Articles
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
Lancet Global Health 2025; 13: e1378-e1395
Summary
Background
Kidney failure with replacement therapy (KFRT) such as dialysis or transplantation represents a severe stage of chronic kidney disease (CKD) and poses a major global health burden. Although many CKD cases are diagnosed in the earlier stages, the greatest risk occurs when CKD progresses to KFRT. Despite its considerable financial and imposing impact on public health, there is a notable gap in international policies addressing CKD and KFRT. To bridge this gap and help policy makers and health systems effectively tackle the public health challenge of KFRT, a better understanding of the disease burden is essential. Thus, this analysis aims to provide a detailed overview of the global prevalence of KFRT and its associated aetiologies with estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) from 1990 to 2023.
Methods
This study defined KFRT as individuals on maintenance dialysis for 90 days or more or those who have undergone a kidney transplant, aligning with the Kidney Disease: Improving Global Outcomes (KDIGO) 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Renal registries served as the primary data sources. Prevalence and underlying aetiology estimates (type 1 diabetes, type 2 diabetes, hypertension, glomerulonephritis, and other causes) were generated with DisMod-MR 2.1, an epidemiological Bayesian mixed-effects meta-regression modelling tool. Both all-age and age-standardised estimates were reported and accompanied with 95% uncertainty intervals (UIs).
Findings
In 2023, the number of global cases of KFRT was 4·59 million (95% UI 4·17–5·08) for both sexes and all ages, with an age-standardised prevalence of 50·7 (46·1–56·0) per 100 000 population. Over the past three decades, there has been a steady increase in KFRT prevalence globally. The highest prevalence was found in the GBD high-income regions, while the lowest was observed in sub-Saharan Africa. KFRT prevalence was generally higher in countries classified within the World Bank's high-income and upper-middle-income groups, while lower prevalence was more common in countries within the World Bank's low-income and lower-middle-income groups. Additionally, a pronounced sex disparity was identified, where male dialysis and transplant prevalence estimates were consistently higher than those for females in most countries. Type 2 diabetes and hypertension were among the leading associated aetiologies of KFRT globally. From 1990 to 2023, the all-age and age-standardised prevalence estimates across the ascribed aetiologies increased for KFRT, with the largest increases associated with type 2 diabetes and hypertension.
Table. Age-standardised prevalence of kidney failure with replacement therapy in 1990 and 2023
| Age-standardised prevalence per 100 000 | Number of cases | ||||
|---|---|---|---|---|---|
| 1990 | 2023 | 1990 | 2023 | ||
| Global | 36·8 (33·0–41·6) | 50·7 (46·1–56·0) | 1 590 000 (1 420 000–1 800 000) | 4 590 000 (4 170 000–5 080 000) | |
| Central Europe, eastern Europe, and central Asia | 18·7 (17·0–21·2) | 30·0 (27·9–32·9) | 86 700 (78 100–98 400) | 179 000 (165 000–195 000) | |
| Central Asia | 28·4 (24·5–33·9) | 29·2 (25·2–34·4) | 15 000 (13 000–17 600) | 28 200 (24 200–33 400) | |
