Global Burden of Chronic Kidney Disease
Chronic kidney disease affects approximately 788 million adults globally as of 2023, representing a 14.2% age-standardized prevalence and ranking as the ninth leading cause of death worldwide with 1.48 million deaths annually. 1
Prevalence and Scale
The global prevalence of CKD has increased dramatically from 378 million cases in 1990 to 788 million cases in 2023, representing a 3.5% relative rise in age-standardized prevalence over this period. 1
CKD now affects approximately 9-14% of the global adult population, with the most recent 2023 estimates placing the age-standardized prevalence at 14.2% among adults aged 20 years and older. 2, 1
Most CKD cases are in early stages, with stages 1-3 accounting for a combined prevalence of 13.9%, while advanced disease requiring kidney replacement therapy affects an estimated 4.9-7.1 million people globally. 1, 3
Regional Disparities
North Africa and the Middle East have the highest age-standardized CKD prevalence at 18.0%, demonstrating substantial geographic variation in disease burden. 1
Low- and middle-income countries bear a disproportionate burden, with 177.4 million men and 210.1 million women affected, compared to 48.3 million men and 61.7 million women in high-income countries. 4
An estimated 188 million people in low- and middle-income countries experience catastrophic health expenditure annually due to kidney disease, representing the greatest financial burden of any disease group in these regions. 2
Mortality and Morbidity Impact
CKD is now the ninth leading cause of death globally and the 12th leading cause of disability-adjusted life years (DALYs), with an age-standardized DALY rate of 769.2 per 100,000 population. 1
CKD contributes to approximately 5-10 million deaths annually, with an additional 1.2 million cardiovascular deaths directly attributed to CKD as a risk factor. 2
Impaired kidney function accounts for 11.5% of all cardiovascular deaths globally, highlighting CKD's role as a major cardiovascular risk factor beyond its direct mortality impact. 1
The mortality rate from CKD has increased with an average annual percentage change of 0.745 between 1990 and 2021, indicating worsening outcomes despite medical advances. 5
Primary Etiologic Drivers
Diabetes is the leading cause of CKD globally, accounting for 30-40% of cases and approximately 40-50% of all patients requiring dialysis or kidney transplantation worldwide. 6, 7
Type 2 diabetes mellitus has the highest age-standardized prevalence rate (1,259.63) and age-standardized incidence rate (23.07) among CKD etiologies, with projections suggesting continued increases through 2045. 8
Hypertension is the second most common cause of CKD in developed countries, present in approximately 70% of individuals with elevated serum creatinine and contributing substantially to disease progression. 6
High fasting plasma glucose, elevated body-mass index, and high systolic blood pressure are the three leading risk factors for CKD-related DALYs, reflecting the dominant role of metabolic and cardiovascular risk factors. 1
Temporal Trends and Projections
The global burden of CKD has increased markedly from 1990 to 2021, primarily driven by aging populations, rising obesity rates, and increasing prevalence of diabetes and hypertension. 2, 5
Age-standardized incidence rates continue to increase for all major CKD etiologies, with an average annual percentage change of 0.634 for overall CKD incidence between 1990 and 2021. 5
Middle sociodemographic index regions experienced the largest increases in CKD prevalence and incidence due to type 2 diabetes, with population growth accounting for 69.93% of prevalence rise and aging contributing 50.05% of deaths. 8
Projections to 2045 indicate continued increases in CKD from type 2 diabetes and hypertension, while CKD from type 1 diabetes and glomerulonephritis may decline. 8
Economic and Healthcare System Impact
In the United States alone, Medicare spending for individuals with CKD or kidney failure exceeds $114 billion annually, representing a substantial portion of total healthcare expenditure. 2
The economic burden is particularly acute in low- and middle-income countries, where lack of access to kidney replacement therapy contributes to the large number of CKD-related deaths. 2
The mounting costs for dialysis and transplantation are occurring simultaneously with increasing costs for other chronic diseases, creating compounding financial pressures on healthcare systems globally. 2
Vulnerable Populations
Socially disadvantaged and vulnerable populations experience a disproportionate burden of CKD and are least likely to receive effective treatments, making CKD screening and early intervention an equity imperative. 2
Populations with limited resources, poor access to healthcare, and low health literacy are at highest risk for kidney disease and related complications, including increased mortality from climate-related events such as heat waves and extreme cold. 2
Native American, Hispanic (especially Mexican-American), and African-American individuals with type 2 diabetes face substantially higher risks of progressing to end-stage renal disease compared to non-Hispanic white populations. 6
Complications and Comorbidities
CKD complicates the management of and heightens mortality associated with many chronic conditions, including cardiovascular disease, cancer, HIV, and SARS-CoV-2 infections. 2
Although most individuals with CKD will not progress to kidney failure, complications of CKD are common, including anemia, mineral-bone disorders, cardiovascular disease, and increased risk of acute kidney injury. 2
The risk of death from any cause, including cardiovascular disease, rises with progressive decrease in GFR, with a swift increase in adverse events when GFR falls below 60 mL/min/1.73 m². 7
Detection and Diagnosis Challenges
Most kidney disease remains undiagnosed and untreated until later stages when interventions are less effective, due to low screening rates in high-risk populations, lack of patient symptoms, and low sensitivity of creatinine-based measures to detect early kidney damage. 2
Due to variability in urinary albumin excretion, two of three specimens collected within a 3-6 month period should be abnormal before confirming CKD diagnosis, highlighting the importance of repeated testing. 7
Early identification of patients with CKD at high risk of progression is difficult, given that eGFR trajectories are usually not quantified and rapid decline in eGFR may not be recognized. 2
Sex-Based Differences
The global age-standardized prevalence of CKD is higher in women (11.8%) compared to men (10.4%), with this pattern consistent across both high-income and low- and middle-income countries. 4
Age-standardized incidence and prevalence rates are higher among females, while males have higher age-standardized mortality and DALY rates, suggesting sex-based differences in disease severity and outcomes. 5