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Epidemiology and burden

TL;DR — GBD estimated 697.5 million prevalent CKD cases in 2017, with a global prevalence of 9.1% and 1.2 million deaths directly attributed to CKD (GBD CKD Collaboration 2020, PMID 32061315). Counts depend on whether CKD is defined by repeated measures, single eGFR, albuminuria or administrative codes. Awareness is far lower than biological prevalence, so diagnosed cohorts systematically under-represent early disease (Gong 2026, PMID 41205219). Screening economics remain contingent on risk enrichment and effective treatment delivery (van Mil 2024, PMID 38213490).

Counting problems

Prevalence based on one creatinine measurement overcalls chronicity, while claims data undercount untested disease. Age-standardisation and equation choice also shift estimates (Cirillo 2012, PMID 22038337).

Global burden

The 2017 GBD analysis attributed 1.2 million deaths directly to CKD and another 1.4 million cardiovascular deaths to impaired kidney function (GBD CKD Collaboration 2020, PMID 32061315). These are modelled estimates with uncertainty, not registry counts.

Awareness and detection

Asymptomatic early disease means awareness is a health-system output: it requires testing, result communication and diagnostic coding. Albuminuria is less often measured than creatinine (van Mil 2024, PMID 39137037).

Inequality

CKD of unknown aetiology clusters in hot agricultural regions and among manual workers; case definitions and causal attribution remain heterogeneous (Rao 2023, PMID 37403003) (Sanchez Polo 2020, PMID 33116757).

Screening

Economic reviews do not support a context-free yes/no answer. Yield, frequency, age range, risk enrichment, downstream drug uptake and local costs determine value (van Mil 2024, PMID 38213490) (Yeo 2024, PMID 38186904).

Forecasting

Kidney-failure replacement therapy is a smaller but resource-intensive subset of CKD; global counts and access differ sharply by geography (GBD 2023 Kidney Failure with Replacement Therapy Collaborators 2025, PMID 40712611).

Estimates are method-dependent

Data source Counts well Misses or distorts
Repeated population eGFR + uACR Biological CKD with chronicity Expensive; attrition can be selective
Single cross-sectional survey Stage distribution and risk markers Cannot prove >3-month chronicity
Clinical coding Recognized disease in care Misses untested and uncoded early CKD
Kidney-failure registry Dialysis/transplant incidence and outcomes Does not represent earlier CKD or untreated kidney failure
GBD model Comparable global estimates and uncertainty Depends on sparse source data and modelling assumptions (GBD CKD Collaboration 2020, PMID 32061315)
Screening cohort Yield in a defined pathway Spectrum and participation bias; not population prevalence

The current global estimate — and how it moved

The GBD 2017 figures that anchor much of the CKD literature have been superseded. GBD 2023 estimated 788 million (95% UI 743–843) adults aged 20 or over with CKD in 2023, up from 378 million (354–407) in 1990, with an age-standardised adult prevalence of 14.2% (13.4–15.2) — a relative rise of only 3.5% (2.7–4.1) since 1990, meaning that most of the doubling in case count is demographic (ageing and population growth), not a rise in age-specific risk (GBD 2023 Chronic Kidney Disease Collaborators 2025, PMID 41213283). CKD was the ninth leading cause of death globally in 2023 with 1.48 million (1.30–1.65) deaths, the twelfth leading cause of DALYs at an age-standardised rate of 769.2 (691.8–857.4) per 100,000, and impaired kidney function as a risk factor accounted for 11.5% (8.4–14.5) of all cardiovascular deaths (GBD 2023 CKD Collaborators 2025, PMID 41213283). Stages G1–G3 make up almost all of it, with a combined prevalence of 13.9% (13.1–15.0).

Regional concentration is not uniform: north Africa and the Middle East had the highest age-standardised prevalence at 18.0% (16.9–19.4) (GBD 2023 CKD Collaborators 2025, PMID 41213283). High fasting plasma glucose, high body-mass index and high systolic blood pressure were the leading attributable risk factors for CKD DALYs, which places most of the modifiable burden outside nephrology.