| Armenia | 31·6 (26·7–37·7) | 32·2 (27·5–38·9) | 956 (807–1150) | 1390 (1170–1700) | |
| Azerbaijan | 26·5 (22·8–31·9) | 27·9 (23·6–33·8) | 1530 (1310–1820) | 3320 (2780–4050) | |
| Georgia | 35·7 (30·2–42·6) | 39·5 (37·7–41·3) | 2180 (1810–2620) | 2050 (1940–2140) | |
| Kazakhstan | 27·1 (23·5–32·5) | 28·2 (24·3–33·9) | 3910 (3380–4680) | 6010 (5100–7230) | |
| Kyrgyzstan | 27·9 (23·8–33·3) | 29·1 (25·0–34·8) | 925 (787–1090) | 1820 (1540–2200) | |
| Mongolia | 25·8 (22·1–30·6) | 26·0 (22·4–30·9) | 342 (300–400) | 784 (671–933) | |
| Tajikistan | 20·3 (19·2–21·2) | 25·5 (21·9–30·0) | 669 (635–698) | 2010 (1720–2350) | |
| Turkmenistan | 26·8 (23·2–32·1) | 26·9 (22·8–32·0) | 630 (545–745) | 1330 (1120–1590) | |
| Uzbekistan | 29·2 (25·2–35·4) | 29·6 (25·4–35·1) | 3830 (3340–4530) | 9520 (8110–11 300) | |
| Central Europe | 29·1 (26·8–32·0) | 54·4 (51·4–58·1) | 42 200 (38 700–46 500) | 99 300 (93 800–106 000) | |
| Albania | 36·0 (30·5–42·5) | 35·0 (34·1–36·0) | 922 (780–1080) | 1320 (1280–1360) | |
| Bosnia and Herzegovina | 43·4 (37·1–51·8) | 48·8 (47·2–50·4) | 1940 (1630–2330) | 2650 (2550–2740) | |
| Bulgaria | 21·2 (19·2–23·7) | 34·3 (33·4–35·3) | 2460 (2210–2750) | 4150 (4030–4290) | |
| Croatia | 50·5 (48·9–52·2) | 53·1 (51·9–55·0) | 3090 (2980–3190) | 3430 (3350–3540) | |
| Czechia | 46·7 (44·9–48·1) | 70·9 (69·1–72·4) | 5830 (5610–6020) | 11 600 (11 400–12 000) | |
| Hungary | 24·8 (22·3–27·6) | 47·9 (46·0–49·8) | 3280 (2930–3690) | 7430 (7160–7730) | |
| Montenegro | 21·1 (18·4–24·5) | 21·2 (19·6–23·3) | 132 (115–152) | 195 (179–215) | |
| North Macedonia | 44·1 (42·0–46·6) | 57·6 (56·2–59·3) | 866 (821–916) | 1640 (1600–1700) | |
| Poland | 25·6 (22·3–29·4) | 56·4 (49·3–64·6) | 11 100 (9620–12 700) | 33 200 (29 100–38 500) | |
| Romania | 15·0 (13·9–16·4) | 63·1 (61·3–65·1) | 4060 (3750–4430) | 20 100 (19 400–20 700) | |
| Serbia | 41·5 (35·9–49·4) | 46·1 (44·8–47·4) | 4470 (3840–5300) | 6500 (6310–6690) | |
| Slovakia | 34·0 (31·7–37·0) | 44·2 (43·0–45·2) | 1980 (1850–2160) | 3770 (3670–3850) | |
| Slovenia | 57·2 (53·9–60·1) | 54·2 (41·7–62·9) | 1340 (1260–1410) | 1840 (1390–2160) | |
| Eastern Europe | 11·2 (10·0–12·8) | 16·4 (14·9–18·4) | 29 600 (26 200–34 000) | 51 500 (46 500–57 500) | |
| Belarus | 15·7 (14·9–16·6) | 26·0 (25·2–26·7) | 1880 (1780–1990) | 3580 (3480–3700) | |
| Estonia | 20·6 (19·3–21·5) | 45·7 (44·4–46·8) | 380 (357–398) | 898 (876–920) | |
| Latvia | 21·6 (20·3–22·9) | 42·0 (40·8–43·2) | 705 (663–744) | 1180 (1150–1220) | |
| Lithuania | 26·2 (24·7–27·9) | 49·6 (48·5–50·6) | 1100 (1040–1170) | 2190 (2140–2240) | |
| Moldova | 3·80 (3·30–4·50) | 3·90 (3·40–4·60) | 174 (150–204) | 207 (177–248) | |
| Russia | 11·3 (10·0–13·2) | 16·1 (14·5–18·3) | 19 600 (17 300–22 900) | 35 400 (31 600–40 000) | |
| Ukraine | 8·70 (7·60–10·2) | 12·0 (10·7–14·0) | 5720 (4960–6670) | 8060 (7090–9450) | |
| High income | 64·6 (59·0–71·4) | 111 (104–119) | 710 000 (645 000–782 000) | 1 970 000 (1 830 000–2 110 000) | |
| Australasia | 37·8 (36·1–39·7) | 67·3 (65·6–69·8) | 8410 (8010–8840) | 31 000 (30 200–32 200) | |
| Australia | 39·8 (38·3–41·4) | 69·0 (67·5–71·0) | 7390 (7100–7700) | 27 000 (26 400–27 700) | |
| New Zealand | 27·8 (23·1–35·8) | 57·8 (49·6–67·7) | 1010 (840–1300) | 4010 (3450–4610) | |
