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. 2025 Aug;13(8):e1378-e1395.
doi: 10.1016/S2214-109X(25)00198-6.

Global, regional, and national prevalence of kidney failure with replacement therapy and associated aetiologies, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023

GBD 2023 Kidney Failure with Replacement Therapy Collaborators
Collaborators
Free article

Global, regional, and national prevalence of kidney failure with replacement therapy and associated aetiologies, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023

GBD 2023 Kidney Failure with Replacement Therapy Collaborators. Lancet Glob Health. 2025 Aug.
Free article

Abstract

Background: Kidney failure with replacement therapy (KFRT) such as dialysis or transplantation represents a severe stage of chronic kidney disease (CKD) and poses a major global health burden. Although many CKD cases are diagnosed in the earlier stages, the greatest risk occurs when CKD progresses to KFRT. Despite its considerable financial and imposing impact on public health, there is a notable gap in international policies addressing CKD and KFRT. To bridge this gap and help policy makers and health systems effectively tackle the public health challenge of KFRT, a better understanding of the disease burden is essential. Thus, this analysis aims to provide a detailed overview of the global prevalence of KFRT and its associated aetiologies with estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) from 1990 to 2023.

Methods: This study defined KFRT as individuals on maintenance dialysis for 90 days or more or those who have undergone a kidney transplant, aligning with the Kidney Disease: Improving Global Outcomes (KDIGO) 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Renal registries served as the primary data sources. Prevalence and underlying aetiology estimates (type 1 diabetes, type 2 diabetes, hypertension, glomerulonephritis, and other causes) were generated with DisMod-MR 2.1, an epidemiological Bayesian mixed-effects meta-regression modelling tool. Both all-age and age-standardised estimates were reported and accompanied with 95% uncertainty intervals (UIs).

Findings: In 2023, the number of global cases of KFRT was 4·59 million (95% UI 4·17-5·08) for both sexes and all ages, with an age-standardised prevalence of 50·7 (46·1-56·0) per 100 000 population. Over the past three decades, there has been a steady increase in KFRT prevalence globally. The highest prevalence was found in the GBD high-income regions, while the lowest was observed in sub-Saharan Africa. KFRT prevalence was generally higher in countries classified within the World Bank's high-income and upper-middle-income groups, while lower prevalence was more common in countries within the World Bank's low-income and lower-middle-income groups. Additionally, a pronounced sex disparity was identified, where male dialysis and transplant prevalence estimates were consistently higher than those for females in most countries. Type 2 diabetes and hypertension were among the leading associated aetiologies of KFRT globally. From 1990 to 2023, the all-age and age-standardised prevalence estimates across the ascribed aetiologies increased for KFRT, with the largest increases associated with type 2 diabetes and hypertension.

Interpretation: KFRT affects approximately 5 million people globally, with high treatment and mortality costs. Our study unveiled considerable geographical variation in KFRT prevalence, which should be seen as indicators of health-care system opportunities. As the prevalence of the leading aetiologies of KFRT-type 2 diabetes and hypertension-continues to rise, there is a crucial need to prioritise the development and implementation of cost-effective strategies aimed at preventing CKD and its progression to KFRT, particularly in low-resource settings. These preventive efforts must happen in tandem with efforts to expand capacity for dialysis and transplant services.

Funding: Gates Foundation.

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Conflict of interest statement

