Highlights
– GBD 2023 estimates 788 million adults (age ≥20) living with CKD in 2023 (95% UI 743–843 million), more than doubling since 1990.
– Age-standardised CKD prevalence rose modestly to 14.2% (13.4–15.2), with north Africa and the Middle East showing the highest regional prevalence.
– CKD was the ninth leading global cause of death in 2023 (~1.48 million deaths) and substantially increased cardiovascular mortality risk; impaired kidney function accounted for 11.5% of cardiovascular deaths.
– Leading attributable risk factors for CKD DALYs include high fasting plasma glucose, elevated BMI, and high systolic blood pressure; policy responses must prioritise detection, risk-factor control, and access to effective therapies.
Background: why this report matters
Chronic kidney disease (CKD) is a progressive syndrome defined by persistent reduction in glomerular filtration rate (GFR) and/or markers of kidney damage (most commonly albuminuria). CKD is associated with morbidity, reduced quality of life, and markedly increased risk of cardiovascular events. Despite advances in understanding and treatments that slow progression and reduce cardiorenal risk, CKD remains underdiagnosed and under-treated in many settings.
The Global Burden of Disease (GBD) 2023 Chronic Kidney Disease analysis provides the most recent systematic, comparable estimates of CKD prevalence, incidence, mortality, and disability-adjusted life-years (DALYs) across 204 countries and territories from 1990 to 2023. The findings are essential for health systems and policy makers planning non-communicable disease (NCD) responses, resource allocation, and implementation of proven interventions such as BP control, renin–angiotensin system blockers, sodium–glucose cotransporter 2 (SGLT2) inhibitors, and strategies to improve early detection.
Study design and methods
The GBD 2023 CKD analysis focused on adults aged 20 years and older across 204 countries and territories from 1990 through 2023. Data inputs included published epidemiological studies, vital registration systems, kidney replacement therapy registries, and household surveys. Analytical methods combined a Cause of Death Ensemble model (CODEm) for mortality estimation with Bayesian meta-regression (DisMod-MR) for prevalence, incidence, and DALY estimation. Comparative risk assessment quantified the proportion of cardiovascular deaths attributable to impaired kidney function and identified leading modifiable risk factors contributing to CKD DALYs.
CKD staging used standard definitions incorporating estimated GFR and albuminuria categories where data allowed. Uncertainty intervals reflect input data variability and model uncertainty. The study acknowledges limitations tied to data sparsity in some regions, inconsistent measurement of albuminuria, and evolving diagnostic coding practices over time.
Key findings
Prevalence and trends
In 2023, an estimated 788 million (95% UI 743–843) adults aged 20 years and older were living with CKD globally, versus 378 million (354–407) in 1990. The global age-standardised prevalence of CKD in adults was 14.2% (13.4–15.2) in 2023, a relative increase of 3.5% (2.7–4.1) since 1990. Most individuals had earlier stages (stage 1–3), which together had a combined prevalence of 13.9% (13.1–15.0).
Regional heterogeneity was notable. North Africa and the Middle East had the highest age-standardised prevalence at 18.0% (16.9–19.4). These geographic differences reflect variations in NCD epidemiology (e.g., diabetes, hypertension, obesity), environmental and occupational exposures (including areas affected by CKD of uncertain aetiology), access to care, and population age structures.
Mortality and DALYs
CKD was the ninth leading cause of death worldwide in 2023, accounting for 1.48 million (1.30–1.65) deaths, and ranked 12th for DALYs with an age-standardised DALY rate of 769.2 (691.8–857.4) per 100,000. These figures reflect both direct deaths from kidney failure and the contribution of CKD to cardiovascular mortality and morbidity.
CKD as a cardiovascular risk factor
Impaired kidney function was estimated to account for 11.5% (8.4–14.5) of cardiovascular deaths globally. This quantification underscores CKD’s role not only as a downstream consequence of diabetes and hypertension but also as an independent amplifier of cardiovascular risk through mechanisms such as volume overload, uraemic toxins, inflammation, endothelial dysfunction, and accelerated atherosclerosis and vascular calcification.
