Chronic Kidney Disease: The Silent Risk in Early Stages and Why Timely Screening Matters in Nepal

# Adrian Mercer

Chronic kidney disease, or CKD, is a condition in which kidney function gradually declines over a prolonged period, often without producing clear warning signs in its early stages. The absence of fatigue, swelling in the legs, or noticeable changes in urination does not necessarily mean that the kidneys are healthy. This silent progression is one of the most dangerous characteristics of the disease.

According to the World Health Organization, an estimated 674 million people worldwide are living with chronic kidney disease, with the majority residing in low- and middle-income countries. The most severe stage is kidney failure, when patients may require dialysis or kidney transplantation to survive.

Nepal is not exempt from this growing burden. A comprehensive review on kidney disease in Nepal published in the Journal of Nephrology in 2025 cited a national survey from 2019 showing a CKD prevalence of 6.2 percent. Separately, estimates from the Global Burden of Disease study suggested that Nepal had approximately 10,888 people with CKD per 100,000 population in 2021. Because these figures were generated using different methodologies, they should not be compared directly, but both indicate that kidney disease represents a significant public health concern in Nepal.

CKD is generally defined as an abnormality in kidney structure or function that persists for at least three months and has implications for health. Assessment focuses primarily on two areas: how effectively the kidneys filter the blood and whether abnormal amounts of protein are leaking into the urine.

A blood creatinine test is used to estimate the glomerular filtration rate, or eGFR. An eGFR below 60 that persists for three months or more can be an important indicator of CKD. However, eGFR alone is not sufficient. In early kidney damage, filtration may still appear relatively normal while albumin is already leaking into the urine.

For this reason, current international guidelines emphasise two basic tests for people at increased risk. The first is eGFR, calculated from blood creatinine. The second is the urine albumin-to-creatinine ratio, known as UACR or ACR. Persistent urine albumin levels of 30 milligrams per gram or higher may indicate kidney damage.

A single abnormal test result is not enough to diagnose chronic kidney disease. Dehydration, acute infection, acute kidney injury and other temporary conditions can alter creatinine and urine test results. Abnormal findings therefore need to be repeated according to medical advice to determine whether they persist for at least three months.

CKD is classified into stages from G1 to G5 according to eGFR. G1 refers to an eGFR of 90 or above, G2 from 60 to 89, G3a from 45 to 59, G3b from 30 to 44, G4 from 15 to 29, and G5 below 15. However, being in G1 or G2 alone does not establish CKD. In these stages, there must also be other evidence of kidney damage, such as persistent albuminuria, structural abnormalities or other recognised clinical findings.

The danger of early CKD lies precisely in its silent nature. Kidney disease may remain asymptomatic until it has progressed substantially. When symptoms eventually appear, they may include fatigue, shortness of breath, swelling of the legs or body, muscle cramps, persistent itching, nausea or vomiting. By that stage, kidney function may already have declined significantly.

Diabetes and high blood pressure are among the leading risk factors for CKD. Cardiovascular disease, inflammatory kidney disorders, certain inherited conditions, prolonged urinary obstruction, exposure to some medicines or toxins, and previous episodes of acute kidney injury can also increase risk.

For Nepal, the relationship between CKD, diabetes and hypertension is particularly important. As the burden of these non-communicable diseases rises, kidney screening should not be treated as a separate issue but as a routine component of diabetes and blood-pressure management.

People with diabetes may require periodic kidney testing even when blood glucose appears well controlled. Similarly, high blood pressure can damage the kidney’s small blood vessels over many years. At the same time, kidney disease itself can raise blood pressure, creating a cycle in which CKD and hypertension worsen each other.

Kidney disease is also not simply a matter of dialysis. As CKD progresses, the risk of cardiovascular disease and stroke rises. Patients may also develop anaemia, fluid retention, elevated potassium, disturbances in acid-base balance, and abnormalities involving bones and minerals. In many cases, cardiovascular complications can cause serious harm even before the kidneys reach the stage of complete failure.

The goal of early detection is therefore not merely to delay dialysis. When CKD is identified in time, appropriate control of blood pressure, diabetes and cholesterol, combined with suitable medication, lifestyle management and regular clinical monitoring, can slow disease progression and reduce cardiovascular risk.

People with diabetes, hypertension or cardiovascular disease, those who have previously experienced acute kidney problems, and others considered at increased risk by a clinician should not wait for symptoms before being tested. Making eGFR and urine ACR testing available through primary healthcare services could substantially improve early detection.

Once CKD is confirmed, relying on a single test is not enough. International KDIGO guidance recommends that adults with CKD have eGFR and albuminuria assessed at least once a year. People at higher risk of progression may require more frequent testing depending on their clinical condition.

Access to care remains another challenge in Nepal. A 2025 review noted that the number of nephrologists and haemodialysis centres remains limited, with specialist services disproportionately concentrated in Kathmandu. This means that a strategy focused mainly on treating patients after kidney disease has reached its final stages is insufficient.

If creatinine, eGFR and urine albumin testing were routinely integrated into facilities already screening and treating diabetes and hypertension, many cases of kidney disease could potentially be identified years before dialysis becomes necessary.

In 2025, the World Health Assembly adopted its first dedicated resolution on kidney health, urging countries to integrate prevention, early detection and treatment of kidney disease into national health systems and primary healthcare. Screening people with diabetes and hypertension was among the priorities highlighted.

At the individual level, protecting kidney health includes controlling blood pressure and diabetes, maintaining a healthy weight, staying physically active, avoiding tobacco and refraining from unnecessary use of medicines or unverified remedies that may harm the kidneys. For people already diagnosed with CKD, dietary requirements can vary according to disease stage, potassium levels, protein needs, blood pressure and other conditions. A single universal “kidney diet” is therefore not appropriate for everyone.

Nepal’s kidney-health strategy should not be limited to expanding dialysis services. Strengthening systems that detect the disease before dialysis becomes necessary may offer a far more effective public-health approach.

The central warning of chronic kidney disease is simple: in its early stages, it may provide no warning at all. For people at increased risk, the most effective approach is therefore not “test when symptoms appear,” but rather “test because the risk is already present.”