dr. Jennifer Lees, study author and senior clinical research fellow at the University of Glasgow, stated: "Chronic kidney disease remains one of the most concerning conditions currently impacting global health. The overriding message from our series of research papers is that there remains a pressing need for attention and resource to be focused on this condition."
She urged doctors to perform regular urine tests on individuals at risk of CKD, as damaged kidneys produce excess proteins that appear in the urine. "There is huge potential to improve early diagnosis, treatment and healthy lifespan by testing urine for protein routinely across a range of health care settings," she said. "This may be particularly important in those most at risk of underdiagnosis, including non-white populations and women."
Causes and Risk Factors
There is no single cause of CKD, but it is often triggered by other conditions such as diabetes and high blood pressure, which damage tiny blood vessels in the kidneys, reducing their ability to filter waste effectively. The disease affects 844 million adults worldwide, and researchers estimate that CKD will become the fifth leading cause of death globally by 2040.
Disparities in Diagnosis
The review, which examined recent studies on CKD and diagnostic methods including blood and urine tests, ultrasound imaging, and kidney biopsies, estimates that 30 to 50 percent of CKD cases in high-income countries are not diagnosed by a doctor. Non-white adults and women are particularly prone to underdiagnosis. The National Kidney Foundation estimates that black adults are 47 percent more likely to have CKD than the overall US population, while American women face a 30 percent increased risk. The researchers estimated that minority populations are about twice as likely as white men to have their CKD go undetected.
Early Signs and Symptoms
The lack of detection may be due to early-stage CKD often causing few to no symptoms, earning it the nickname "silent disease." However, patients in the early stages may notice increased urination, as well as foam or frothiness in the urine, which indicates protein leakage. Other early signs include puffiness around the eyes due to albumin in the urine, and swelling in the ankles and feet as the body retains sodium. As the condition progresses, CKD leads to severe fatigue, nausea, decreased urination, and a dull ache in the back under the ribs.
Call for Action
Alison Railton, director of policy at Kidney Research UK, emphasized: "Governments need to prioritize resourcing health services to diagnose at-risk patients, such as those with heart disease, high blood pressure, or diabetes, earlier, and deliver urgent, preventative care, or millions of patients and economies worldwide will suffer the consequences."
