Chronic kidney disease (CKD) remains a major cause of mortality and morbidity worldwide. In 2023, among adults aged 20 years and older across 204 countries and territories, estimates showed a large and growing number living with CKD, most in earlier stages. CKD ranked among the top causes of death and disability-adjusted life-years, and impaired kidney function contributed to cardiovascular mortality. Regional and socio-demographic patterns varied, reflecting differences in population structure, detection and access to treatment.
Scope, Definitions and Estimation
The assessment covered adults aged 20 years and older from 1990 to 2023, drawing on published literature, vital registration systems, kidney failure treatment registries and household surveys. To enable comparisons across populations with different age structures, results were reported as age-standardised measures. Mortality attributable to CKD was modelled using the Cause of Death Ensemble model, which tested multiple specifications against out-of-sample performance before combining them. Non-fatal burden was estimated using a hierarchical Bayesian meta-regression framework (DisMod-MR 2.1) that integrated information on prevalence, incidence, remission and excess mortality to produce internally consistent estimates by age, sex, location and year.
CKD categories aligned with KDIGO G- and A-stages based on eGFR and ACR. Six groups were modelled: stages 1–2, stage 3, stage 4, stage 5, end-stage kidney disease on maintenance dialysis and kidney transplantation. The case definition used a single measurement of eGFR or ACR, rather than the KDIGO duration criterion of persistent abnormality for more than three months. DALYs were calculated as the sum of years of life lost and years lived with disability. Aetiological attribution encompassed type 1 diabetes, type 2 diabetes, glomerulonephritis, hypertension and other or unspecified causes. Impaired kidney function was also used as a risk factor to quantify cardiovascular deaths attributable to reduced kidney function.
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Prevalence, Mortality and Regional Patterns
In 2023, an estimated 788 million adults were living with CKD, up from 378 million in 1990. The global age-standardised prevalence in adults was 14.2 percent, a relative increase of 3.5 percent since 1990. Most affected individuals were in earlier stages: stages 1–3 together accounted for a prevalence of 13.9 percent. CKD ranked ninth among causes of death globally in 2023, responsible for 1.48 million deaths, and 12th for DALYs, with an age-standardised DALY rate of 769.2 per 100 000 population. These figures reflected both premature mortality and substantial years lived with disability.
Regional differences were pronounced. North Africa and the Middle East recorded the highest age-standardised prevalence at 18.0 percent. Variation across locations and socio-demographic settings indicated that high prevalence did not always coincide with the highest mortality rates. Differences in demographic profiles, competing risks, case detection and access to kidney replacement therapy contributed to these patterns. As a result, the burden was evident both in absolute numbers and in age-standardised rates, with implications for service planning, workforce requirements and financing. The long time horizon from 1990 to 2023 allowed changes to be tracked consistently, showing sustained growth in the number of adults living with CKD alongside persistent regional heterogeneity.
Risk Attribution and Stage Distribution
Impaired kidney function accounted for 11.5 percent of cardiovascular deaths in 2023, highlighting the close association between CKD and cardiovascular disease. Metabolic risks were prominent among contributors to CKD DALYs, with high fasting plasma glucose, body-mass index and systolic blood pressure identified as leading factors. These findings aligned with the central role of diabetes and hypertension as major causes of CKD, while glomerulonephritis and other or unspecified causes also contributed to the overall burden.
The distribution by stage emphasised that most adults with CKD were in earlier phases of disease. This pattern reinforced the relevance of timely identification and management before progression to kidney failure requiring dialysis or transplantation. The definitional choice to base estimates on single measurements facilitated globally comparable estimation but differed from the KDIGO persistence requirement, which may have influenced case ascertainment relative to clinical practice. Even so, the staged profile, the link to cardiovascular mortality and the prominence of metabolic risks together characterised a burden that affected both survival and long-term health.
By 2023, CKD had reached high prevalence, ranked among leading causes of death and DALYs, and was responsible for a meaningful share of cardiovascular mortality. Most affected adults were in earlier stages, and regional patterns varied widely. These findings mapped the scale and distribution of CKD and its connection to cardiovascular risk, supporting planning and prioritisation for detection, risk reduction and delivery of services appropriate to local contexts.
Source: The Lancet
Image Credit: iStock
