Chronic kidney disease awareness: a narrative review of patient, healthcare system, and community perspectives

Chronic kidney disease (CKD) affects 788 million adults worldwide and is among the leading causes of death globally, yet awareness of the disease remains critically low across all populations. This narrative review synthesises the current evidence on CKD awareness at three interconnected levels: the individual patient, the healthcare system, and the community. At the patient level, pooled estimates indicate that overall CKD awareness is approximately 19%, with awareness in general population settings as low as 7.3%. Even among patients under nephrology care, significant knowledge gaps persist regarding treatment modalities and disease progression. At the healthcare system level, studies such as the multinational REVEAL-CKD study demonstrate that over 75% of stage 3 CKD cases remain undiagnosed, with underdiagnosis rates reaching 95% in some countries. Provider-level barriers include time constraints, lack of clinical confidence, and reluctance to communicate a CKD diagnosis. At the community level, public understanding of kidney health is profoundly limited compared with awareness of other chronic conditions such as diabetes and cardiovascular disease. This review further examines the determinants of CKD awareness, including education, socioeconomic status, age, and comorbidities. Health literacy emerges as a critical mediating factor, with approximately 25% of CKD patients demonstrating limited health literacy. Current evidence on awareness-enhancing interventions, measurement tools, and national policy initiatives is also reviewed. The findings underscore the urgent need for coordinated, multilevel strategies that address individual knowledge deficits, strengthen healthcare system capacity for early detection, and enhance community-level understanding of CKD.