A simple and affordable urine test could significantly improve the early detection of chronic kidney disease (CKD), according to a landmark series of papers published in The Lancet. Global experts are urging healthcare systems to prioritise routine kidney screening as millions of cases remain undiagnosed despite the availability of effective diagnostic tools and treatments.
The research highlights CKD as the world's ninth leading cause of death, affecting an estimated 844 million adults globally. The disease is projected to become the fifth leading cause of death by 2040 if diagnosis and treatment rates do not improve.
The authors estimate that 30–50 per cent of CKD cases remain undiagnosed in high-income countries, with underdiagnosis believed to be even higher in low- and middle-income regions. The condition is often detected only after it has progressed because patients with mild or moderate CKD typically experience few or no symptoms. Researchers also note that women and people from non-white ethnic groups are disproportionately affected by delayed diagnosis.
Led by Dr Jennifer Lees, Senior Clinical Research Fellow at the University of Glasgow and Honorary Consultant Nephrologist at NHS Greater Glasgow & Clyde, the international research team is calling for routine urine protein testing across a wider range of healthcare settings to enable earlier diagnosis and intervention.
"Chronic kidney disease remains one of the most concerning conditions currently impacting global health," said Dr Lees. "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 underdiagnosis, including non-white populations and women."
The three-part Lancet series also examines advances in CKD diagnostics and disease understanding, including the growing role of biomarkers, kidney biopsy and genetic testing in identifying the underlying causes of kidney disease. Researchers argue that these technologies, combined with simple urine protein testing and blood creatinine measurements, can enable more personalised treatment strategies and improve long-term patient outcomes.
Professor Luxia Zhang of Peking University emphasised that while advanced diagnostic technologies are improving disease characterisation, access remains uneven worldwide.
"Advances in biomarkers, biopsy, and genetic testing now allow us to understand why an individual has kidney disease, not just that they have it. Realising this benefit for patients everywhere will require sustained investment in diagnostics, laboratory capacity, and workforce," Zhang said.
Professor Adeera Levin of the University of British Columbia highlighted the importance of combining routine screening with newer therapeutic options.
"Simple tests like urine protein and blood for creatinine (eGFR), along with blood pressure measurements, can increase early detection of CKD. We now have a terrific array of medications to delay or indeed stop kidney disease progressing, so that early identification is really important," Levin said.
The researchers also stress that CKD is closely associated with diabetes, hypertension, obesity and cardiovascular disease, making integrated screening programmes particularly important for high-risk populations. Earlier diagnosis could reduce hospitalisations, delay progression to kidney failure, and lower the need for dialysis or transplantation.
The publication coincides with the European Renal Association Congress in Glasgow, where thousands of kidney specialists are discussing advances in CKD prevention, diagnosis and treatment. The authors conclude that expanding access to routine kidney screening and modern diagnostic technologies will be essential to reducing the global burden of chronic kidney disease.
