Up to half of life-threatening kidney disease cases may go undiagnosed

Chronic kidney disease (CKD) ranks ninth among causes of death worldwide, yet up to half of cases may go undetected despite the availability of simple urine and blood tests. A global team of experts, including researchers from the SingHealth Duke-NUS Academic Center, the University of Glasgow, the University of Toronto and Peking University, published a series of research papers in The Lancet, emphasizing the need for a renewed focus on CKD diagnosis and treatment.

CKD affects 844 million adults globally, projected to become the fifth-leading cause of death by 2040. In Singapore, the prevalence stands at 14.9%, with about six new patients diagnosed daily. Up to 70% of CKD cases in Singapore may be undiagnosed in the community. Early detection through urine and blood tests is crucial for interventions that can halt or delay CKD progression.

Without early diagnosis, kidney disease may lead to failure, requiring dialysis or causing early mortality. The lack of symptoms contributes to low diagnosis rates among patients and health professionals. The risk of CKD is higher among nonwhite people, women, and those with diabetes, hypertension, obesity, heart disease, and a family history of kidney disease.

The leading cause of CKD is cardiovascular disease. Despite a 2025 World Health Assembly resolution prioritizing kidney health, progress in early diagnosis and guideline-directed medical therapy has remained suboptimal globally and in Singapore. The research papers detail the global health burden of CKD, including delayed diagnosis, advanced stages leading to kidney failure, and increased risks of all-cause and cardiovascular mortality.

Dr. Jennifer Lees, senior clinical research fellow at the University of Glasgow, stated that early diagnosis and treatment require attention and resources, particularly for at-risk populations, such as nonwhite individuals and women. Recent advances in CKD treatment and diagnosis, including gender differences, causes, and consequences for global health, are highlighted.

In Singapore, drivers of CKD include diabetes, hypertension, obesity, and lifestyle-related risk factors, with the disease more prevalent in ethnic Malays and the elderly. Early detection through screening at-risk populations, personalized risk assessment, preventive measures, and optimized implementation of guideline-directed medical therapies could delay CKD progression and lower kidney failure rates. Lifestyle interventions remain essential for CKD management.