800 Million People Have Chronic Kidney Disease — Most Don’t Know It

Your kidneys filter approximately 200 litres of blood every day — removing waste products, balancing electrolytes, regulating blood pressure, and producing hormones essential for red blood cell production and bone health. They perform this work silently, without complaint, for decades. And when they begin to fail — as they now are for an extraordinary number of people — they do so quietly, without pain or obvious warning, until the damage is severe and often irreversible.

A landmark analysis published by IHME in late 2025 revealed a number that stunned the global nephrology community: the number of adults living with chronic kidney disease (CKD) has more than doubled since 1990, reaching nearly 800 million. CKD is now among the fastest-growing causes of death globally — and the majority of those affected do not know they have it.

What Is Chronic Kidney Disease?

CKD is defined as abnormalities of kidney structure or function, present for more than three months, with health implications. It is staged from G1 (normal or high GFR with kidney damage markers) through G5 (kidney failure, GFR below 15 mL/min). The primary measure of kidney function is the estimated glomerular filtration rate (eGFR) — which measures how much blood the kidneys filter per minute — combined with the albumin-to-creatinine ratio (ACR), which detects protein leaking into urine.

Most people with early-stage CKD (G1–G3) have no symptoms whatsoever. By the time symptoms appear — fatigue, swelling, decreased urine output, nausea — significant irreversible damage has usually already occurred. This is why CKD is called the “silent disease,” and why detection relies entirely on routine blood and urine screening.

The Scale: 800 Million and Growing

The IHME data — representing the most comprehensive global assessment of CKD burden ever conducted — shows that CKD affected approximately 370 million people in 1990. By 2023, that number had reached 800 million. The drivers of this doubling are the parallel epidemics of diabetes and hypertension — the two leading causes of CKD globally — combined with ageing populations and rising rates of obesity-related kidney injury.

CKD kills approximately 1.2 million people per year directly, and contributes to millions more deaths from cardiovascular disease — people with CKD have 10–20× the cardiovascular mortality risk of the general population. The global cost of kidney replacement therapy (dialysis and transplantation) already exceeds $1 trillion annually.

Who Is Most at Risk?

• Diabetes: Diabetic nephropathy causes 30–40% of all CKD globally. Poor blood sugar control over years damages the delicate filtration units of the kidney
• Hypertension: Chronic high blood pressure scars and stiffens renal blood vessels, progressively reducing filtration capacity
• Obesity: Excess weight directly causes glomerular hyperfiltration — the kidneys work too hard and eventually burn out
• Family history: Genetic forms of CKD — including polycystic kidney disease — affect millions worldwide
• NSAIDs overuse: Regular use of ibuprofen, diclofenac, and other non-steroidal anti-inflammatory drugs is a leading cause of drug-induced CKD — particularly relevant in South Asia where self-medication with NSAIDs is extremely common
• Recurrent infections: Repeated urinary tract infections, untreated kidney stones, and chronic glomerulonephritis all accelerate kidney damage

How CKD Is Diagnosed

Two simple, inexpensive tests detect CKD: a serum creatinine blood test (used to calculate eGFR) and a urine dipstick or ACR test (to detect proteinuria). Annual screening is recommended for all people with diabetes, hypertension, obesity, a family history of kidney disease, or age over 60. In India, both tests are available at government health facilities and are included in NCD screening programmes — yet uptake remains very low.

Slowing Progression: What Works

• SGLT2 inhibitors: Originally developed for diabetes, drugs like empagliflozin and dapagliflozin have shown remarkable kidney-protective effects in large RCTs — reducing CKD progression by 30–40% regardless of diabetes status. Now recommended first-line for CKD by major nephrology guidelines
• ACE inhibitors / ARBs: These blood pressure drugs have specific kidney-protective properties beyond BP lowering — reducing proteinuria and slowing GFR decline
• Blood pressure control: Target below 130/80 mmHg in CKD patients — crucial to slowing progression
• Blood sugar control: HbA1c target of 7% or below in diabetic CKD
• Dietary modification: Reduced sodium, controlled protein intake, and potassium management as guided by a nephrologist
• Avoid nephrotoxic drugs: NSAIDs, contrast dyes, and certain antibiotics require dose adjustment or avoidance in CKD

Conclusion

Eight hundred million people with chronic kidney disease — most unaware they have it, many living in countries where dialysis is unaffordable when their kidneys eventually fail. This is a preventable tragedy unfolding in slow motion, driven by the same modifiable risk factors — diabetes, hypertension, obesity — that are reshaping the global disease burden across every organ system. The kidneys are telling us something important about how we are living. It is past time to listen.

Sources: IHME — Global Burden of Chronic Kidney Disease (2025) · Kidney International (KDIGO Guidelines 2024) · The Lancet — SGLT2 Inhibitors in CKD · WHO NCD Global Action Plan · Indian Society of Nephrology

⚠️ Medical Disclaimer: This article is for educational purposes only. Consult a nephrologist or physician for CKD screening and management. See our Medical Disclaimer.