Source Year of estimate Prevalence What it counts
GBD 2023 CKD Collaborators (PMID 41213283) 2023 788 million adults; 14.2% age-standardised Modelled adult prevalence, 204 countries, survey + registry + literature inputs
GBD 2017 CKD Collaboration (PMID 32061315) 2017 697.5 million all ages; 9.1% Earlier model, all ages — the denominators differ, so the two are not a time series
Hill 2016 meta-analysis (PMID 27383068) ≤2016 13.4% (11.7–15.1) stages 1–5; 10.6% (9.2–12.2) stages 3–5 Pooled observational studies, 6,908,440 participants across 100 studies
GBD 2023 KFRT Collaborators (PMID 40712611) 2023 Kidney failure with replacement therapy, global Treated kidney failure only

Hill's pooled stage-specific estimates remain the clearest picture of where prevalence sits: stage 1, 3.5% (2.8–4.2); stage 2, 3.9% (2.7–5.3); stage 3, 7.6% (6.4–8.9); stage 4, 0.4% (0.3–0.5); stage 5, 0.1% (0.1–0.1) (Hill 2016, PMID 27383068). Note that the studies pooled were of "diverse quality" and mostly single-measurement, so this is prevalence of the biochemical state, not of confirmed three-month chronicity — the GBD models make the same compromise.

Lifetime risk, which the prevalence figures conceal

Prevalence answers "how many now"; lifetime risk answers "how likely is this to be me". Using Japanese national dialysis registry incidence with competing-mortality adjustment, cumulative incidence of dialysis-requiring kidney failure from birth to age 95 was 3.14% (95% CI 3.10–3.18) in men and 1.42% (1.39–1.44) in women — about 1 in 32 men and 1 in 71 women (Wakasugi 2020, PMID 32040656). Compared with the 14.2% global adult prevalence estimate above, lifetime risk of treated kidney failure is roughly fourfold lower in men and tenfold lower in women; the populations and methods differ, so these are scale comparisons rather than directly commensurable risks.

Sex and gender: opposite directions on the two axes

CKD epidemiology is not sex-neutral, and the direction reverses between prevalence and progression. Women have higher prevalence of CKD stages G3–G5, while men have higher prevalence of albuminuria and hence of stages G1–G2; men then show faster eGFR decline, progress to kidney failure more often, and have higher mortality and cardiovascular risk — but the female advantage narrows as CKD advances (Chesnaye 2024, PMID 37985869). Part of the higher measured prevalence in women reflects the interaction of longer life expectancy with age-related GFR decline and with equations applied at the extremes of age, which is a measurement effect rather than a disease effect (Carrero 2018, PMID 29355169).

The management gradient runs the other way from the prevalence gradient: women are less likely to be aware of, screened for and diagnosed with CKD, less likely to be started on antiproteinuric medication and less likely to be referred to nephrology, and they report worse health-related quality of life and higher symptom burden; access to the transplant waiting list is also more constrained for women, particularly with older age and obesity, although post-transplant survival is longer (Chesnaye 2024, PMID 37985869) (Carrero 2018, PMID 29355169). A prevalence figure disaggregated by sex therefore cannot be read as a care-need figure without the treatment data alongside it.

Screening economics, quantified

The claim that screening "may or may not be worthwhile" is now answerable with numbers in a US setting, because SGLT2 inhibitor efficacy changed the downstream value of finding a case. In a Markov cohort model calibrated to NHANES with DAPA-CKD-derived treatment effects, one-time albuminuria screening at age 55 had an ICER of $86,300 per QALY gained (costs $249,800 → $259,000; QALYs 12.61 → 12.72), reduced the incidence of kidney failure requiring dialysis or transplant by 0.29 percentage points and raised life expectancy from 17.29 to 17.45 years; screening once during ages 35–75 prevented dialysis or transplant in 398,000 people, and screening every 10 years to age 75 cost under $100,000 per QALY (Cusick 2023, PMID 37216661). The result is fragile to the treatment assumption: with SGLT2 inhibitor efficacy 30% lower, decennial screening cost $145,400–$182,600 per QALY and required price reductions to remain attractive (Cusick 2023, PMID 37216661).

