Mark, Patrick B. and Stafford, Lauryn K. and Grams, Morgan E. and Aalruz, Hasan and Abd ElHafeez, Samar and Abdelgalil, Ahmed Abdelrahman and Abdulkader, Rizwan Suliankatchi and Abeywickrama, Hansani Madushika and Abiodun, Olugbenga Olusola and Abramov, Dmitry and Abrar, Mohammed Mehdi and Abreu, Lucas Guimarães and Abubakar, Bilyaminu and Aburuz, Salahdein and Addo, Isaac Yeboah and Adegboye, Oyelola A. and Adegoke, Nurudeen A. and Adeyeoluwa, Temitayo Esther and Adnani, Qorinah Estiningtyas Sakilah and Ahinkorah, Bright Opoku and Ahmad, Sajjad and Ahmad, Khabir and Ahmadi, Ali and Ahmadzade, Amir Mahmoud and Ahmed, Ayman and Ahmed, Aram Mahmood and Ahmed, Nesredin and Ahmed, Shahzaib and Ahmed, Syed Anees and Ajami, Marjan and Akbari, Mohammadreza and Akeju, Oluwasefunmi and Akkaif, Mohammed Ahmed and Al Awaidy, Salah and Al Hamad, Hanadi and Al Hasan, Syed Mahfuz and Al Thaher, Yazan and Al-Aly, Ziyad and Al-Ashwal, Fahmi Y. and Albashtawy, Mohammed and Aleidi, Shereen M. and Alfalki, Ali M. and Alhalaiqa, Fadwa Naji and Alhasan, Khalid A. and Ali, Endale Alemayehu and Ali, Rafat and Ali, Syed Shujait and Ali, Syed Yusuf and Al-Jabi, Samah W. and Allouh, Mohammed Z. and Almagharbeh, Wesam Taher and Almidani, Omar and Alnawafleh, Khaldoon Aied and Alshahrani, Najim Z. and Altaf, Awais and Alvis-Guzman, Nelson and Al-Worafi, Yaser Mohammed and Alzoubi, Karem H. and Al-Zubairi, Adel Sharaf and Aman Mohammadi, Masoud and Amu, Hubert and Anagnostakis, Filippos and Anil, Abhishek and Anyasodor, Anayochukwu Edward and Apostol, Geminn Louis Carace and Appati, Walter and Araromi, Sulaimon O. and Aravkin, Aleksandr Y. and ÃrnlÃv, Johan and Arockiaraj, Jesu and Asiamah-Asare, Bernard Kwadwo Yeboah and Asri, Yuni and Assaye, Ashagre Molla and Atout, Maha Moh'd Wahbi and Aurangzeb, Khursheed and Awotidebe, Adedapo Wasiu and Aziz, Sadat Abdulla and Azzolino, Domenico and Badar, Muhammad and Bakhshali, Mohamad Amin and Ballew, Shoshana H. and Baltatu, Ovidiu Constantin and Banach, Maciej and Bardhan, Mainak and Barqawi, Hiba Jawdat and Bashar, M. 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D. and Spearman, Sandra and Sreeram, Saraswathy and Starodubova, Antonina V. and Stockfelt, Leo and Sujon, Hasnat and Sulaieva, Oksana and Suleiman Odidi, Muritala and Suleman, Muhammad and Sulistiyorini, Desy and Sun, Xiaodong and Sundström, Johan and Sunuwar, Dev Ram and Susianti, Hani and Swain, Chandan Kumar and Szarpak, Lukasz and Sree Sudha, T.Y. and Tabche, Celine and Talaat, Iman M. and Tamehri Zadeh, Seyed Saeed and Tanchanco, Roberto C. and Tegegne, Kaleab Tesfaye and Tekola, Abainash and Teramoto, Masayuki and Tesfaye, Wubshet H. and Tewari, Jay and Ticoalu, Jansje Henny Vera and Tiwari, Krishna and Tomo, Sojit and Tonapa, Santo Imanuel and Tonelli, Marcello and Trabelsi, Khaled and Tran, Thang Huu and Tran, Quynh Thuy Huong and Tran, Tam Quoc Minh and Tran Minh Duc, Nguyen and Trico, Domenico and Tuo, Zhouting and Tye, Sok Cin and Ullah, Himayat and Valdez, Pascual R. and Van den Eynde, Jef and Varghese, Joe and Vart, Priya and Varthya, Shoban Babu and Vasishta, Sampara and Vipparthy, Sharath Chaitanya and Waheed, Yasir and Wang, Jingyu and Wang, Wanzhou and Wang, Zhihua and Wang, Qingzhi and Wang, Ziyue and Wang, Yanzhong and Weerasekara, Ishanka and Weiss, Jordan and Werdecker, Andrea and Westerman, Ronny and Wickramasinghe, Nuwan Darshana and Wilandika, Angga and Willeit, Peter and Wojewodzic, Marcin W. and Wong, Yen Jun and Wu, Shijie and Xia, Qing and Xie, Zhaomin and Yahoo, Saba and Yahya, Galal and Yamagishi, Kazumasa and Yang, Haibo and Yao, Haiqiang and Yao, Laiang and Ye, Pengpeng and Yergaliyev, Kuanysh A. and Yewodiaw, Thomas Kidanemariam and Yismaw, Malede Berihun and Yon, Dong Keon and Yonemoto, Naohiro and Yu, Yong and Yuzbashian, Emad and Zaman, Sojib Bin and Zamora, Nelson and Zawiah, Mohammed and Zhang, Haijun and Zhang, Danting and Zhang, Beijian and Zhang, Xuying and Zhang, Zhiqiang and Zhang, Yue and Zhao, Hanqing and Zhumagaliuly, Abzal and Zielinska, Magdalena and Zyoud, Sa'ed H. and Vos, Theo and Lees, Jennifer Susan and Ong, Kanyin Liane and Coresh, Josef (2025) Global, regional, and national burden of chronic kidney disease in adults, 1990â2023, and its attributable risk factors: a systematic analysis for the Global Burden of Disease Study 2023. The Lancet, 406 (10518). 2461 - 2482. ISSN 01406736

