The number of adults with chronic kidney disease is growing, according to a recent study published in The Lancet, which suggests the statistics might be indicative of not just the world’s ageing population but also better awareness of the disease.
It was the ninth leading cause of death worldwide in 2023, up from the 27th leading cause in 1990, reports The New York Times. In 2023, about 14% of adults aged 20 and older – 788m people – were estimated to have chronic kidney disease, up from just more than 12% in 1990, according to the study.
The increase reflects the ageing of the world’s population, the rise in common risk factors, like diabetes, high blood pressure and obesity, and possibly also growing awareness and diagnosis of the disease, noted the researchers.
Kidney disease is largely asymptomatic until it becomes advanced, at which point patients could already need dialysis or an organ transplant. But there are simple tests that detect it earlier and a host of newer medications to slow its progress.
“We should be doing a better job of identifying individuals at risk and intervening,” said Dr Susan Quaggin, a former President of the American Society of Nephrology and chair of medicine at the Northwestern University Feinberg School of Medicine, who was not involved in the study.
How chronic kidney disease develops
Healthy kidneys are powerhouses of filtration, processing more than 150 litres of fluid from the blood each day, filtering out waste and toxins into urine and retaining important proteins in the blood. The kidneys also help make red blood cells, regulate the balance of certain minerals and keep bones healthy.
Diabetes and high blood pressure, which become more common with age, are the most common risk factors for kidney disease, said Dr Andrew Levey, the emeritus Chief of Nephrology at Tufts Medical Centre in Boston. In the past 20 years, obesity, which is also linked to diabetes and high blood pressure, has become increasingly important.
The underlying link between these conditions and kidney disease is damage to the blood vessels, said Levey. The kidneys are highly vascular: about 20% of the blood that the heart pumps goes to the kidney. Conditions like diabetes and high blood pressure damage blood vessels, leading to protein in the urine and a slower filtration rate.
Other risk factors for kidney disease include chronic infections, autoimmune disorders, and certain genetic variants. The new study also noted that chronic kidney disease is an emerging public health concern in Central America and South Asia, where excessive heat stress and exposure to environmental pollutants are thought to play a role.
An amplifier of other conditions
Left untreated, chronic kidney disease can progress more quickly to kidney failure, which in most cases requires dialysis or a transplant, said Dr Teresa Chen, an assistant Professor of Medicine at the University of California-San Francisco. But most people with chronic kidney disease won’t die of it; rather, they are more likely to die of cardiovascular complications like a heart attack, stroke or heart failure.
This is because kidney disease amplifies the processes that lead to cardiovascular conditions, Quaggin said. For example, people with kidney disease are at increased risk for high blood pressure, more plaque build-up and hardening in their arteries, all of which place increased stress on their hearts.
The connections between cardiovascular, metabolic and kidney health are increasingly being recognised. In 2023, the American Heart Association formally defined “cardiovascular-kidney-metabolic syndrome”, a health disorder resulting from the overlap of obesity, diabetes, chronic kidney disease and cardiovascular disease, and it is expected to issue new guidelines for screening and management next year.
“Metabolic dysfunction is at the root,” said Dr Josef Coresh, a Professor of Population Health and Medicine at the New York University Grossman School of Medicine and a senior author on the new paper.
The kidney, he said, multiplies the damage and can lead to cardiovascular death.
Early detection is critical but under-used.
Current guidelines recommend that patients with diabetes, high blood pressure and other risk factors are screened for kidney disease with blood and urine tests. But these tests are vastly under-utilised, in part because urine collection can be cumbersome and because of limited awareness about kidney disease, doctors said.
Research has shown that only 35% of patients with diabetes, and only 4% of patients with high blood pressure receive the urine test for screening.
Early diagnosis is crucial to preventing the bad outcomes associated with kidney disease, Quaggin said.
“We have incredible tools now to slow down the progression,” she said. These include traditional drugs like ACE inhibitors, as well as several new classes of drugs shown to be effective at protecting kidney function, such as drugs used to treat heart failure and GLP-1 drugs.
These newer medications are not used broadly yet, but they’re becoming more popular.
“I would be very hopeful that we could see this arc trend downward if we are able to really identify kidney disease early and implement these medications early,” Quaggin added.
Study details
Global, regional, and national burden of chronic kidney disease in adults, 1990–2023, and its attributable risk factors: a systematic analysis for the Global Burden of Disease Study 2023
GBD 2023 Chronic Kidney Disease Collaborators†
Published in The Lancet on 7 November 2025
Summary
Background
Chronic kidney disease (CKD) is common and ranks among the leading causes of mortality and morbidity. This analysis aimed to present global CKD estimates using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 to inform evidence-based policies for CKD identification and treatment.
Methods
This analysis focused on adults aged 20 years and older over the period 1990 to 2023, from 204 countries and territories. Data sources used were published literature, vital registration systems, kidney failure treatment registries, and household surveys. Estimates of CKD burden, including deaths, incidence, prevalence, and disability-adjusted life-years (DALYs), were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool. A comparative risk assessment approach estimated the proportion of cardiovascular deaths attributable to impaired kidney function and estimated risk factors for CKD.
Findings
Globally, in 2023, 788 million (95% uncertainty interval 743–843) people aged 20 years and older were estimated to have CKD, up from 378 million (354–407) in 1990. The global age-standardised prevalence of CKD in adults was 14·2% (13·4–15·2), a relative rise of 3·5% (2·7–4·1) from 1990. The region with the highest age-standardised prevalence was north Africa and the Middle East (18·0%; 16·9–19·4). Most people had stage 1–3 CKD, with a combined prevalence of 13·9% (13·1–15·0). In 2023, CKD was the ninth leading cause of death globally, accounting for 1·48 million (1·30–1·65) deaths, and the 12th leading cause of DALYs, with an age-standardised DALY rate of 769·2 (691·8–857·4) per 100 000. Impaired kidney function as a risk factor accounted for 11·5% (8·4–14·5) of cardiovascular deaths. High fasting plasma glucose, body-mass index, and systolic blood pressure were all leading risk factors for CKD DALYs.
Interpretation
CKD is a major global health issue, with rising prevalence and increasing importance as a cause of death and as a risk factor for cardiovascular death. A better understating of aetiology, appropriate screening, and implementation programmes are needed to translate advances in CKD treatment into improved patient outcomes.
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