It has been described by experts as a slow-moving tidal wave threatening to engulf the NHS. Chronic kidney disease – a condition that causes the kidneys to gradually stop working – already affects more than seven million Britons and contributes to 45,000 deaths a year.

That’s more than prostate and breast cancer combined. The danger is that in most cases it has no symptoms until the kidneys are close to failing – by which point it is often too late for treatment. As a result, at least one million are thought to be living with the disease right now without knowing it. And worryingly, the problem is only growing. The number of people diagnosed is expected to rise by 400,000 over the next decade.

The cost to the NHS is staggering. Dialysis – the gruelling, life-sustaining treatment for kidney failure – is already one of the health service’s biggest expenses, forecast to hit £13 billion a year by the end of the decade.

The number of patients waiting for kidney transplants is expected to triple by 2033. Nearly 1,000 people die every year waiting for a new kidney.

This staggering rise is being driven by a number of factors including an ageing population and a growth in patients living with high blood pressure – which is known to trigger kidney disease.

But experts say the biggest driver of this looming crisis is the explosion in diabetes cases. There are now around four million Britons living with the blood-sugar condition – double the figure of 20 years ago – and by 2030 that number is expected to climb by another million. Research shows persistently high blood sugar almost inevitably damages the kidneys. Nearly four in ten diabetes patients will develop kidney disease and up to a third will progress to the severe form, putting them at risk of organ failure.

The tragedy is that once kidney damage sets in, it cannot be undone. Prevention – or catching the disease early – has long been the only defence.

And until recently, there were few effective treatments to halt its progress.

But that picture has changed. A new class of drugs – £1-a-day tablets with few side-effects – is being hailed as revolutionary. Called SGLT2 inhibitors, kidney specialists say they represent an even greater breakthrough than the blockbuster weight-loss jabs such as Wegovy and Mounjaro.

Earlier this month the NHS announced that millions more patients would soon be able to get these pills directly from their GP – a move experts believe could be crucial in turning the tide against kidney disease.

But campaigners warn many eligible patients may still miss out, simply because too few doctors know these drugs exist.

So who stands to benefit from these game-changing tablets – and how can patients get hold of them? First, it’s important to understand what chronic kidney disease is. The condition develops when the kidneys, which filter waste from the blood and produce urine, no longer work properly. A poor diet and lack of exercise raise the risk, while high blood pressure – which affects over 14million Britons, including rising numbers of younger people – is another major trigger.

But diabetes is by far the biggest culprit, particularly in driving the most severe forms of kidney disease – the kind that puts people in hospital and claims lives. Diabetes occurs when the body is unable to keep blood sugar levels down using the hormone insulin. In type 1 diabetes, patients are unable to produce enough insulin, usually due to genetic mutations. But nine in ten cases are type 2 diabetes, which is largely driven by poor diet and obesity and occurs because the body stops responding to insulin.

Left unchecked, diabetes can cause devastating complications, from heart disease to blindness.

It also damages the kidneys, which must work overtime to flush out excess sugar. Over time, this leads to failure. Most kidney disease sufferers have no symptoms for years, with the condition often spotted only in routine blood tests. When it does show, warning signs include fatigue, swelling in the ankles or hands and nausea.There is no cure. Many patients end up on dialysis several times a week or need a kidney transplant.

Ultimately, kidney failure can trigger fatal heart attacks and strokes. In order to prevent kidney disease – along with other complications – diabetes patients are, at present, offered a series of increasingly potent drugs designed to reduce blood sugar levels. The first step is a cheap tablet called metformin.

If that fails, then a type of drug known as gliptins, is prescribed. Currently, only if neither of these treatments is able to get blood sugar under control will the NHS consider offering patients SGLT2 inhibitors.

These tablets, which include empagliflozin (also known as Jardiance), dapagliflozin (forxiga), canagliflozin and ertugliflozin, have been used for nearly a decade on the NHS. They are typically taken as a once-daily tablet, usually with breakfast. Experts say their primary purpose is blocking the absorption of sugar and salt by the kidneys and flushing it out into the urine. This reduces blood sugar levels, which is what makes it useful for diabetics, and reduces the pressure on kidney function.

However, in recent years, growing research has shown that SGLT2 inhibitors have a number of other unexpected benefits.

‘Not only do these tablets help remove sugar via the urine, they also seem to protect against some of the damage done to the kidneys and heart by diabetes,’ says Professor Will Herrington, a University of Oxford nephrologist who led a major empagliflozin study. ‘No one expected these drugs to be so effective and we’re still unsure exactly how they work, but it would appear that they have an anti-inflammatory effect that protects these crucial organs.’

