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
- PMID: 41213283
- DOI: 10.1016/S0140-6736(25)01853-7
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
Abstract
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.
Funding: Gates Foundation, Wellcome, US National Kidney Foundation, and US National Institute of Diabetes and Digestive and Kidney Diseases.
Copyright © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.
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, Boehringer Ingelheim, and Novartis; and participation on a data safety monitoring board or advisory board from AstraZeneca, Boehringer Ingelheim, and Astella; outside the submitted work. D Abramov reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Bayer and AstraZeneca; participation on a data safety monitoring board or advisory board from BridgeBio; and receipt of equipment, materials, drugs, medical writing, gifts, or other services from Bayer; 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, Alfaisal University; leadership or fiduciary roles in other board, society, committee or advocacy groups, paid or unpaid from VividiWise Analytics as Managing Partner and São José dos Campos Tech Park–CITE as Biotech Advisory Board Member, outside the submitted work. A K Bello reports grants or contracts from the Canadian Institute of Health Research, Heart and Stroke Foundation of Canada, Amgen Incorporated, Canada; consulting fees from Amgen, AstraZeneca, Bayer, Glaxosmith, Otsuka, and Novo Nordisk; leadership or fiduciary roles in other board, society, committee or advocacy groups, paid or unpaid as co-chair of the Global Kidney Health Atlas ISN; outside the submitted work. A S Bhagavathula reports support for attending meetings or travel, or both, to attend conferences from the North Dakota State University, American College of Epidemiology, and University of Virginia; leadership or fiduciary roles in other board, society, committee or advocacy groups, paid or unpaid as a member of the Board of Directors, American College of Epidemiology and GBD Lead Collaborator; 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), Grant-in-Aid for Scientific Research (KAKENHI; Grant ID 23KF0126), JSPS, and the Australian Academy of Science, JSPS International Fellowship (Grant ID P23712); leadership or fiduciary roles in other board, society, committee or advocacy groups, paid or unpaid as District Chair, Diversity, Equity, Inclusion & Belonging of Rotary District 9675 (Sydney, Australia), as Chair, Founding Member and Manager of the Global Health & Migration Hub Community, Global Health Hub Germany (Berlin, Germany), as Editorial Board Member of PLoS One, BMC Neurology, Frontiers in Neurology, Frontiers in Stroke, Frontiers in Public Health, Journal of Aging Research, Neurology International, Diagnostics, and BMC Medical Research Methodology, as a member of the College of Reviewers, Canadian Institutes of Health Research (CIHR), Government of Canada, as the Director of Research of the World Headache Society (Bengaluru, India), as Expert Adviser/Reviewer of Cariplo Foundation (Milan, Italy), as Visiting Director of National Cerebral and Cardiovascular Center, Department of Neurology, Division of Cerebrovascular Medicine and Neurology, Suita (Osaka, Japan), as Member, Scientific Review Committee of Cardiff University Biobank (Cardiff, UK), as Chair of Rotary Reconciliation Action Plan, and Healthcare and Medical Adviser at Japan Connect (Osaka, Japan); outside the submitted work. M Carvalho reports support from Fundação para a Ciência e a Tecnologia/Ministério da Ciência, Tecnologia e Ensino Superior (FCT/MCTES) under the scope of the project UIDP/50006/2020 (https://doi.org/10.54499/UIDP/50006/2020) LAQV/REQUIMTE, University of Porto, Porto, Portugal, outside the submitted work. A L Catapano reports grants or contracts from Chiesi, Amarin, Ultragenyx; consulting fees from Amarin, Amgen, AstraZeneca, Chiesi, Daiichi Sankyo, Eli Lilly, Esperion, Ionis Pharmaceutical, Medscape, Menarini, MSD, Novartis, Novo Nordisk, Regeneron, Sanofi, Ultragenyx, and Viatris; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Amarin, Amgen, AstraZeneca, Chiesi, Daiichi Sankyo, Eli Lilly, Esperion, Ionis Pharmaceutical, Medscape, Menarini, MSD, Novartis, Novo Nordisk, Regeneron, Sanofi, Ultragenyx, and Viatris; participation on a data safety monitoring board or advisory board with Amarin, Amgen, Astrazeneca, Chiesi, Daiichi Sankyo, Eli Lilly, Esperion, Ionis Pharmaceutical, Medscape, Menarini, MSD, Novartis, Novo Nordisk, Regeneron, Sanofi, Ultragenyx, and Viatris; outside the submitted work. J Coresh reports support for the present manuscript from the US National Institutes of Health and US National Kidney Foundation; grants or contracts from the US National Institutes of Health and US National Kidney Foundation; royalties or licenses from Health.IO; participation on a data safety monitoring board or advisory board from Health.IO; and stock or stock options from Health.IO; outside the submitted work. I M Ilic reports support for the present manuscript from the 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 other board, society, committee or advocacy groups, unpaid as The Bursar and Council Member, Malaysian Academy of Pharmacy, Malaysia and as Committee Member, Malaysian Pharmacists Society Education Chapter Committee; outside the submitted work. V Jha reports grants or contracts from Variant Bio (paid to the George Institute); and consulting fees from Bayer, AstraZeneca, Boehringer Ingelheim, Baxter, Vera, Visterra, Otsuka, Novartis, Tim-berlyne, Biogen, Chinook, and Alpine (paid to the George Institute); outside the submitted work. J J Jozwiak reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Novartis, Adamed, Amgen, Boehringer Ingelheim, Servier, and Novo Nordisk; outside the submitted work. M Kivimäki reports grants or contracts from the Wellcome Trust (221854/Z/20/Z), Medical Research Council (MR/Y014154/1), and Research Council of Finland (350426); outside the submitted work. K Krishan acknowledges 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. J S Lees reports consulting fees from Boehringer Ingelheim; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from