An NHS report has called for better detection and earlier treatment to help tackle chronic kidney disease.
The study commissioned by NHS Kidney Care says it causes up to 45,000 premature deaths each year, more than lung and breast cancer combined.
An improved approach could help many people to lead better lives and save the NHS money, it adds.
The report says 1.8m people in England have been diagnosed, but suggests there are one million undetected cases.
The disease, also known as CKD, is where the kidneys become less effective at filtering waste products from blood.
The study has been published in the journal Nephrology Dialysis Transplantation and its findings are drawn from NHS data and economic modelling based on clinical studies.
The paper, "Chronic Kidney Disease in England: The Human and Financial Cost", concludes that CKD costs the NHS in England more than £1.4bn a year.
The author, Marion Kerr, said better diagnosis and early treatment - particularly from GPs - could make a big difference.
"Chronic kidney disease has a much greater impact on people's lives, and on NHS costs, than is generally recognised," she said.
Her paper says nearly half the spending goes on dialysis or transplantation, yet this accounted for only 2% of all patients diagnosed with CKD.
Ms Kerr said failure to detect the disease meant many people did not get the lifestyle advice and treatment they needed.
"Most of the spending on CKD is for people with advanced disease. We hope this report will focus attention on the need for early detection and intervention, to reduce the human and financial cost of advanced kidney disease."
Dr Charlie Tonson, chairman of the Royal College of Physicians renal medicine committee, said chronic kidney disease was an important public health problem.
"Patients with early kidney disease are particularly likely to benefit from lifestyle changes and drug treatments aimed at the risk factors for heart disease and strokes, as these will help reduce the risk of progressive kidney disease," he said.
Dr Donal O'Donoghue, national clinical director for Kidney Care, described the report as a "wake-up call" for everyone involved in the fight against kidney disease.
"Putting the cost of care aside, for individuals the late identification of kidney disease means delays in diagnosis with a failure to manage risk factors including heart attacks, strokes and progressive kidney disease," he said.