As many as half of chronic kidney disease (CKD) cases may remain undiagnosed worldwide despite the availability of simple urine and blood tests, according to a new series of research papers published in The Lancet. The global team of researchers is calling for greater attention to early CKD diagnosis and treatment.
Led by Jennifer Lees, PhD, of the University of Glasgow, the series examines the global burden of CKD and challenges in diagnosis and treatment. The papers also explore gender differences in kidney disease, the causes and mechanisms of CKD and its health consequences, as well as advances in treatment and opportunities for more integrated approaches to prevention and care.
CKD affects up to an estimated 844 million adults worldwide and is projected to become the fifth leading cause of death globally by 2040. In high-income countries such as the United Kingdom, an estimated 30% to 50% of CKD cases are undiagnosed, while the proportion may be higher in middle- and lower-income countries.
Simple tests could support earlier diagnosis
CKD can remain asymptomatic during its mild to moderate stages, with symptoms potentially appearing only when the disease has progressed toward kidney failure. Early diagnosis can allow intervention intended to halt or delay disease progression.
The researchers note that CKD can be detected through urine and blood testing, which can be requested at primary care clinics and polyclinics. Routine urine testing for protein may be particularly useful for people at increased risk, including those with diabetes, high blood pressure, obesity, heart disease, or a family history of kidney disease.
“There is huge potential for early diagnosis and initiation of treatment by testing urine for protein routinely across a range of healthcare settings and among at risk population such as those with diabetes, high blood pressure, obesity, heart disease and family histories of kidney disease,” said Jennifer Lees, PhD, senior clinical research fellow at the University of Glasgow and Honorary Consultant Nephrologist at NHS Greater Glasgow & Clyde, in a DukeNUS release.
The series also highlights disparities in CKD diagnosis. Non-white people and women may be up to twice as likely to remain undiagnosed as white men, according to the researchers. The authors say this makes early testing particularly important for populations at greater risk of underdiagnosis. Lees specifically points to routine urine testing for protein among at-risk populations, including people with diabetes, high blood pressure, obesity, heart disease, or a family history of kidney disease. The researchers also note that CKD is more common among people who are Black or of South Asian origin, while in Singapore, people of Malay ethnicity have the highest incidence of kidney failure.
Emerging tools may advance precision medicine
The papers examine advances in understanding CKD, including differences in kidney disease between men and women, disease causes and mechanisms, and treatment strategies. The authors also point to opportunities involving biomarkers, kidney biopsies, genetic testing, digital technologies, and artificial intelligence.
Angela Wang Yee Moon, a senior researcher with the Medicine Academic Clinical Programme within the SingHealth Duke-NUS Academic Medical Centre and Senior Consultant at Singapore General Hospital's Department of Renal Medicine, said the rise of CKD in Singapore is being driven by increasing rates of diabetes, hypertension, obesity, and lifestyle-related risk factors, as well as an ageing population.
“Early detection through screening at-risk populations, coupled with personalized risk assessment and preventive measures as well as optimized implementation and adherence to guidelines-directed medical therapies, could help to delay the progression of kidney disease and lower the alarming rates of kidney failure. Additionally, lifestyle interventions remain an important foundation therapy for management of CKD,” said Moon in a DukeNUS release.
Wang added that advances in biomarkers, kidney biopsies, and genetic testing are providing new insights into the causes of kidney disease, while digital technologies and artificial intelligence may create further opportunities to improve patient outcomes through precision medicine.
This article was created with the assistance of Generative AI and has undergone editorial review before publishing.