Optimal starting age is a separate question with a different answer. Screening every 5 years from age 55 to 75 with SGLT2 inhibitors reduced cumulative kidney failure requiring KRT from 2.4% to 1.9%, added 0.13 life-years, and cost $128,400 per QALY; starting the same 5-yearly programme at 35 or 45 produced greater population health gain but cost more than $200,000 per additional QALY (Cusick 2024, PMID 39514193). Equity and efficiency are not automatically aligned across these strategies (Cusick 2025, PMID 40227684). All of this is model output conditioned on US prices and on efficacy imported from a single trial; the transportability to systems with different drug prices and dialysis costs is untested.

Microsimulation across 31 countries in the Inside CKD programme projects that, at current diagnosis rates, the CKD population rises 5.8% and associated healthcare costs rise 9.3% by 2027 — costs growing faster than cases because case-mix shifts toward advanced disease when detection lags (Wish 2025, PMID 41141496).

Capacity, not just burden

Burden estimates are only actionable where there is a workforce to act. In the ISN Global Kidney Health Atlas survey of 167 countries, the median global prevalence of nephrologists was 11.75 per million population (IQR 1.78–24.76), with Africa at 1.12, South Asia at 1.81 and Oceania/Southeast Asia at 3.18 per million; paediatric nephrologist prevalence was 0.69 per million (IQR 0.03–1.78) and nephrology trainees 1.15 per million (IQR 0.18–3.81) (Okpechi 2024, PMID 39235198). More than half of countries reported shortages of transplant surgeons (65%), nephrologists (64%), vascular-access coordinators (59%), dialysis nurses (58%) and interventional radiologists (54%), concentrated in low- and lower-middle-income countries (Okpechi 2024, PMID 39235198). Within Africa specifically, the Atlas identified severe workforce limitation, low government funding, limited availability and reporting of kidney replacement therapy, and weak national strategies, with north African countries substantially better provided than sub-Saharan ones (Oguejiofor 2021, PMID 33981467).

The consequence for interpreting global prevalence figures is direct: a 14.2% prevalence estimate in a country with 1.12 nephrologists per million and a 14.2% estimate in one with 25 per million describe the same biology and entirely different diseases as experienced.

Heat as a measurable exposure in established CKD

Occupational heat stress has long been implicated in CKD of unknown aetiology in agricultural populations. A post-hoc analysis of DAPA-CKD tested whether ambient heat affects kidney function in an established, treated CKD population. Climate and eGFR data were available for 4,017 of 4,304 participants (93.3%) across 21 countries (mean age 61.9, mean eGFR 43.3 mL/min/1.73 m², median 28 months' follow-up), linking a time-varying daily centre-level heat index from the ERA5 dataset to individual eGFR change.

A heat index above 30 °C occurred on a median of only 0.6% of days across centres. In adjusted linear mixed-effect models, within each 120-day window each 30 days of heat index above 30 °C was associated with a −0.6% change in eGFR (95% CI −0.9 to −0.3), reproduced in case-time-series analysis. Extrapolated, the estimates corresponded to an additional 3.7 mL/min/1.73 m² (95% CI 0.1 to 7.0) of eGFR loss per year for a patient with eGFR 45 in a very hot versus a temperate environment (Zhang 2024, PMID 38580424).

The authors note that longer time-window analyses gave results consistent with haemodynamic or seasonal variability, so this is not established as irreversible nephron loss. The result identifies ambient heat as an exposure to test prospectively rather than as an established modifiable cause of progression.

