REVEAL-CKD highlights substantial shortcomings in CKD diagnosis across the globe. Blood tests showing that patients have CKD are being performed, but a diagnosis of CKD is not being recorded. Patients may therefore be missing opportunities to manage their disease. Similarly, UACR testing is rarely performed, meaning that the severity of the disease often remains unknown.

It appears that patients and clinicians are not talking about CKD in the same way that they would talk about blood pressure or diabetes. Patients need to be empowered to ask about their kidneys, especially because there are often no symptoms in the early stages of CKD. If a person relies on symptoms alone to identify the disease, then they may only be diagnosed after their kidney function has declined to a point where kidney failure is very close. Acting upon earlier opportunities to foster self-care and improve health behaviour will help to avoid negative outcomes and mitigate the burden of living with CKD.

Improving patients’ understanding of the laboratory tests used to diagnose CKD could help to normalize the discussion of kidney health. If patients understand these tests, they may feel comfortable requesting them and discussing the results with their clinician. Simply understanding that lower eGFR corresponds to reduced kidney function, or high UACR indicates kidney damage, could help patients to engage in conversations about kidney health. A clear and concise understanding of some threshold values for CKD may also help prompt a conversation: eGFR less than 60 mL/min/1.73 m2 and/or UACR of 30 mg/g or more (Fig. 1). For example, if their eGFR is 45 mL/min/1.73 m2, patients should feel comfortable asking their doctor about this, just as they might ask about a high blood pressure reading. Furthermore, if a patient has an eGFR that could indicate CKD, they should be confident in asking their clinician for a UACR test so that the disease can be staged accurately.

Empowering patients with knowledge of kidney function tests and the meaning of their results could help to improve CKD diagnosis rates. CKD chronic kidney disease, eGFR estimated glomerular filtration rate, UACR urinary albumin–creatinine ratio

Awareness of these tests could prompt patients to start conversations about CKD, but clinicians still have an important role to play. In recent years, focus has been placed on early CKD diagnosis and treatment [5], although results from REVEAL-CKD show that there is still much to be done. Clinicians may still be hesitant to diagnose patients with CKD because they are afraid of overwhelming them with the diagnosis of a lifelong condition [17]. However, research has shown that patients want to know about their CKD, and they want to know early [18]. Clinicians should follow guideline recommendations for screening at-risk individuals using both eGFR and UACR tests.

Healthcare systems and policymakers also have an important role to play, and public awareness of CKD could be increased through broad national campaigns. Policymakers should implement changes in the care pathway to incentivize screening and diagnosis of CKD at earlier stages, and increase accessibility of blood and urine tests for CKD.

Early-stage CKD should not be ignored. Patients with undiagnosed CKD may be missing out on lifestyle changes or medical treatments that could prevent further damage to their kidneys. The benefits of early diagnosis are clear, not only from REVEAL-CKD [15] but from a wide array of research that outlines the high burden of late-stage CKD in terms of both symptoms and financial costs [10, 19, 20].