Significant under diagnosis of chronic kidney disease (CKD), now the ninth leading cause of death globally, is endangering millions of patients around the world. But according to new research from a global team of experts including Adelaide University, suggests outcomes could be improved through wider use of a simple urine test.
This significant finding is laid out in a landmark series of research papers, published in The Lancet this week. Researchers 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. In Australia, about 2.7 million people have CKD, an equivalent of one in every seven adults.
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 a 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. In Australia, about 2.7 million adults have markers for CKD yet only 7.4 per cent of people are aware of their 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.
Healthcare burden
The new landmark series of papers, authored by researchers from around the world and led by Dr Jennifer Lees, Senior Clinical Research Fellow at the University of Glasgow and Honorary Consultant Nephrologist at NHS Greater Glasgow & Clyde, detail the full extent of the healthcare burden caused by CKD, including its poor diagnosis rates and the complications and risks around delayed treatment.
‘Chronic kidney disease remains one of the most concerning conditions currently impacting global health,’ Dr Lees said. ‘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.’
The three research papers also offer detailed insights into recent advances in CKD, including 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.
Drivers and detection
There are many drivers of CKD, including diabetes, hypertension, obesity and cardiovascular disease, with the risk of developing the disease increasing with age. Compared to those without the condition, people with chronic kidney disease have about 2-3 times higher hospitalisation rates.
Adelaide University researcher Dr Matthew Borg said early detection was critical to improving outcomes for people living with chronic kidney disease. ‘Kidney disease is often described as a silent condition because many people don’t realise they have it until it has already progressed,’ Dr Borg said.
‘That’s why simple, low-cost tests are so important – they can detect kidney disease early, when treatment is most effective. A simple combination of urine and blood tests, together with blood pressure checks, can identify kidney disease much earlier and open the door to treatments that can slow or even prevent progression to kidney failure.
‘With chronic kidney disease now affecting hundreds of millions of people globally, improving access to routine screening could help save lives and reduce pressure on health systems around the world,’ he said.