Decision and interpretation matrix

Dimension Question Guardrail
Diagnostic axis Cause + G category + A category Avoid treating eGFR as the diagnosis
Time axis Chronicity and trajectory Separate acute change from persistent disease
Risk axis Kidney failure + cardiovascular events + death Show competing events
Treatment axis Eligibility, absolute benefit, harm, burden Do not rank drugs by relative effect alone
Measurement axis Assay, equation, repeatability State what was actually measured
Equity axis Testing, referral, access, affordability Audit downstream care, not labels only
Patient axis Symptoms, function, life participation Include outcomes patients prioritize
Evidence axis RCT, cohort, model, guideline Do not collapse designs

Evidence ledger

This ledger makes the page’s evidentiary mix inspectable. It does not imply that every source answers every question.

PMID Record used Role and boundary
32061315 Global, regional, and national burden of chronic kidney disease, 1990-2017. (GBD CKD Collaboration 2020, PMID 32061315) Modelled projection; the estimate follows from the model inputs and assumptions, not from observed randomized follow-up.
41205219 Chronic Kidney Disease Prevalence and Awareness Among US Adults. (Gong 2026, PMID 41205219) Observational or conceptual evidence; association is not treatment effect.
38213490 Cost-effectiveness of screening for chronic kidney disease: evidence and gaps. (van Mil 2024, PMID 38213490) Guideline or commentary; recommendation evidence depends on its review.
22038337 A population-based approach for the definition of chronic kidney disease: CKD Prognosis Consortium. (Cirillo 2012, PMID 22038337) Synthesis; heterogeneity and included-study definitions constrain transport.
39137037 Screening for chronic kidney disease: change of perspective and novel developments. (van Mil 2024, PMID 39137037) Observational or conceptual evidence; association is not treatment effect.
37403003 Chronic kidney disease of unknown aetiology: a global review. (Rao 2023, PMID 37403003) Observational or conceptual evidence; association is not treatment effect.
33116757 Mesoamerican Nephropathy: What We Know so Far. (Sanchez Polo 2020, PMID 33116757) Observational or conceptual evidence; association is not treatment effect.
38186904 Cost-effectiveness of screening for CKD in the general adult population: systematic review. (Yeo 2024, PMID 38186904) Synthesis; heterogeneity and included-study definitions constrain transport.
40712611 Global, regional, and national prevalence of kidney failure with replacement therapy and associated aetiologies, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023. (GBD 2023 Kidney Failure with Replacement Therapy Collaborators 2025, PMID 40712611) Modelled projection; the estimate follows from the model inputs and assumptions, not from observed randomized follow-up.
38490803 KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. (KDIGO CKD Work Group 2024, PMID 38490803) Guideline or commentary; recommendation evidence depends on its review.
38519239 Executive summary of the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease: known knowns and known unknowns. (Levin 2024, PMID 38519239) Guideline or commentary; recommendation evidence depends on its review.
23243116 Cohort profile: the chronic kidney disease prognosis consortium. (Matsushita 2013, PMID 23243116) Observational or conceptual evidence; association is not treatment effect.
37787795 Estimated GFR, Albuminuria, and Adverse Outcomes: individual-participant data meta-analysis. (CKD Prognosis Consortium 2023, PMID 37787795) Synthesis; heterogeneity and included-study definitions constrain transport.
30348535 Relationship of Estimated GFR and Albuminuria to Concurrent Laboratory Abnormalities. (Inker 2019, PMID 30348535) Synthesis; heterogeneity and included-study definitions constrain transport.
34554658 New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race. (Inker 2021, PMID 34554658) Observational or conceptual evidence; association is not treatment effect.
34563581 A Unifying Approach for GFR Estimation: Recommendations of the NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease. (Delgado 2022, PMID 34563581) Guideline or commentary; recommendation evidence depends on its review.
26757465 Multinational assessment of equations predicting kidney failure. (Tangri 2016, PMID 26757465) Synthesis; heterogeneity and included-study definitions constrain transport.
36857500 Kidney Failure Risk Equation evaluation with novel inputs in 59 cohorts. (Grams 2023, PMID 36857500) Observational or conceptual evidence; association is not treatment effect.
26028594 eGFR and albuminuria for prediction of cardiovascular outcomes: individual-participant meta-analysis. (Matsushita 2015, PMID 26028594) Synthesis; heterogeneity and included-study definitions constrain transport.
32970396 Dapagliflozin in Patients with Chronic Kidney Disease. (Heerspink 2020, PMID 32970396) Intervention study; eligibility, comparator, endpoint and follow-up bound inference.
36331190 Empagliflozin in Patients with Chronic Kidney Disease. (EMPA-KIDNEY Collaborative Group 2023, PMID 36331190) Intervention study; eligibility, comparator, endpoint and follow-up bound inference.
30990260 Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. (Perkovic 2019, PMID 30990260) Intervention study; eligibility, comparator, endpoint and follow-up bound inference.
40227684 Balancing Efficiency and Equity in Population-Wide CKD Screening. (Cusick 2025, PMID 40227684) Modelled projection; the estimate follows from the model inputs and assumptions, not from observed randomized follow-up.
18161745 Cellular and molecular mechanisms of fibrosis. (Wynn 2008, PMID 18161745) Observational or conceptual evidence; association is not treatment effect.
7246778 Hyperfiltration in remnant nephrons: a potentially adverse response to renal ablation. (Hostetter 1981, PMID 7246778) Observational or conceptual evidence; association is not treatment effect.
24522492 Relative risks of CKD for mortality and end-stage renal disease across races are similar. (Wen 2014, PMID 24522492) Observational or conceptual evidence; association is not treatment effect.

