Chronic kidney failure now ninth leading cause of death, global analysis finds

A record number of men and women around the world are now estimated to have reduced kidney function, according to a new study. Figures rose from 378 million people with the disease in 1990 to 788 million in 2023 as the world’s population grew and aged, making it one of the world’s top 10 causes of death for the first time.

Led by researchers from NYU Langone Health, the University of Glasgow and the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, the analysis explored the rise of the disease, in which the kidneys gradually lose their ability to filter waste and excess fluid from the blood. Mild cases may have no symptoms, while more severe stages may require dialysis, kidney replacement therapy or an organ transplant.

The results revealed that approximately 14% of adults worldwide suffer from chronic kidney disease. The results further showed that approximately 1.5 million people died from the disease in 2023, an increase of more than 6% since 1993, when accounting for country age demographic differences over time.

“Our work shows that chronic kidney disease is common, deadly, and worsening as a major public health problem,” said study co-senior author Josef Coresh, MD, Ph.D., director of the Optimal Aging Institute at NYU Langone. “These findings support efforts to recognize this disease, alongside cancer, heart disease and mental health issues, as a major priority for policymakers around the world.”

Last May, the World Health Organization officially added chronic kidney disease to its agenda to reduce premature deaths from non-communicable diseases by a third by 2030. To combat the epidemic, experts must first have an up-to-date understanding of demographic trends, says Coresh, who is also the Terry and Mel Karmazin Professor of Population Health at the NYU Grossman School of Medicine.

The new report, published online November 7 in the journal The Lancetis the most comprehensive estimate of the disease in nearly a decade, according to the authors. It is presented concurrently at the American Society of Nephrology’s annual Kidney Week conference.

The survey was conducted as part of the Global Burden of Disease (GBD) 2023 study, the world’s most comprehensive effort to track health losses across countries and over time. Its findings are widely used to guide policy development and inform global health research.

For the study, the team analyzed 2,230 published research papers and national health datasets from 133 countries. In addition to looking for trends in diagnoses and mortality, the team examined the consequences of disability caused by chronic kidney disease.

Another major finding was that kidney failure, in addition to killing people directly, was a key risk factor for heart disease, contributing to about 12% of global cardiovascular mortality. The results further showed that in 2023, this pathology was the 12th cause of reduced quality of life due to disability. The main risk factors for kidney disease were high blood sugar, high blood pressure, and a high body mass index (a measure of obesity).

Most people with chronic kidney disease in the study were in the early stages of the disease. This is important, Coresh says, because prompt treatment with medications and lifestyle changes can avoid the need for more dramatic and costly interventions such as dialysis and kidney transplantation.

He adds that in sub-Saharan Africa, Southeast Asia, Latin America and other low-income regions, relatively few people receive dialysis or kidney transplants, likely because these treatments are less available and harder to access in these regions.

“Chronic kidney disease is underdiagnosed and undertreated,” said Morgan Grams, MD, Ph.D, co-senior author of the study. “Our report highlights the need for more urine testing to detect the disease early and to ensure patients can afford to access treatment once they are diagnosed.”

Grams, the Susan and Morris Mark Professor of Medicine at NYU Grossman School of Medicine, notes that new medications have become available in the past five years that can slow the progression of kidney disease and reduce the risk of heart attacks, strokes and heart failure. However, it will take time to see improvements on a global scale.

Grams also cautions that because chronic kidney disease is understudied, it may be even more common than the current findings suggest.