Significant under diagnosis of chronic kidney disease (CKD), now the ninth leading cause of death globally, is endangering millions of patients around the world and could be improved with the increased use of a simple urine test.
The stark healthcare message is laid out in a landmark series of research papers, published in The Lancet by a global team of experts who are now calling for a renewed focus on CKD diagnosis and treatments.
Chronic kidney disease, a long-term condition where the kidneys don't work as well as they should, currently affects 844 million adults worldwide and is projected to become the fifth leading cause of death by 2040. It is estimated that around 7.2m people have CKD in the UK.
Early diagnosis of CKD is critical for treatment success, and the condition can be detected using a simple and affordable urine test; however, the test isn't routinely used across all healthcare settings, and often only when kidney disease has already progressed.
In mild and moderate stages of the disease, people rarely experience any symptoms. Symptoms may develop only in the most severe stages, close to the time when dialysis or kidney transplant may be required. Without successful treatment the condition can be fatal.
The lack of symptoms likely contributes to low rates of diagnosis and awareness. Currently it is estimated that around 30-50% of CKD cases are not diagnosed by a doctor in high-income countries like the UK, with the percentage of undiagnosed cases in middle and lower-income countries thought to be much higher. In some groups, the percentage of undiagnosed cases is particularly high: non-white people and women may be up to twice as likely to remain undiagnosed as white men. Even among individuals who do have a diagnosis of CKD in their medical record, 9 in 10 are unaware they have the condition.
Despite being recognised by both the United Nations and the World Health Organization as a major global health concern in recent years, progress in improving the diagnosis of CKD remains slow.
The new landmark series of papers, authored by researchers from around the world and led by Dr Jennifer Lees from the University of Glasgow, detail the full extent of the healthcare burden caused by CKD, including its poor diagnosis rates and the complications and risks around delayed treatment.
Dr Jennifer Lees, Senior Clinical Research Fellow at the University of Glasgow and Honorary Consultant Nephrologist at NHS Greater Glasgow & Clyde, said: "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.
"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, including non-white populations and women."
Professor Louise Oni, Chief Investigator of the LifeArc-KRUK Rare Kidney Centre, at the University of Liverpool and based at University College London, is a co-author. She said: "This impactful Lancet series which highlight the global problem of rising chronic kidney disease. Her role was to represent children who are an important group in this increasing problem and they remain at the focus of her work led from Liverpool.
The three research papers also offer detailed insights into recent advances in CKD, including our increased understanding of the disease and its consequences for global health, as well as the opportunities provided by advances in treatment strategies. The research papers highlight the differences in treatments and diagnosis between men and women, alongside the need for integrated approaches to CKD prevention and treatments across a range of healthcare settings.
The Lancet papers are released as up to 10,000 kidney experts arrive in Glasgow for the European Renal Association Congress on the 3-6 June.
There are many drivers of CKD, including diabetes, hypertension, obesity and cardiovascular disease, with the risk of developing the disease increasing with age. While it can affect anyone, chronic kidney disease is more common in people who are black or of south Asian origin.
Compared to those without the condition, people with chronic kidney disease are more likely to be hospitalised, develop complications while in hospital, and also be re-admitted.