What can and cannot be concluded

  • Risk associations do not by themselves establish that changing the marker changes risk.
  • A relative effect must be paired with baseline risk, follow-up and the exact endpoint.
  • Albuminuria, acute eGFR change, chronic eGFR slope and kidney failure are not interchangeable.
  • Subgroup consistency is not evidence that every subgroup had adequate power.
  • Guideline recommendations combine evidence with values, feasibility, cost and service capacity.
  • Older adults require competing-mortality and treatment-burden framing.
  • Dialysis and transplantation comparisons are vulnerable to eligibility and immortal-time bias.
  • Modelled lifetime benefit is not a randomized observed benefit.
  • A biochemical response without a patient-important outcome remains a surrogate result.
  • This page is research synthesis, not individualized medical advice.

Research-design checklist

  • Define CKD cause, G category, A category and chronicity at baseline.
  • Report the creatinine or cystatin C equation and laboratory calibration.
  • Prespecify acute and chronic eGFR slopes when haemodynamic effects are expected.
  • Keep sustained GFR decline, kidney failure and replacement therapy separable.
  • Report absolute event risks, follow-up and confidence intervals with relative effects.
  • Treat death as a competing event where it can preclude kidney failure.
  • Measure hyperkalaemia, acute kidney injury and treatment discontinuation consistently.
  • Include symptoms, function, life participation and treatment burden.
  • Describe background RAS, SGLT2, MRA and GLP-1 therapy explicitly.
  • Prespecify albuminuria and cause strata without over-reading underpowered interactions.
  • Record screening, prescribing, persistence and monitoring as separate implementation steps.
  • Report representation, access and affordability variables needed for equity analysis.

Open questions

  • How large is the gap between measured, diagnosed and coded CKD prevalence in the same population measured all three ways? Each method is used separately; direct within-population comparisons are scarce (Cirillo 2012, PMID 22038337) (Gong 2026, PMID 41205219).
  • Which screening strategy maximises health gain while narrowing rather than widening inequity? Efficiency and equity can select different populations and starting ages (Cusick 2025, PMID 40227684) (Yeo 2024, PMID 38186904). → OQ-4
  • Why is uACR measured so much less often than creatinine, and which system intervention closes that gap? The under-measurement is documented; the remedy is not (van Mil 2024, PMID 39137037).

  • How much of the global burden attributed to CKD of unknown aetiology is heat, toxin, infection or social exposure? Case definitions remain unharmonised (Rao 2023, PMID 37403003) (Sanchez Polo 2020, PMID 33116757). → OQ-20

  • Is the apparent rise in global CKD prevalence real or demographic? GBD 2023 shows case counts more than doubling since 1990 while age-standardised prevalence rose only 3.5% (2.7–4.1) (GBD 2023 CKD Collaborators 2025, PMID 41213283), yet the underlying survey inputs are mostly single-measurement and cannot confirm chronicity.

