Chronic kidney disease (CKD) has quietly become one of the most serious health threats of our time. New global estimates suggest that the number of people living with reduced kidney function has more than doubled in a little over three decades, rising from around 378 million in 1990 to about 788 million in 2023. As populations grow and age, CKD has moved into the ranks of the top causes of death worldwide, and its impact is especially visible in countries like India, which now has the second-highest number of people living with the condition.
CKD is a long-term condition in which the kidneys gradually lose their ability to filter waste and excess fluid from the blood. In the early stages, the damage is often silent: most people have few or no symptoms, and may feel completely normal. Over time, however, waste products and fluids build up in the body, leading to serious health problems. In advanced stages, people may require lifelong dialysis or a kidney transplant just to stay alive. Because early disease is so quiet, many individuals are diagnosed only when irreversible damage has already occurred.
Large international research collaborations, including teams from institutions such as NYU Langone Health, the University of Glasgow, and the Institute for Health Metrics and Evaluation at the University of Washington, have analysed data from thousands of studies and health databases to understand the true scale of the problem. Their findings show that roughly 14% of adults globally live with some form of CKD. In 2023 alone, about 1.5 million people are estimated to have died directly from CKD, and impaired kidney function contributed significantly to deaths from other conditions, especially heart disease. When shifts in population age are taken into account, deaths due to CKD have risen by more than 6% since the early 1990s.
India – epicentres of the global kidney crisis
India features prominently in this global picture. Recent estimates indicate that about 13.8 crore Indians were living with chronic kidney disease in 2023, second only to China’s 15.2 crore. In absolute numbers, this makes India one of the epicentres of the global kidney crisis. CKD is responsible for over 1.2 lakh deaths in the country each year and is part of a broader wave of non-communicable diseases linked to lifestyle and metabolic disorders. While the global prevalence is around 14.2%, India’s rate is slightly higher at about 16%, placing it above the world average, though still below some countries such as Iran and Haiti, where more than one in five people are affected.
The kidneys have a vital role in maintaining internal balance. They filter blood, remove waste products and excess fluid, regulate electrolytes like sodium and potassium, help control blood pressure, and even influence bone health and red blood cell production. When kidney function begins to decline, these processes falter. In early CKD, the body often compensates, so symptoms may be subtle or completely absent. As damage progresses, people may experience nausea, vomiting, loss of appetite, fatigue, weakness, sleep disturbances, muscle cramps, changes in urination, swelling in the feet and ankles, dry and itchy skin, shortness of breath from fluid in the lungs, and chest pain if fluid collects around the heart. Difficult-to-control high blood pressure is both a cause and a consequence of worsening kidney function.
CKD rarely appears out of nowhere. In most cases, it develops because another condition has been damaging the kidneys over many years. The leading culprits worldwide—and in India—are type 1 and type 2 diabetes and long-standing high blood pressure. Other causes include glomerulonephritis (inflammation of the kidney’s filtering units), interstitial nephritis (inflammation of the tubules), polycystic kidney disease and other inherited conditions, prolonged blockage of the urinary tract from an enlarged prostate, kidney stones or tumours, vesicoureteral reflux (backflow of urine into the kidneys), and recurrent kidney infections. Additional risk factors such as cardiovascular disease, smoking, obesity, older age, a family history of kidney disease, structural abnormalities of the kidneys, and frequent use of certain kidney-harming medications further increase vulnerability.
The consequences of CKD extend far beyond the kidneys. Impaired kidney function is now recognised as a major driver of cardiovascular disease. Globally, reduced kidney function is estimated to contribute to around 12% of cardiovascular deaths, and CKD ranks among the top causes of heart-related mortality, ahead of some better-known risk conditions. People with CKD are more likely to suffer heart attacks, strokes and heart failure. The condition can also cause fluid retention leading to swelling and pulmonary oedema, dangerous elevations in blood potassium, anaemia, weakened bones and fractures, reduced sexual function, impaired concentration and even seizures, lowered immunity, inflammation around the heart, pregnancy complications and, ultimately, complete kidney failure.
Lifestyle an important reason for CKD
Lifestyle plays a central role in both causing and preventing CKD. Rising rates of obesity, diabetes and hypertension globally are tightly linked to modern diets and sedentary habits. Research highlights low intake of fruits and vegetables and high consumption of salt as key risk factors. Processed foods and ready-to-eat meals typically contain large amounts of sodium, which raises blood pressure and strains the kidneys. In India, increasing reliance on packaged and restaurant foods, combined with low fruit and vegetable consumption and declining physical activity, has created a fertile ground for CKD and other non-communicable diseases.
