Chronic Kidney Disease Now Strikes 788 Million Worldwide

The number of people living with chronic kidney disease has more than doubled in a single generation, climbing from 378 million in 1990 to 788 million in 2023, according to a global analysis published in The Lancet. Chronic kidney disease (CKD, a condition in which the kidneys slowly lose their ability to filter waste and extra fluid from the blood) now affects roughly 14% of the world’s adults and has become the ninth leading cause of death worldwide, entering the top 10 for the first time.

The damage does not stop at the kidneys. Impaired kidney function is now tied to almost 12% of all cardiovascular deaths on the planet, which means the organ most people never think about is quietly feeding the conditions that kill the most: heart attacks, strokes, and heart failure.

How a Kidney Disease Became a Heart-Attack Risk

The kidneys and the heart run on the same plumbing. When the kidneys stop clearing fluid and waste efficiently, blood pressure rises, the heart works harder, and arteries stiffen. That is why nephrologists have long argued that most people with kidney damage are far more likely to die of a cardiac event than to ever reach dialysis.

The new numbers put a scale on that argument. Kidney dysfunction ranked as the seventh-leading risk factor for cardiovascular death in 2023, ahead of both diabetes and obesity, and accounted for close to 12% of cardiovascular deaths globally. For a condition that rarely makes headlines, that is an outsized footprint on the world’s biggest killer.

Josef Coresh, MD, PhD, director of NYU Langone’s Optimal Aging Institute and a co-senior author of the study, said the disease has been hiding in plain sight. The findings, he argued, should push kidney health into the same policy tier as the conditions it helps drive.

• 788 million people lived with CKD in 2023, double the 1990 count.
• Roughly 1.5 million deaths were linked to the disease in 2023.
• CKD was the 12th leading cause of disability-related health loss worldwide.
• Age-adjusted death rates ran more than 6% higher than three decades earlier.

788 Million People, Most of Them Undiagnosed

What makes the climb so dangerous is how silent it is. In its early stages, kidney disease produces no clear symptoms, so people carry it for years without knowing. By the time fatigue, swelling, or changes in urination appear, the damage is often advanced, and most remain undiagnosed until then. Researchers warn the true count may run higher than 788 million because so many people are never tested.

The estimate comes from the Global Burden of Disease (GBD, a long-running international project that tracks health loss across countries and over time) and is the most comprehensive look at kidney disease in nearly a decade. To build it, researchers reviewed 2,230 published studies and national health datasets from 133 countries, work detailed in the 2023 Global Burden of Disease analysis in The Lancet.

What Is Driving the Climb

The growth is partly a story of demographics. As the global population has grown older and larger, the pool of people at risk has widened. But aging alone does not explain the rise in death rates, which climbed even after adjusting for age.

The real accelerants are the chronic conditions spreading alongside it. The study identified three dominant risk factors, all of them increasingly common.

• High blood sugar, driven by the global rise in type 2 diabetes, which damages the tiny filtering vessels inside the kidney.
• High blood pressure, which strains those same vessels over years and is both a cause and a consequence of kidney decline.
• High body mass index (BMI, a standard measure of obesity), which raises the load on the kidneys and feeds the other two risks.

Each of these is treatable, and each is becoming more widespread at once. That combination is why a disease tied to old age is now showing up earlier and in more people than the models a decade ago predicted.

Why Early Detection Changes the Math

The most hopeful finding in the report is also the most overlooked: most people with kidney disease are still in the early stages. That window matters, because early action can slow the decline and keep patients off the expensive, life-altering treatments that come later.

The Case for Routine Urine Testing

Catching the disease early is cheap and simple. A urine test for protein, paired with a routine blood test, can flag failing kidneys long before symptoms appear. The problem is that those tests are not done often enough, even in wealthy health systems where they are readily available.

Morgan Grams, MD, PhD, a professor of medicine at the NYU Grossman School of Medicine and a co-lead author, framed the gap bluntly.

Chronic kidney disease is underdiagnosed and undertreated. Our report underscores the need for more urine testing to catch it early and the need to ensure that patients can afford and access therapy once they are diagnosed.

Slowing the Slide to Dialysis

When kidney disease is caught early, medications and lifestyle changes can often hold the line, preventing or delaying the move to dialysis or transplant. That changes the math for health systems as well as patients, since late-stage care is far costlier than the testing that could have headed it off.

Grams cautioned that the disease is likely even more common than the estimates suggest, precisely because so many cases go untested and uncounted.