  • Do the US screening cost-effectiveness results transport to systems with different drug prices and dialysis costs? Every published base case is calibrated to US prices and imports efficacy from one trial (Cusick 2023, PMID 37216661) (Cusick 2024, PMID 39514193).
  • Why does the sex gradient reverse between prevalence (higher in women at G3–G5) and progression (faster in men), and how much of it is equation artefact at older ages (Chesnaye 2024, PMID 37985869) (Carrero 2018, PMID 29355169)?

  • What is the lifetime risk of treated kidney failure outside high-income registries? The best available estimate — 1 in 32 men, 1 in 71 women — comes from a single national registry (Wakasugi 2020, PMID 32040656).

  • Is heat-associated eGFR loss in established CKD reversible haemodynamic variation or true nephron loss? Longer time-window analyses were consistent with haemodynamic or seasonal effects, yet the extrapolated annual difference is 3.7 mL/min/1.73 m² (0.1–7.0) (Zhang 2024, PMID 38580424).

  • If ambient heat measurably affects kidney function in a treated trial population from 21 countries (Zhang 2024, PMID 38580424), how should climate exposure enter burden projections that currently model only demographic and metabolic risk factors (GBD 2023 CKD Collaborators 2025, PMID 41213283)?

References

  1. GBD CKD Collaboration et al. Global, regional, and national burden of chronic kidney disease, 1990-2017. Lancet. 2020;395(10225):709-733. PMID 32061315
  2. Gong et al. Chronic Kidney Disease Prevalence and Awareness Among US Adults. JAMA Cardiol. 2026;11(1):77-81. PMID 41205219
  3. van Mil et al. Cost-effectiveness of screening for chronic kidney disease: evidence and gaps. Clin Kidney J. 2024;17(1):sfad254. PMID 38213490
  4. Cirillo et al. A population-based approach for the definition of chronic kidney disease: CKD Prognosis Consortium. J Nephrol. 2012;25(1):7-12. PMID 22038337
  5. van Mil et al. Screening for chronic kidney disease: change of perspective and novel developments. Curr Opin Nephrol Hypertens. 2024;33(6):583-592. PMID 39137037
  6. Rao et al. Chronic kidney disease of unknown aetiology: a global review. Trop Med Int Health. 2023;28(8):588-600. PMID 37403003
  7. Sanchez Polo et al. Mesoamerican Nephropathy: What We Know so Far. Int J Nephrol Renovasc Dis. 2020;13:261-272. PMID 33116757
  8. Yeo et al. Cost-effectiveness of screening for CKD in the general adult population: systematic review. Clin Kidney J. 2024;17(1):sfad137. PMID 38186904
  9. GBD 2023 Kidney Failure with Replacement Therapy Collaborators et al. Global, regional, and national prevalence of kidney failure with replacement therapy and associated aetiologies, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet Glob Health. 2025;13(8):e1378-e1395. PMID 40712611
  10. KDIGO CKD Work Group et al. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024;105(4S):S117-S314. PMID 38490803
  11. Levin et al. Executive summary of the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease: known knowns and known unknowns. Kidney Int. 2024;105(4):684-701. PMID 38519239
  12. Matsushita et al. Cohort profile: the chronic kidney disease prognosis consortium. Int J Epidemiol. 2013;42(6):1660-1668. PMID 23243116
  13. CKD Prognosis Consortium et al. Estimated GFR, Albuminuria, and Adverse Outcomes: individual-participant data meta-analysis. JAMA. 2023;330(13):1266-1277. PMID 37787795
  14. Inker et al. Relationship of Estimated GFR and Albuminuria to Concurrent Laboratory Abnormalities. Am J Kidney Dis. 2019;73(2):206-217. PMID 30348535