AstraZeneca; outside the submitted work. A S Levey reports grants or contracts from the US National Institutes of Health and National Kidney Foundation; and royalties or licences from UpToDate; outside the submitted work. P B 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 from Vertex and Novartis; outside the submitted work. S Masi reports grants or contracts from Servier; consulting fees from Servier; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Servier; support for attending meetings or travel, or both, from Servier; participation on a data safety monitoring board or advisory board from Servier; and leadership or fiduciary roles in other board, society, committee or advocacy groups, paid or unpaid from the Italian Society of Internal Medicine; outside the submitted work. S A Nabipoorashrafi reports grants or contracts from GE Healthcare and North American Society for Cardiovascular Imaging (NASCI); outside the submitted work. S Nomura reports support for the present manuscript from the Ministry of Education, Culture, Sports, Science and Technology of Japan (grant 24H00663) and from Precursory Research for Embryonic Science and Technology from the Japan Science and Technology Agency (grant JPMJPR22R8). B Oancea reports support for the present manuscript from the Ministry of Research, Innovation and Digitalization through the Core Program of the National Research, Development and Innovation Plan 2022–27, project number PN 23-02-0101-Contract No. 7N/2023; PNRR/2022/C9/MCID/I8 project 760096. A Ortiz reports grants or contracts as Director of the Catedra AstraZeneca-Universidad Autonoma de Madrid of chronic kidney disease and electrolytes (Grants to Universidad Autonoma de Madrid), and grants from Sanofi (to their institution: The Fundación Jiménez Díaz Health Research Institute [IIS-FJD, UAM]); consulting fees from Astellas, AstraZeneca, Bioporto, Boehringer Ingelheim, Fresenius Medical Care, GSK, Bayer, Sanofi-Genzyme, Lilly, Chiesi, Otsuka, Novo Nordisk, Sysmex; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Astellas, AstraZeneca, Bioporto, Boehringer Ingelheim, Fresenius Medical Care, GSK, Bayer, Sanofi-Genzyme, Sobi, Menarini, Lilly, Chiesi, Otsuka, Novo Nordisk, Sysmex, Vifor Fresenius Medical Care Renal Pharma, and Spafarma; support for attending meetings or travel, or both, from Astellas, AstraZeneca, Fresenius Medical Care, Boehringer Ingelheim, Bayer, Sanofi-Genzyme, Chiesi, Sobi, and Bayer; participation on a data safety monitoring board or advisory board from Astellas, AstraZeneca, Boehringer Ingelheim, Fresenius Medical Care, Bayer, Sanofi-Genzyme, Chiesi, Otsuka, Novo Nordisk, and Sysmex; leadership or fiduciary roles in other board, society, committee or advocacy groups, unpaid with Council ERA and the Sociedad Madrileña de Nefrología (SOMANE); outside the submitted work. Y L Samodra reports grants or contracts from the National Science and Technology Council (Taiwan) – Institute of Epidemiology and Preventive Medicine National Taiwan University, Taiwan; leadership or fiduciary roles in other board, society, committee or advocacy groups, paid or unpaid from Benang Merah Research Center (co-founder), Indonesia; and other financial or non-financial interests as scholarship advisor from Jago Beasiswa (https://idebeasiswa.com); outside the submitted work. J A Singh reports consulting fees from ROMTech, Atheneum, Clearview Healthcare Partners, American College of Rheumatology, Yale, Hulio, Horizon Pharmaceuticals, DINO-RA, ANI/Exeltis, USA Inc, 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 from Simply Speaking; support for attending meetings or travel, or both, from OMERACT as a past steering committee member; participation on a data safety monitoring board or advisory board from FDA Arthritis Advisory Committee; leadership or fiduciary roles in other board, society, committee or advocacy groups, paid or unpaid as a past steering committee member of the OMERACT, an international organisation that develops measures for clinical trials and receives arm's length funding from 12 pharmaceutical companies; 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 pharmaceuticals; outside the submitted work. J Sundström reports direct or indirect stock ownership in companies (Anagram kommunikation, Sence Research, Symptoms Europe, MinForskning) providing services to companies and authorities in the health sector, including Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Gilead, GSK, Göteborg University, Itrim, Ipsen, Janssen, Karolinska Institutet, LIF, Linköping University, Novo Nordisk, Parexel, Pfizer, Region Stockholm, Region Uppsala, Sanofi, STRAMA, Takeda, TLV (The Dental and Pharmaceutical Benefits Agency; Tandvårds- och läkemedelsförmånsverket; affiliated with Uppsala University), Uppsala University, Vifor Pharma, and WeMind; outside the submitted work. R C Tanchanco reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from AstraZeneca; support for attending meetings or travel, or both, from AstraZeneca, and Boehringer Ingelheim; leadership or fiduciary roles in other board, society, committee or advocacy groups, paid or unpaid on the Council of Past Presidents, Philippine Society of Nephrology Oceania South East Asia Regional Board member, International Society of Nephrology; outside the submitted work. J H V Ticoalu reports leadership or fiduciary roles in other board, society, committee or advocacy groups, paid or unpaid from Benang Merah Research Center, Indonesia (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 from Amarin, Boehringer Ingelheim, and Novo Nordisk; leadership or fiduciary roles in other board, society, committee or advocacy groups, paid or unpaid from the EASD Early Career Academy and EASD Committee on Clinical Affairs; receipt of equipment, materials, drugs, medical writing, gifts, or other services from Abbott and PharmaNutra; outside the submitted work. P Willeit reports consulting fees from Novartis Pharmaceuticals; outside the submitted work. M Zielińska reports other financial or non-financial interests as an Alexion AstraZeneca Rare Disease employee; outside the submitted work. All other authors declare no competing interests.
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