Why It Goes Unnoticed and What to Do About It

By Nelius W.K, AGACNP-BC, Nurse Practitioner and Founder of Suilen Health. Health education only; this does not replace advice from your own clinician.

Your kidneys work around the clock, and they’re quiet about it. They filter waste from your blood, help control your blood pressure, and keep your body’s balance in check. When they start to struggle, you often feel nothing at all. That’s exactly why kidney disease gets caught late, and why it’s worth talking about.

How common is it?

The CDC estimates that about 14 percent of U.S. adults, roughly 37 million people, have chronic kidney disease. Here’s the part that should stop you: about 87 percent of adults with kidney disease don’t know they have it.

It’s more common among Black adults. In recent CDC survey data (2021 to 2023), about 22 percent of non-Hispanic Black adults had chronic kidney disease, compared with about 13 percent of non-Hispanic white adults. (The CDC points out that these numbers may run a little high, since they’re based on a single test, but the gap is real and it matches what other research shows.)

The gap is widest when kidneys fail completely. According to the U.S. Renal Data System, as reported by the National Institute of Diabetes and Digestive and Kidney Diseases, Black people are more than four times as likely as white people to develop kidney failure. Black Americans make up about 14 percent of the population but about 30 percent of people with kidney failure.

What’s behind it?

Diabetes and high blood pressure are the two most common causes of kidney disease overall, and both are common in Black adults. Over time, high blood pressure and high blood sugar damage the tiny filters in the kidneys. The same data show that Black people are more likely than white or Hispanic people to have kidney failure caused by high blood pressure.

That ties this topic to the two articles before it on our site. Keep blood pressure and blood sugar under control and you’re protecting your kidneys at the same time.

A change worth knowing about

For years, the standard formula that labs used to estimate kidney function, called eGFR, included an adjustment based on race. In 2021, the National Kidney Foundation and the American Society of Nephrology recommended a new equation that doesn’t use race, and U.S. labs have since been moving to it. The task force also encouraged more use of a second blood test called cystatin C, alongside the usual creatinine test, to get a more accurate picture.

What does that mean for you? Your eGFR number may look different from the one on an older lab report. If you’ve had your kidneys checked before, ask your clinician what your current number means and whether anything about your care should change.

The two tests that matter

Kidney checks are simple, and both are usually done with routine lab work:

  • A blood test (eGFR) estimates how well your kidneys are filtering.
  • A urine test for protein (called UACR) catches early damage, often before the blood test changes.

If you have diabetes, high blood pressure, a family history of kidney disease, or you’re over 60, ask for both tests. If you have diabetes, the American Diabetes Association recommends checking your kidneys at least once a year.

What you can do

  • Keep your blood pressure in range. For most adults with diabetes or kidney disease, the goal is below 130/80.
  • Keep your blood sugar steady if you have diabetes.
  • Go easy on salt. Most of it comes from packaged and restaurant food.
  • Be careful with pain relievers. Regular use of ibuprofen or naproxen (Advil, Motrin, Aleve) can strain the kidneys. Ask your pharmacist or clinician what’s safe for you.
  • Don’t smoke, and stay active most days of the week.
  • Ask about newer medicines. Some diabetes medicines, such as SGLT2 inhibitors and GLP-1 medicines, are recommended because they can protect the kidneys and heart, not just lower blood sugar.

When symptoms show up

In later stages, people notice swelling in the feet or ankles, tiredness, foamy urine, or changes in how much they urinate. If you see these, call your clinician. But don’t wait for symptoms to get checked. By then, a lot of damage may be done.

Questions to take to your next visit

  • Have my kidneys been checked this year, with both the blood test and the urine test?
  • What is my eGFR, and what does it mean for me?
  • Are any of my medicines hard on my kidneys?
  • What is my blood pressure goal?

Related reading: Diabetes and Hypertension

Want more support?

Our Kidney Health: Take Control Care Kit explains the numbers, the tests and what to do next, in plain language: Get the kit.

If you’d rather learn with others, our monthly membership has live Saturday sessions at 10:00 AM, one topic at a time: Join Suilen Health.

Sources

  • Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States (prevalence, awareness, and race and ethnicity; NHANES 2021 to 2023).
  • National Institute of Diabetes and Digestive and Kidney Diseases. Kidney Disease Statistics for the United States (citing the U.S. Renal Data System, 2023 Annual Data Report).
  • National Kidney Foundation. “Changes to eGFR Calculation and What that Means for People Living with Kidney Disease” (NKF-ASN Task Force, 2021).
  • American Diabetes Association. Standards of Care in Diabetes, 2026 (yearly kidney screening, blood pressure goal, and medicines).