  15. Inker et al. New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race. N Engl J Med. 2021;385(19):1737-1749. PMID 34554658
  16. Delgado et al. A Unifying Approach for GFR Estimation: Recommendations of the NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease. Am J Kidney Dis. 2022;79(2):268-288.e1. PMID 34563581
  17. Tangri et al. Multinational assessment of equations predicting kidney failure. JAMA. 2016;315(2):164-174. PMID 26757465
  18. Grams et al. Kidney Failure Risk Equation evaluation with novel inputs in 59 cohorts. J Am Soc Nephrol. 2023;34(3):482-494. PMID 36857500
  19. Matsushita et al. eGFR and albuminuria for prediction of cardiovascular outcomes: individual-participant meta-analysis. Lancet Diabetes Endocrinol. 2015;3(7):514-525. PMID 26028594
  20. Heerspink et al. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2020;383(15):1436-1446. PMID 32970396
  21. EMPA-KIDNEY Collaborative Group et al. Empagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2023;388(2):117-127. PMID 36331190
  22. Perkovic et al. Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. N Engl J Med. 2019;380(24):2295-2306. PMID 30990260
  23. Cusick et al. Balancing Efficiency and Equity in Population-Wide CKD Screening. JAMA Netw Open. 2025;8(4):e254740. PMID 40227684
  24. Wynn et al. Cellular and molecular mechanisms of fibrosis. J Pathol. 2008;214(2):199-210. PMID 18161745
  25. Hostetter et al. Hyperfiltration in remnant nephrons: a potentially adverse response to renal ablation. Am J Physiol. 1981;241(1):F85-F93. PMID 7246778
  26. Wen et al. Relative risks of CKD for mortality and end-stage renal disease across races are similar. Kidney Int. 2014;86(4):819-827. PMID 24522492
  27. GBD 2023 Chronic Kidney Disease Collaborators. Global, regional, and national burden of chronic kidney disease in adults, 1990-2023, and its attributable risk factors: a systematic analysis for the Global Burden of Disease Study 2023. Lancet. 2025;406(10518):2461-2482. PMID 41213283
  28. Hill NR, et al. Global Prevalence of Chronic Kidney Disease - A Systematic Review and Meta-Analysis. PLoS One. 2016;11(7):e0158765. PMID 27383068
  29. Wakasugi M, et al. Lifetime and age-conditional risk estimates of end-stage kidney disease requiring maintenance dialysis in Japan. Clin Exp Nephrol. 2020;24(6):518-525. PMID 32040656
  30. Chesnaye NC, et al. Differences in the epidemiology, management and outcomes of kidney disease in men and women. Nat Rev Nephrol. 2024;20(1):7-20. PMID 37985869
  31. Carrero JJ, et al. Sex and gender disparities in the epidemiology and outcomes of chronic kidney disease. Nat Rev Nephrol. 2018;14(3):151-164. PMID 29355169
  32. Cusick MM, et al. Population-Wide Screening for Chronic Kidney Disease: A Cost-Effectiveness Analysis. Ann Intern Med. 2023;176(6):788-797. PMID 37216661
  33. Cusick MM, et al. When to Start Population-Wide Screening for Chronic Kidney Disease: A Cost-Effectiveness Analysis. JAMA Health Forum. 2024;5(11):e243892. PMID 39514193
  34. Wish J, et al. "Inside CKD" Multinational-Microsimulation Modelling Insights Into the Increasing CKD Burden. Kidney Int Rep. 2025;10(10):3356-3368. PMID 41141496
  35. Okpechi IG, et al. A global assessment of kidney care workforce. Nephrol Dial Transplant. 2024;39(Supplement_2):ii43-ii48. PMID 39235198
  36. Oguejiofor F, et al. International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Africa. Kidney Int Suppl (2011). 2021;11(2):e11-e23. PMID 33981467
  37. Zhang Z, et al. Ambient heat exposure and kidney function in patients with chronic kidney disease: a post-hoc analysis of the DAPA-CKD trial. Lancet Planet Health. 2024;8(4):e225-e233. PMID 38580424