Declaration of interests J Ärnlöv reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AstraZeneca and Boerhinger Ingelheim; participation on a data safety monitoring board or advisory board with AstraZeneca, Boerhinger Ingelheim, and Astella; all outside the submitted work. O C Baltatu reports support for the present manuscript from the National Council for Scientific and Technological Development Fellowship (CNPq, 304224/2022-7), Anima Institute (AI) Research Professor Fellowship, and Alfaisal University; leadership or fiduciary roles in board, society, committee, or advocacy groups outside the submitted work, paid or unpaid with VividiWise Analytics as Managing Partner and São José dos Campos Tech Park – CITE as Biotech Advisory Board Member. L Belo reports support from Fundação para a Ciência e a Tecnologia (FCT) in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB, outside the submitted work. S Bhaskar reports grants or contracts from the Japan Society for the Promotion of Science (JSPS), Japanese Ministry of Education, Culture, Sports, Science and Technology (MEXT) for a Grant-in-Aid for Scientific Research (KAKENHI; grant ID: 23KF0126) and from JSPS and the Australian Academy of Science for a JSPS International Fellowship (grant ID: P23712); leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Rotary District 9675, Sydney, Australia, as District Chair, Diversity, Equity & Inclusion, Global Health & Migration Hub Community, Global Health Hub Germany, Berlin, Germany, as Chair, Founding Member and Manager; PLOS One, BMC Neurology, Frontiers in Neurology, Frontiers in Stroke, Frontiers in Public Health, Journal of Aging Research, Neurology International, Diagnostics, Vas-Cog, and BMC Medical Research Methodology as Editorial Board Member; College of Reviewers, Canadian Institutes of Health Research (CIHR), Government of Canada as Member; World Headache Society, Bengaluru, India as Director of Research; Cariplo Foundation, Milan, Italy as Expert Adviser/Reviewer, National Cerebral and Cardiovascular Center, Department of Neurology, Division of Cerebrovascular Medicine and Neurology, Suita, Osaka, Japan, as Visiting Director, Cardiff University Biobank, Cardiff, UK, as Member, Scientific Review Committee, and Rotary Reconciliation Action Plan as Chair; all outside the submitted work. B Bikbov reports grants or contracts from European Commission, Politecnico di Milano, University of Rome, Nova Biomedical; support for attending meetings or travel, or both, from the European Renal Association; leadership or fiduciary roles in board, society, committee, or advocacy groups, unpaid with Advocacy Group, International Society of Nephrology and Western Europe Regional Board, International Society of Nephrology; and other non-financial support from Scientific-Tools.Org for a public health consultancy; all outside the submitted work. M Carvalho reports other financial or non-financial support from LAQV/REQUIMTE, University of Porto, Porto, Portugal and FCT/MCTES under the scope of the project UIDP/50006/2020 (DOI: 10.54499/UIDP/50006/2020), all outside the submitted work. A L Catapano reports grants or contracts from Chiesi–Amarin Ultragenyx; consulting fees from Menarini-Menarini Ricerche–Sanofi; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Amarin Amgen Amryt Pharma, AstraZeneca, Daiichi Sankyo Esperion Ionis Pharmaceutical Medscaper, Menarini, Merck, Novartis, NovoNordisk, PeerVoice, Pfizer, Recordati, Regeneron, Sandoz, Sanofi The Corpus, Ultragenyx, and Viatris; all outside the submitted work. I Ilic reports support for the present manuscript from Ministry of Science, Technological Development and Innovation of the Republic of Serbia (number 451-03-137/2025-03/200110). N E Ismail reports leadership or fiduciary roles in board, society, committee, or advocacy groups, unpaid with the Malaysian Academy of Pharmacy as Bursar and Council Member and Malaysian Pharmacists Society as Committee Member of Education Chapter, outside the submitted work. V Jha reports consulting fees paid to their institution from Bayer, AstraZeneca, Boehringer Ingelheim, Baxter, Vera, Visterra, Otsuka, Novartis, Timberlyne, Biogen, Chinook, and Alpine, outside the submitted work. K Krewel reports non-financial support from the UGC Centre of Advanced Study, CAS II, awarded to the Department of Anthropology, Panjab University, Chandigarh, India, outside the submitted work. M Lee reports support for the present manuscript from the Ministry of Education of South Korea and the National Research Foundation of Korea (NRF-2023S1A3A2A05095298). P Mark reports grants or contracts from AstraZeneca and Boehringer Ingelheim; consulting fees from AstraZeneca, Boehringer Ingelheim, Pharmacosmos, and Vifor; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from AstraZeneca, Boehringer Ingelheim, Pharmacosmos, Bayer, and Vifor; and participation on a data safety monitoring board or advisory board with Vertex and Novartis; all outside the submitted work. B Oancea reports support for the present manuscript from the Ministry of Research, Innovation and Digitalization (MRID), project PNRR-I8 (number 842027778, contract number 760096). O Odukoya reports grants or contracts from Northwestern/Nigeria Research Training Program in HIV and Malignancies (NN-HAM; 2D43TW009575–11), outside the submitted work. A Ortiz reports grants from Sanofi to the Fundación Jiménez Díaz Health Research Institute (IIS-FJD, UAM) and to Universidad Autonoma de Madrid; consulting fees from Advicenne, Astellas, AstraZeneca, Amicus, Amgen, Fresenius