Just as he was stepping on stage to perform for tens of thousands of people at the Made in America Festival, Philadelphia rapper Freeway felt like he was going to pass out.

For months, Freeway was having trouble keeping food down. He was chronically exhausted. He couldn't pin down why. Now it was coming to a head, as a massive crowd waited in anticipation at one of the country's largest concerts.

"Before I perform, I always get nervous. It's just part of being an artist," said Freeway, whose legal name is Leslie Pridgen. "But I never felt how I felt that day."

Panic set in. He thought he was having an anxiety attack.

"I felt like I couldn't do it," he said.

Somehow, though, Freeway soldiered through the performance, but his nagging symptoms wouldn't disappear. Shortly after, he wound up in the hospital, grappling with a life-threatening diagnosis: kidney failure.

This was September of 2015. Doctors immediately cut a plastic tube into his chest and hooked him up to emergency dialysis, a process that filtered out the dangerous levels of toxins that had built up in his blood.

In retrospect, the warning signs could not have been more obvious, Freeway says now. But he was shocked to learn how many other friends and fellow artists are in a similar situation.

African Americans are nearly four times as likely as whites to develop kidney failure. Diabetes and high blood pressure, two conditions that Freeway had developed in the years prior, are also major risk factors.

"I was clueless to it," said Freeway. "I feel as though it's not talked about very much because it's something that a lot of people are ashamed of."

Risk factors on the road

By his early twenties, he made a name for himself (and his beard), touring the world and playing big shows as a member of Jay Z's Roc-A-Fella label.

"The thing that I love about music and hip hop and rap is it's a way for me to express how I feel and what I go through in my life," he said. "When I was younger, I just used it as an avenue to get my emotions out and to air how I was feeling."

Health wasn't exactly a focus.

"We feel invincible, running around from city to city," he said. "So we wasn't too mindful of those things when we should have been."

He began experiencing fatigue and shortness of breath. By 2012, it became unbearable. He was diagnosed with diabetes and high blood pressure.

"I have family members that had high blood pressure and diabetes, but I wasn't really too in tune with what it does to you and the effects that it has on the body," he said.

The news marked a big lifestyle shift. He took insulin at first but was able to wean himself off through diet and exercise.

"I wouldn't even eat a cheesesteak," he said.

He even remembers chiding a fellow artist who also had diabetes and blood pressure for eating poorly. But over time, he let things slip.

"Like six, seven months later I was probably eating cheesesteaks again," he admitted. "You know, as time goes past, you might get away with it one time and feel fine. And then, you find yourself doing it three or four times."

He struggled to keep his blood pressure under control.

Fast forward to 2015, to that near anxiety attack before the Made in America show, to that emergency visit to the hospital, to that life-changing diagnosis of kidney failure.

He was 37 years old.

"It can happen to anyone, but I am kind of young for it," he said.

Going public about a new reality

From the beginning, Freeway was open about his diagnosis. He had to cancel some big shows shortly after, and he wanted to let people know what was going on.

"I wasn't too timid about it. The type of person I am, I share my life with my fans," he said. "Because they see how hard I go in life and how successful I became, and if something like that can affect me, it opened up a lot of people's eyes."

But he wasn't expecting all of the personal responses.

"When I came out with my story, you'd be surprised how many people came to me - it was people that I dealt with at least a couple times a month - that had kidney failure. I didn't even know. They never said nothing to me or told nobody," he said. "It's a disease, you know, and ain't nobody running around saying I got a disease and I'm sick."

People also told him of loved ones - a father or sister - who also had kidney failure. The stories hit close to home. His uncle had had a kidney transplant. A cousin had died of kidney failure.

"I knew about it, but we didn't discuss it," he said.

And then there was Phife Dawg from a Tribe Called Quest, an artist Freeway looked up to growing up. He had diabetes, underwent a kidney transplant in 2008, but continued to experience complications. He died last March at the age of 45.

"There are countless artists that have high blood pressure and diabetes. You know, it's normal in the African American community," he said. "It's really serious. It's really affecting us."

Freeway has since been working on a documentary about dealing with kidney failure. He shares his experiences on social media. He has been honored by the National Kidney Foundation for his advocacy work.

"The best thing I can do is take care of myself to the best of my ability and keep spreading awareness," he said.

See the doctor routinely, he often tells people. He's more adamant about maintaining a healthy diet and exercising.

On dialysis

But for Freeway, a major part of his new reality is dialysis: four hours a day, three days a week.

The process replaces the functions of the kidney by cleaning out toxins and fluid in the blood. He had surgery to move a main vein located on the bottom of his arm to the top, making it easier to access the vein and hook it up to the machine.

While the routine is critical, it can be, well, boring. He schedules it early in the day, after his Muslim prayers.

Dialysis can also be really draining. Literally. Blood gets pumped out and back into the body. Still, Freeway continues to stay active and wants others to see that such is possible, even with kidney failure. He schedules recording sessions and concerts around his dialysis. When on the road, he gets the treatment in other cities.

He made it back to the Made in America Festival this year, performing twice.

"I feel as though the key to living the lifestyle that I live is taking care of yourself, making sure you're eating right, and keeping a good team around you," he said.

As a result of his condition, he can only drink 32 ounces a day. That can be tough in the summer. But one of the biggest things, he says, is keeping his cell phone charged and with him at all times. He's waiting for a new kidney and is hopeful the call could come any day.

"My understanding is you can live on dialysis for years, but once you get a kidney, it doubles your life expectancy," he said.

'I'm still breathing'

In the same way that hip hop has always been a way to express what's going on in his life, his diagnosis has also made it into his music.

"It's not like I got a whole song about kidney failure, I just touch bases in it, you know," he said.

"...I'm breathing / I'm living / I'm still breathing / Yeah my kidney's bad, but I'm still breathing..."

At the end of a song released in early 2016, "Wasted", Freeway raps about being on the kidney transplant list. Expect to hear about kidney failure in upcoming projects, too, he said. 

"It changed me. It just matured me a lot," he said. "It really made me appreciate life and the blessing that God has given me. And the opportunity to keep being here, and to keep pushing."