The Drugs That Arrived in the Last Five Years

The timing of all this could hardly be better, because the treatment options have changed dramatically. Over roughly the past five years, several drug classes have been shown not only to slow kidney decline but also to cut the risk of heart attack, stroke, and heart failure, which targets the cardiovascular danger and the kidney damage together.

• SGLT2 inhibitors (sodium-glucose cotransporter-2 inhibitors), now recommended across many causes of kidney disease, not just diabetes-related cases.
• GLP-1-based therapies (glucagon-like peptide-1 receptor agonists), increasingly studied for kidney protection on top of their effects on blood sugar and weight.
• Nonsteroidal mineralocorticoid receptor antagonists, which reduce inflammation and scarring in the kidney.

Clinical guidance is racing to keep up. The body behind the most widely used kidney care standards, Kidney Disease: Improving Global Outcomes (KDIGO), is updating its 2024 guidance to reflect new evidence on these therapies, including their use in people without diabetes. You can track the live framework through the KDIGO clinical guideline on CKD evaluation and management.

The catch is scale. New drugs only bend a global curve once they reach the people carrying the disease, and Grams warned it will take years for these advances to show up in worldwide death rates.

Where Treatment Runs Out

That gap between what exists and what reaches patients is where the story turns mixed. The tests and drugs that could change the trajectory are concentrated in high-income health systems, and access runs out exactly where the burden is heaviest.

In sub-Saharan Africa, Southeast Asia, Latin America, and other lower-income regions, dialysis and transplants remain scarce and expensive, so many people who reach kidney failure simply do not get treated. The newer protective drugs face the same barrier of cost and availability, which means the regions with the fastest-rising burden are often the last to benefit. The scale of undetected disease is captured in the global undiagnosed-CKD estimates compiled by the National Kidney Foundation.

There is institutional momentum building. In May 2025, the World Health Organization (WHO) formally added kidney disease to its push to cut early deaths from noncommunicable diseases (NCDs, the chronic conditions like heart disease, cancer, and diabetes that are not passed between people) by one third before 2030, a goal tracked through the World Health Organization’s targets on noncommunicable disease deaths.

The forward read sharpens the stakes. While deaths from stroke and heart disease are projected to fall sharply in the decades ahead, kidney disease deaths are forecast to keep rising, with one analysis placing it among the top five global causes of death by 2050. If testing and the new therapies reach the regions carrying the heaviest load, that curve can bend. If they stay locked inside wealthy health systems, the silent disease keeps doing its loudest work far from where the cures are written.

Frequently Asked Questions

What is chronic kidney disease?

Chronic kidney disease is the gradual loss of the kidneys’ ability to filter waste and excess fluid from the blood. It is staged from mild to severe, and in its advanced form can require dialysis or a transplant. About 14% of the world’s adults are estimated to have it.

What are the early warning signs of kidney disease?

Often there are none. In early stages most people feel completely normal, which is why the disease is described as silent. When symptoms do appear, they can include fatigue, swelling in the legs or ankles, changes in how often you urinate, and difficulty concentrating, usually signaling that damage is already advanced.

How is chronic kidney disease detected?

Two simple tests do most of the work: a urine test that checks for protein (often reported as a urine albumin-to-creatinine ratio, or ACR) and a blood test that estimates how well the kidneys filter, known as eGFR (estimated glomerular filtration rate). Both are inexpensive and can flag the disease years before symptoms.

Can chronic kidney disease be slowed or reversed?

Existing damage usually cannot be reversed, but progression can often be slowed when the disease is caught early. Controlling blood pressure and blood sugar, alongside newer drugs such as SGLT2 inhibitors, can delay or prevent the need for dialysis or transplant.

Who is most at risk of chronic kidney disease?

The largest risk factors are high blood sugar (especially from type 2 diabetes), high blood pressure, and obesity. Risk also rises with age and with a family history of kidney disease, and access to early testing is lowest in many lower-income regions where the burden is climbing fastest.

Why is kidney disease linked to heart disease?

The kidneys and heart depend on each other. Failing kidneys drive up blood pressure and fluid load and damage blood vessels, which strains the heart. Impaired kidney function was tied to almost 12% of global cardiovascular deaths in 2023, ranking ahead of diabetes and obesity as a cardiac risk factor.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Chronic kidney disease is a serious health condition; anyone concerned about kidney health, symptoms, or risk factors should consult a qualified healthcare professional for diagnosis and treatment. Figures cited are accurate as of publication.