Medical Care, GSK, Bayer, Sanofi-Genzyme, Menarini, Kyowa Kirin, Alexion, Idorsia, Chiesi, Otsuka, Novo-Nordisk, and Vifor Fresenius Medical Care Renal Pharma; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Advicenne, Astellas, AstraZeneca, Amicus, Amgen, Fresenius Medical Care, GSK, Bayer, Sanofi-Genzyme, Menarini, Kyowa Kirin, Alexion, Idorsia, Chiesi, Otsuka, Novo-Nordisk, and Vifor Fresenius Medical Care Renal Pharma; support for attending meetings or travel, or both, from Advicenne, Astellas, AstraZeneca, Fresenius Medical Care, Boehringer Ingelheim Bayer, Sanofi-Genzyme, Menarini, Chiesi, Otsuka, and Sysmex; participation on a data safety monitoring board or advisory board from Astellas, AstraZeneca, Boehringer Ingelheim, Fresenius Medical Care, Bayer, Sanofi-Genzyme, Idorsia, Chiesi, Otsuka, Novo Nordisk, and Sysmex; leadership or fiduciary role in other board, society, committee or advocacy group, unpaid as Council European Renal Association (ERA) Reunión de la Sociedad Madrileña de Nefrología (SOMANE); outside the submitted work. D P Rasali reports leadership or fiduciary roles, or both, in the following non-profit organizations on volunteering (unpaid) basis: President, Emotional Well-Being Institute- Canada; Chair, Sahayatra International Alliance for Social Justice; Trustee of the Board, Association of Nepalese in Americas, outside the submitted work. Y L Samodra reports grants or contracts from the Institute of Epidemiology and Preventive Medicine at National Taiwan University – National Science and Technology Council (Taiwan; NTU EPM–NSTC); leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Benang Merah Research Center as co-founder; and other financial or non-financial support from Jago Beasiswa as mentor; all outside the submitted work. J Sanabria reports federal funding (USA) via grants or contracts for their laboratory; support for attending meetings or travel, or both, from the Medical School and Department at Marshall University School of Medicine; seven patents planned, issued, or pending; participation on a data safety monitoring board or advisory board as quality officer of the Department of Surgery at Marshall University School of Medicine; all outside the submitted work. A E Schutte reports grants or contracts paid to their institution from the National Health and Medical Research Council of Australia and Medical Research Future Fund; consulting fees from Medtronic, Servier, Sky Labs, and AstraZeneca; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Medtronic, Servier, AstraZeneca, Sanofi, Abbott, Omron, and Aktiia; support for attending meetings or travel, or both, from Medtronic and Servier; leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid with Hypertension Australia as Board Member, Australian Cardiovascular Alliance as Secretary, and National Hypertension Taskforce of Australia as Co-Chair; all outside the submitted work. J A Singh reports consulting fees from ROMTech, Atheneum, Clearview Healthcare Partners, American College of Rheumatology, Yale, Hulio, Horizon Pharmaceuticals, DINORA, ANI Pharmaceuticals/Exeltis, USA, Frictionless Solutions, Schipher, Crealta/Horizon, Medisys, Fidia, PK Med, Two Labs Inc, Adept Field Solutions, Clinical Care Options, Putnam Associates, Focus Forward, Navigant Consulting, Spherix, MedIQ, Jupiter Life Science, UBM LLC, Trio Health, Medscape, WebMD, and Practice Point Communications; and the National Institutes of Health; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events as a member of the speaker's bureau of Simply Speaking; support for attending meetings or travel, or both, as a past steering committee member of OMERACT; participation on a data safety monitoring board or advisory board from the FDA Arthritis Advisory Committee; leadership or fiduciary roles in other board, society, committee or advocacy group, paid or unpaid as a past steering committee member of the OMERACT; stock or stock options in Atai Life Sciences, Kintara Therapeutics, Intelligent Biosolutions, Acumen Pharmaceutical, TPT Global Tech, Vaxart Pharmaceuticals, Atyu Biopharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics, Seres Therapeutics, Tonix Pharmaceuticals Holding, Aebona Pharmaceuticals, and Charlotte's Web Holdings, and previously owned stock options in Amarin, Viking, and Moderna; outside the submitted work. V S Stel reports support for the present manuscript paid to their institution from the European Renal Association (ERA). J H V Ticoalu reports leadership or fiduciary roles in other board, society, committee or advocacy groups, paid or unpaid with Benang Merah Research Center as Co-founder, outside the submitted work. D Trico reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from AstraZeneca, Eli Lilly, and Novo Nordisk; support for attending meetings or travel, or both, from AstraZeneca; participation on a data safety monitoring board or advisory board with Amarin, Boehringer Ingelheim, and Novo Nordisk; leadership or fiduciary roles in other board, society, committee or advocacy groups, paid or unpaid with EASD Early Career Academy and EASD Committee on Clinical Affairs receipt of equipment, materials, drugs, medical writing, gifts or other services paid to their institution from PharmaNutra and Abbott; all outside the submitted work. M Zielińska reports other support from Alexion, AstraZeneca Rare Disease as an employee, outside the submitted work. All other authors declare no competing interests.

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