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Abstract

Background Chronic kidney disease (CKD) is common and ranks among the leading causes of mortality and morbidity. This analysis aimed to present global CKD estimates using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 to inform evidence-based policies for CKD identification and treatment. Methods This analysis focused on adults aged 20 years and older over the period 1990 to 2023, from 204 countries and territories. Data sources used were published literature, vital registration systems, kidney failure treatment registries, and household surveys. Estimates of CKD burden, including deaths, incidence, prevalence, and disability-adjusted life-years (DALYs), were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool. A comparative risk assessment approach estimated the proportion of cardiovascular deaths attributable to impaired kidney function and estimated risk factors for CKD. Findings Globally, in 2023, 788 million (95 uncertainty interval 743â843) people aged 20 years and older were estimated to have CKD, up from 378 million (354â407) in 1990. The global age-standardised prevalence of CKD in adults was 14·2 (13·4â15·2), a relative rise of 3·5 (2·7â4·1) from 1990. The region with the highest age-standardised prevalence was north Africa and the Middle East (18·0; 16·9â19·4). Most people had stage 1â3 CKD, with a combined prevalence of 13·9 (13·1â15·0). In 2023, CKD was the ninth leading cause of death globally, accounting for 1·48 million (1·30â1·65) deaths, and the 12th leading cause of DALYs, with an age-standardised DALY rate of 769·2 (691·8â857·4) per 100 000. Impaired kidney function as a risk factor accounted for 11·5 (8·4â14·5) of cardiovascular deaths. High fasting plasma glucose, body-mass index, and systolic blood pressure were all leading risk factors for CKD DALYs. Interpretation CKD is a major global health issue, with rising prevalence and increasing importance as a cause of death and as a risk factor for cardiovascular death. A better understating of aetiology, appropriate screening, and implementation programmes are needed to translate advances in CKD treatment into improved patient outcomes. Funding Gates Foundation, Wellcome, US National Kidney Foundation, and US National Institute of Diabetes and Digestive and Kidney Diseases. © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

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