At the same time, CKD remains underdiagnosed and undertreated. Most people in large global studies were found to be in the early stages of CKD, which paradoxically is both the most dangerous and the most hopeful phase. Dangerous because the condition is easy to miss, and hopeful because timely intervention can slow or even significantly halt progression. Simple blood and urine tests can detect reduced kidney function or protein leakage at an early stage, allowing lifestyle changes and medications—such as drugs that control blood pressure, blood sugar and protect kidney function—to have maximum impact. Over the past five years, new therapies have emerged that can slow CKD progression and reduce the risk of heart attack, stroke and heart failure. However, gaps in awareness, access and affordability mean that many people never benefit from these advances.
Access to dialysis and transplantation remains uneven across the globe, and India is no exception. In several regions of sub-Saharan Africa, Southeast Asia, Latin America and other lower-income settings, dialysis and transplants are simply out of reach for many due to cost and limited infrastructure. Recognising this challenge, international health agencies have begun to prioritise kidney disease alongside other non-communicable diseases. CKD has been included in global health targets aimed at reducing premature deaths from non-infectious conditions, reflecting a growing understanding that ignoring kidney health undermines progress on heart disease, diabetes and other major killers.
Government Programmes for CKD
In India, the government has launched several programmes to respond to the rising burden of kidney disease. The Pradhan Mantri National Dialysis Programme supports states and union territories in providing haemodialysis and peritoneal dialysis services in district hospitals. Under this initiative, dialysis is made available free of cost to patients below the poverty line in public facilities. The programme has expanded across the country, with hundreds of districts, thousands of dialysis machines and millions of dialysis sessions delivered. The number of people availing dialysis services under this scheme has almost doubled in just a few years, indicating both an increasing disease burden and improved access to life-sustaining treatment.
Treatment for non-communicable diseases, including CKD, is also covered under Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana, which provides substantial financial protection for secondary and tertiary care to millions of families. Recent policy moves to extend coverage to all senior citizens above a certain age threshold, regardless of income, are expected to further support older adults who are at higher risk for CKD. To reduce out-of-pocket spending on medicines and tests, the government has rolled out free drug and diagnostic schemes, expanded Jan Aushadhi stores that sell affordable generic medicines, and capped prices for several essential formulations, including those used in dialysis and CKD management.
Interestingly, even as absolute numbers of affected individuals in India remain very high, some long-term indicators are encouraging. Estimates suggest that the prevalence of CKD in India has declined by more than 14% since 1990, even while it has risen globally. This suggests that improvements in public health, early detection and better management of risk factors may be having an impact. At the same time, the sheer size of India’s population means that even a slightly lower prevalence translates into tens of millions of people living with the condition and needing continuous care.
Nephrologists working on the frontlines of this crisis underline that treatment alone cannot solve the problem. Doctors in India consistently report high rates of obesity, diabetes and hypertension in screening camps conducted across both urban and rural areas. They point to the combined effects of junk food, processed food rich in salt and preservatives, declining physical activity and limited nutritional awareness as major drivers of kidney damage. While dialysis schemes and insurance coverage for advanced treatments are essential, many experts argue that the country’s strategy must tilt more strongly toward prevention—promoting healthy eating, regular exercise, smoking cessation, blood pressure and diabetes control, and routine screening for high-risk groups.
Ultimately, chronic kidney disease is both a warning and an opportunity. It signals that the same forces driving obesity, diabetes and heart disease are quietly damaging the kidneys of hundreds of millions of people. But because most cases are detected in early stages, there is a crucial window in which action can make a real difference. Regular health check-ups, simple blood and urine tests, better control of blood sugar and blood pressure, reducing salt intake, eating more fresh fruits and vegetables, staying active and avoiding unnecessary use of kidney-harming painkillers can all help preserve kidney function. For policymakers, strengthening primary care, expanding screening, improving food labelling and regulation, and investing in public education may prevent far more suffering than expanding dialysis alone.
The global and Indian data together paint a clear picture: chronic kidney disease is no longer a niche or rare disorder. It is a major public health challenge that affects nearly every organ system, fuels other leading causes of death and strains health systems. Yet it is also largely preventable and, if caught early, often manageable. Treating kidneys as a priority—at the level of individuals, communities and governments—could save countless lives and improve the quality of life for millions in the decades to come.
