Routine Urine Protein Testing Identifies Undiagnosed Chronic Kidney Disease

Chronic kidney disease (CKD) is a major cause of mortality worldwide and often progresses silently until advanced stages. Despite the availability of simple urine and blood tests, many cases remain undetected, limiting timely initiation of therapy. Population estimates point to a substantial disease burden, with high rates of underdiagnosis across income settings and demographic groups. New findings in a three-paper series in The Lancet highlight the scale of missed diagnoses and underscore the need to prioritize earlier detection and treatment.

Duke-NUS Medical School said a global team from institutions including the SingHealth Duke-NUS Academic Medical Centre, the University of Glasgow, the University of Toronto and Peking University has published a three-paper series in The Lancet examining CKD’s burden, delays in diagnosis and treatment gaps. The authors call for renewed attention to CKD detection and management, noting that up to half of cases may remain undiagnosed even though straightforward urine and blood tests are available in primary care.

The series emphasizes that CKD can be identified early through basic laboratory testing, including urine protein assessments, which individuals can request at General Practitioner clinics or polyclinics. Early diagnosis enables initiation of therapies aimed at halting or delaying progression. Because mild to moderate CKD is often asymptomatic, the lack of overt clinical signs contributes to low awareness among both patients and health professionals.

Across settings, the papers synthesize data showing CKD affects 844 million adults globally and is currently the ninth leading cause of death, with projections indicating it may become the fifth by 2040. In Singapore, CKD prevalence is 14.9%, with around six new patients diagnosed daily, and as many as seven in ten people with CKD may be unaware they have the condition. Estimates suggest that 30–50% of CKD cases go undiagnosed in high‑income countries, with even higher proportions likely in middle‑ and lower‑income countries; some groups, including non‑white populations and women, may be up to twice as likely to be undiagnosed as white men.

The authors also describe differences in diagnosis and treatment between men and women and outline opportunities created by advances in treatment strategies. They note that people with CKD are more likely to be hospitalized, develop complications during admission and be re‑admitted. Although a 2025 World Health Assembly resolution recognized kidney health as a global priority, progress in early detection and guideline‑directed therapy remains suboptimal. The series highlights emerging avenues—such as biomarker development, kidney biopsies, genetic testing and digital technologies including artificial intelligence—that could support more precise care pathways.

“Chronic kidney disease remains one of the most concerning conditions currently impacting global health. There is huge potential for early diagnosis and initiation of treatment by testing urine for protein routinely across a range of healthcare settings and among at risk population such as those with diabetes, high blood pressure, obesity, heart disease and family histories of kidney disease. This may be particularly important in those who are at risk of underdiagnosis, including non-white populations and women,” said Dr Jennifer Lees, Senior Clinical Research Fellow at the University of Glasgow and Honorary Consultant Nephrologist at NHS Greater Glasgow & Clyde.

“The rise of chronic kidney disease in Singapore is driven by increasing rates of diabetes, hypertension, obesity and lifestyle-related risk factors and an ageing population. Early detection through screening at-risk populations, coupled with personalised risk assessment and preventive measures as well as optimised implementation and adherence to guidelines-directed medical therapies, could help to delay the progression of kidney disease and lower the alarming rates of kidney failure. Additionally, lifestyle interventions remain an important foundation therapy for management of CKD,” stated Clinical Professor Wang Yee Moon Angela, senior researcher with the Medicine Academic Clinical Programme within the SingHealth Duke-NUS Academic Medical Centre and Senior Consultant at Singapore General Hospital's Department of Renal Medicine.e.

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