Experts say that multiple trials of SGLT2 inhibitors have shown remarkable results. The tablets can reduce the risk of heart disease and death from cardiovascular problems by about a third.

They can slow the progression of kidney disease by around 40 per cent and, crucially, cut the risk of needing dialysis or a transplant by a quarter.

For this reason, the tablets are also offered on the NHS to patients with severe kidney disease who do not have diabetes.

However, at present, experts say they are being handed out too late. ‘The best time to put patients on SGLT2 inhibitors is as soon as possible after they are diagnosed with diabetes,’ says Prof Herrington. ‘If you give a patient with advanced kidney disease these drugs, you may slow it down, but you’re only temporarily putting off the inevitable – dialysis and a transplant. But if you give diabetes patients a drug like empagliflozin early you can prevent kidney disease from occurring.

‘That would dramatically cut the number of new diagnoses. You’d save countless lives.’

It’s why, earlier this month, the NHS spending watchdog, the National Institute for Health and Care Excellence, issued new guidance which stated that GPs should now offer diabetes patients an SGLT2 inhibitor immediately after diagnosis, alongside metformin.

Those who have some form of heart disease will also be offered these two drugs with the addition of a GLP-1 injection – the blood sugar-controlling jabs, like Ozempic, which are also highly effective weight-loss treatments.

Diabetes patients who fail to respond to an SGLT2 in combination with metformin will then be considered for a GLP-1 drug too. ‘Our research shows that this triple therapy provides the best protection against developing kidney disease,’ says Prof Herrington. ‘There’s a strong argument for diabetes patients being offered all three drugs.’

Studies show the tablets are safe, with few side-effects. The most common is genital thrush – an uncomfortable yeast infection that causes stinging and itching. ‘The drugs flush sugar out in the urine and that extra sugar provides food for yeast, making infections more likely,’ explains Prof Herrington.

‘The good news is it’s easily prevented by keeping the area clean and dry. And if it does occur, an over-the-counter cream such as Canesten from the pharmacist will clear it up.’

Experts say that it will take around a year before the new guidance comes into effect. They also add that, while there are a number of SGLT2 inhibitors available, research shows they all appear equally safe and effective – meaning there is no need to ask a GP for a specific version.

However, campaigners have warned that thousands of patients are in danger of missing out on the tablets because many GPs are unaware of them.

NHS figures show that many patients who should already be receiving SGLT2 inhibitors are not getting them – needlessly putting them at risk of kidney and heart problems.

‘The number of kidney disease patients getting these drugs is worryingly low as it stands,’ says Fiona Loud, policy director at the charity Kidney Care UK.

‘With more patients now becoming eligible for SGLT2 inhibitors, it’s important GPs take time to learn about them, so that everyone who qualifies can get one. And anyone who thinks they might qualify to take these drugs should talk to their GP.’

Experts say the tablets should be easy for GPs to hand out and, since they have few serious side- effects, are simple to take.

‘We’ve used these drugs for a decade now and we know they are very safe,’ says Prof Herrington. ‘Getting patients on these tablets is an easy win for GPs. For 20 years, there were very few options out there to tackle kidney disease and, as a field, it was pretty depressing.

‘We’re now entering the golden age of kidney drugs – so it’s important that we get them to the right patients as quickly as possible.’

My kidneys were in trouble before pill  

Mary Cooper had always believed she was perfectly healthy until, 15 years ago, she began to feel fatigued.

‘I was terribly tired all the time,’ says the IT worker from Milton Keynes. ‘So I went to my GP and he ordered a blood test.’

A week later Mary, now 82, received her results: she had advanced kidney disease. ‘I’d never really thought about kidney disease before,’ she says.

‘But I must have had it for some time because you only get symptoms once it gets bad.’ Over the years, Mary’s kidney function continued to go down. ‘It was getting to the point where the doctors were getting concerned,’ she says.

Then, in 2018, Mary was offered the chance to join a drug trial for the tablet empagliflozin – which is designed to remove excess sugar from the blood and reduce pressure on the kidneys.

‘I was told it would protect my kidneys and my heart,’ says Mary. ‘So I thought it sounded worth a try.’ For five years, Mary took one tablet every day. She never experienced side-effects. Crucially, scans and blood tests revealed that her kidney function remained stable, meaning it was not getting any worse.

‘It was such good news because I really didn’t want to think about dialysis or a transplant,’ she says.

However, in 2023, when the trial was completed, Mary came off the tablets.

She now hopes that her GP will be able to prescribe them to her. ‘I’d go on it in a heartbeat,’ she says.

‘It was really easy to take and it clearly can make a big difference to your health.’