Daijiworld Media Network - Singapore
Singapore, Aug 18: Up to half of chronic kidney disease (CKD) cases may remain undetected globally despite the availability of simple blood and urine tests, according to a landmark series of research papers published in The Lancet by an international team of experts.
The researchers, from institutions including the SingHealth Duke-NUS Academic Medical Centre, University of Glasgow, University of Toronto and Peking University, have called for greater focus on early diagnosis and treatment of CKD, warning that delayed detection can allow the disease to progress to kidney failure and increase the risk of premature death and cardiovascular complications.
CKD, a long-term condition in which the kidneys do not function as effectively as they should, affects an estimated 844 million adults worldwide and is projected to become the fifth leading cause of death by 2040.
In Singapore, CKD affects 14.9% of the population, while around six new patients are diagnosed with the disease every day. Researchers estimate that as many as seven in 10 people with CKD in Singapore may not know they have the condition, meaning around 70% of cases could remain undiagnosed in the community.
Early diagnosis is important because treatment can be started sooner to halt or slow the progression of kidney disease. CKD can be detected through relatively simple blood and urine tests, which can be requested at general practitioner clinics or polyclinics.
Many people with mild to moderate CKD do not experience noticeable symptoms. Symptoms may emerge only when the disease reaches an advanced stage, sometimes close to kidney failure, when dialysis or a kidney transplant may become necessary.
Without early detection and treatment, CKD can progress to kidney failure and lead to dialysis, transplantation or premature death. The absence of symptoms is also a major reason for low levels of awareness and diagnosis among both patients and healthcare professionals.
An estimated 30-50% of CKD cases remain undiagnosed in high-income countries such as the United Kingdom, while the proportion is believed to be even higher in middle- and low-income countries. Certain groups face an especially high risk of underdiagnosis, with non-white people and women potentially up to twice as likely to remain undiagnosed as white men.
Although the World Health Assembly adopted a landmark resolution in 2025 recognising kidney health as a global priority, progress in early CKD diagnosis and the timely initiation of guideline-directed treatment remains inadequate worldwide and in Singapore.
The three papers in the new series, led by Dr Jennifer Lees of the University of Glasgow, examine the global healthcare burden associated with CKD, including delayed diagnosis and its consequences. The researchers noted that delayed diagnosis can contribute to progression towards advanced kidney disease and kidney failure, while also increasing the risks of overall and cardiovascular mortality.
Dr Lees, Senior Clinical Research Fellow at the University of Glasgow and Honorary Consultant Nephrologist at NHS Greater Glasgow & Clyde, said CKD remains one of the most concerning conditions affecting global health and called for greater attention and resources to be directed towards the disease.
She said there was significant potential for earlier diagnosis and treatment by routinely testing urine for protein in different healthcare settings and among people at increased risk, including those with diabetes, high blood pressure, obesity, heart disease and a family history of kidney disease.
The researchers said such screening could be particularly important for groups at greater risk of underdiagnosis, including non-white populations and women.
The three papers also examine recent advances in understanding CKD, including differences between men and women, the various causes and mechanisms of kidney disease and its consequences for global health. They also highlight emerging treatment strategies and the need for integrated approaches to prevention, diagnosis and treatment across different healthcare settings.
Diabetes, hypertension, obesity and cardiovascular disease are among the major drivers of CKD, while the risk of developing the disease increases with age. Although CKD can affect anyone, it is more common among Black and South Asian populations. In Singapore, people of Malay ethnicity have the highest incidence of kidney failure.
People with CKD are also more likely than those without the disease to require hospitalisation, develop complications during hospital stays and be readmitted.
Clinical Professor Wang Yee Moon Angela, a senior researcher with the Medicine Academic Clinical Programme at the SingHealth Duke-NUS Academic Medical Centre and Senior Consultant at Singapore General Hospital's Department of Renal Medicine, co-authored two of the papers.
She said the rise of CKD in Singapore was being driven by increasing rates of diabetes, hypertension, obesity and lifestyle-related risk factors, together with an ageing population.
She stressed that early detection among at-risk groups, personalised risk assessment, preventive measures and better implementation and adherence to guideline-directed medical therapies could help slow kidney disease progression and reduce the country's high rates of kidney failure.
Lifestyle interventions, she added, remain an important foundation of CKD management.
Advances in biomarkers, kidney biopsies and genetic testing are also providing researchers with a deeper understanding of the causes of kidney disease. Prof Wang said emerging digital technologies and artificial intelligence could further create opportunities to improve patient outcomes through precision medicine.
The researchers hope the series will raise awareness of CKD globally and locally and encourage people at increased risk to undergo early screening and take steps to prevent or delay progression of the disease.