Silent Threats: Why millions remain unaware of their risk for kidney disease

Millions of people worldwide face a serious health risk from a combination of diabetes, high blood pressure, and kidney disease. However, many don't think about it until it's too late.

Even then, understanding how these conditions are connected can be challenging.

But doctors say that understanding the relationship between them is important for anyone wanting to lower their risk or manage these conditions, especially for those helping family members with these health issues.

In Kenya, diabetes is becoming a big public health concern. In 2021, around 821,500 adults were living with diabetes, and about 4% of adults have the condition.

Most of these cases are Type 2 diabetes, which usually starts in adulthood. A large number of people with diabetes are not diagnosed, according to Kenya's Ministry of Health.

Diabetes occurs when the body has trouble making or using insulin. This causes blood sugar levels to rise, leading to health problems throughout the body.

"Diabetes can affect small blood vessels. This can cause high blood pressure and also lead to kidney disease," says Dr. John Ngigi, the head of the Nephrology and Kidney Transplant Unit at Nairobi West Hospital and chairperson of Renal Association of Kenya.

This can create a harmful cycle, as explained by Mohamed Hany Hafez of the African Association of Nephrology.

Walk for World Kidney Day celebrated on March 13, 2025/HANDOUT

Diabetes makes the kidneys less effective at filtering blood and causes blood vessels to stiffen, leading to high blood pressure.

High blood pressure, in turn, makes kidney disease worse, like adding fuel to a fire. It also increases the risk of heart problems.

The worst part is that many of these issues go unnoticed. "Most people with Type 2 diabetes don't get diagnosed or start taking medication until about five years after developing the condition," said Hafez. "High blood pressure is known as a 'silent killer,' and kidney disease often shows no symptoms until it is very advanced."

In Kenya, the Kenya Renal Association estimates that 4 million people suffer from kidney disease, and this number is expected to rise to 4.8 million by 2030. Diabetic nephropathy (kidney disease caused by diabetes) and hypertensive renal disease are leading causes.

New medications for diabetes could help a lot. One type of drug, called SGLT2 inhibitors prevents blood sugar from being absorbed by the kidneys.

Another type, GLP-1 receptor agonists, helps the pancreas make more insulin. Both types of drugs help keep blood sugar at healthy levels.

Dr. Hafez calls these new drugs "game-changing" because they can reduce the risk of kidney disease, heart failure, stroke, and death from heart problems. Studies show that these drugs have consistently shown benefits for patients in different risk groups.

However, these drugs work in several parts of the body, and that has made doctors slow to use them. Dr. Ngigi pointed out that the treatment process is often divided among specialists, which can delay proper care for patients.

"Doctors need to communicate better with each other," Dr. Ngigi said. "Right now, patients often visit different doctors for different problems, and they may not coordinate their care."

Esther Nyota, who had diabetes and end-stage kidney disease and recently received a kidney transplant at Nairobi West Hospital, agrees.

She emphasizes the importance of communication between doctors. She found that one doctor's treatment plan for one condition could make another condition worse, leading her to change doctors.

"You have to take charge of your own healthcare and make sure everyone is communicating with you at the center," Nyota said.

Dr. Ngigi recommends that patients choose one doctor to be their main advocate, who can help coordinate care. He also stresses that living a healthy lifestyle can help prevent many health problems. Drinking plenty of water, eating well, exercising regularly, and losing weight can all make a big difference.

"If you are slightly overweight, losing weight through diet can lower your blood sugar, blood pressure, and risk of kidney disease," Dr. Ngigi said. "It's not easy, but it's possible, and it can make a huge difference for people dealing with all three of these conditions."