Attributable risk factors
The leading risk factors for CKD DALYs were high fasting plasma glucose, elevated body-mass index, and high systolic blood pressure. These results align with the dominant contribution of diabetic kidney disease and hypertensive nephropathy to CKD burden globally and highlight the overlap between drivers of CKD and other major NCDs.
Interpretation and clinical implications
The GBD 2023 estimates paint a stark picture: hundreds of millions of adults live with CKD, prevalence is rising in many regions, and CKD now occupies a top-10 position among global causes of death. The dual role of CKD as a chronic disease requiring renal-specific care and as a potent cardiovascular risk factor argues for integration of kidney health into broader NCD and cardiovascular prevention strategies.
Key clinical and policy implications include:
- Prioritise early detection. Routine assessment of estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (uACR) in people with diabetes, hypertension, cardiovascular disease, or other CKD risk factors should be scaled up.
- Address major upstream drivers. Tight glucose control, blood pressure control with guideline-directed targets, weight management, and tobacco cessation will reduce incident CKD and slow progression.
- Increase access to renoprotective therapies. Widespread implementation of renin–angiotensin system inhibitors and SGLT2 inhibitors where indicated can reduce progression and cardiovascular events; health systems should remove barriers to access and affordability.
- Integrate CKD within NCD programs. Screening and management pathways should be embedded in primary care and cardiovascular programs to detect disease earlier and streamline referral to nephrology where needed.
- Plan for advanced disease. Health systems must prepare for increasing needs for kidney replacement therapy (dialysis, transplantation) while investing in primary and secondary prevention to reduce demand.
Strengths and limitations of the GBD analysis
Strengths include the global scope, standardized modelling across countries and time, and systematic comparative risk assessment linking CKD to cardiovascular mortality and modifiable risk factors. The use of multiple data sources adds breadth to estimates.
Important limitations must temper interpretation. Data quality and availability vary; albuminuria is undermeasured in many population surveys, which can underestimate earlier-stage CKD. Modelling assumptions and case definitions evolve and can influence trend estimates. Some regional patterns may reflect improved case ascertainment rather than true incidence increases. Finally, GBD quantifies attributable fractions using population-level associations which do not substitute for causal inference at the individual level.
Expert commentary and guideline context
Contemporary kidney care guidelines emphasise early detection using combined eGFR and albuminuria testing, risk stratification, and initiation of renoprotective therapies to slow progression and reduce cardiovascular events. Clinicians should interpret the GBD findings as a call to action: adopt guideline-based screening in high-risk groups, optimise cardiometabolic risk control, and advocate for system-level measures improving access to effective medications and integrated chronic care.
For example, KDIGO guidance (2012) provides a widely used framework for CKD evaluation and staging that remains relevant for detection strategies, while more recent evidence supports use of SGLT2 inhibitors in many patients with CKD to reduce progression and cardiovascular outcomes.
Research and policy gaps
Key gaps that warrant attention include improved population-level measurement (routine inclusion of uACR in epidemiological surveys), region-specific research into nontraditional causes of CKD (including CKD of uncertain aetiology), trials of implementation strategies to close the treatment gap, evaluation of cost-effective models of care for low-resource settings, and health-economic analyses to guide investment in prevention versus kidney replacement therapy capacity.
Conclusion
The GBD 2023 CKD analysis documents a large and growing global burden: nearly 800 million adults with CKD in 2023, rising mortality, and a substantial contribution of impaired kidney function to cardiovascular deaths. These findings demand coordinated clinical and policy responses that emphasise early detection, risk-factor control, equitable access to renoprotective therapies, and systems planning for advanced kidney disease. Integrating kidney health into NCD strategies is essential to reduce the future clinical and economic toll of CKD.
Funding and clinicaltrials.gov
The GBD 2023 Chronic Kidney Disease analysis reported funding from the Gates Foundation, Wellcome, US National Kidney Foundation, and the US National Institute of Diabetes and Digestive and Kidney Diseases. No specific clinicaltrials.gov registration applies to this modelling study.
References
1. GBD 2023 Chronic Kidney Disease Collaborators. 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. Lancet. 2025 Nov 7:S0140-6736(25)01853-7. doi:10.1016/S0140-6736(25)01853-7. Epub ahead of print. PMID: 41213283.
2. Kidney Disease: Improving Global Outcomes (KDIGO) Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl. 2013;3(1):1–150.