| High-income Asia Pacific | 105 (92·7–121) | 134 (124–146) | 212 000 (187 000–246 000) | 479 000 (441 000–524 000) | |
| Brunei | 143 (132–152) | 96·9 (83·1–116) | 207 (195–219) | 466 (398–557) | |
| Japan | 121 (106–141) | 141 (128–159) | 199 000 (173 000–232 000) | 361 000 (324 000–406 000) | |
| South Korea | 31·6 (30·3–33·0) | 117 (115–118) | 11 800 (11 300–12 200) | 105 000 (103 000–106 000) | |
| Singapore | 62·9 (60·0–66·0) | 136 (130–141) | 1710 (1640–1790) | 12 300 (11 700–12 700) | |
| High-income North America | 77·1 (68·8–86·3) | 165 (154–176) | 247 000 (220 000–277 000) | 921 000 (851 000–986 000) | |
| Canada | 38·7 (38·0–39·4) | 75·2 (72·7–77·3) | 12 200 (11 900–12 400) | 44 900 (43 300–46 400) | |
| Greenland | 61·0 (53·9–68·9) | 66·2 (58·6–75·0) | 28·3 (25·2–32·0) | 47·7 (41·4–54·7) | |
| USA | 81·3 (72·2–91·5) | 176 (163–189) | 235 000 (208 000–265 000) | 876 000 (808 000–940 000) | |
| Southern Latin America | 51·2 (49·4–53·4) | 58·1 (54·3–63·4) | 24 200 (23 300–25 300) | 50 300 (47 000–55 000) | |
| Argentina | 51·1 (49·1–53·5) | 55·4 (51·4–60·5) | 16 600 (16 000–17 400) | 31 300 (29 000–34 200) | |
| Chile | 56·2 (53·9–58·4) | 64·8 (60·2–70·3) | 6210 (5960–6460) | 16 300 (15 100–17 700) | |
| Uruguay | 38·2 (36·6–40·0) | 55·3 (52·5–58·8) | 1380 (1320–1450) | 2650 (2490–2810) | |
| Western Europe | 43·2 (40·6–46·2) | 66·6 (63·0–71·3) | 217 000 (205 000–232 000) | 484 000 (457 000–519 000) | |
| Andorra | 49·3 (44·3–54·8) | 52·5 (47·2–60·3) | 29·9 (26·7–33·4) | 75·8 (68·0–87·4) | |
| Austria | 41·2 (39·6–43·1) | 66·2 (65·0–67·5) | 4140 (3970–4360) | 9770 (9580–10 000) | |
| Belgium | 44·2 (42·4–46·1) | 79·2 (77·5–81·0) | 5850 (5610–6120) | 14 800 (14 400–15 100) | |
| Cyprus | 26·9 (25·7–27·9) | 57·6 (50·9–65·1) | 218 (209–226) | 1080 (960–1220) | |
| Denmark | 36·8 (34·8–38·8) | 60·4 (59·6–61·4) | 2510 (2360–2670) | 5560 (5490–5660) | |
| Finland | 33·8 (32·4–35·6) | 56·3 (55·2–57·4) | 2150 (2060–2270) | 4990 (4890–5090) | |
| France | 44·9 (43·0–47·1) | 80·3 (78·4–82·0) | 32 500 (31 100–34 100) | 89 200 (86 600–91 500) | |
| Germany | 42·5 (41·0–44·3) | 52·0 (45·5–61·3) | 47 600 (45 800–49 600) | 77 900 (67 800–92 700) | |
| Greece | 35·0 (32·8–37·8) | 72·7 (70·8–74·6) | 4870 (4520–5300) | 14 400 (14 000–14 800) | |
| Iceland | 29·2 (27·8–30·6) | 52·5 (51·6–53·5) | 77·3 (73·4–81·2) | 269 (263–273) | |
| Ireland | 20·3 (19·7–21·1) | 29·6 (26·4–34·0) | 779 (751–809) | 2230 (1980–2570) | |
| Israel | 41·7 (40·5–42·9) | 79·5 (77·8–81·1) | 1980 (1920–2040) | 9090 (8890–9270) | |
| Italy | 41·4 (36·6–47·8) | 55·8 (49·2–64·5) | 32 600 (28 700–37 900) | 61 300 (53 600–71 600) | |
| Luxembourg | 27·2 (26·2–28·6) | 37·9 (32·3–45·9) | 138 (133–146) | 369 (313–453) | |
| Malta | 44·9 (40·3–49·9) | 50·1 (44·7–57·3) | 190 (170–212) | 432 (382–497) | |
| Monaco | 45·2 (40·3–50·8) | 48·1 (43·0–55·0) | 24·0 (21·2–27·2) | 36·1 (32·2–41·6) | |
| Netherlands | 41·2 (39·3–43·3) | 64·1 (62·6–65·5) | 7460 (7090–7840) | 18 000 (17 500–18 400) | |
| Norway | 42·4 (35·7–51·9) | 66·4 (56·0–80·0) | 2220 (1890–2690) | 5310 (4560–6320) | |
| Portugal | 51·7 (49·2–54·9) | 111 (110–113) | 6610 (6280–7060) | 20 700 (20 400–21 000) | |
| San Marino | 49·0 (44·6–54·9) | 51·8 (46·9–59·1) | 13·7 (12·3–15·4) | 33·1 (29·3–38·5) | |
| Spain | 32·0 (30·3–34·0) | 77·8 (76·8–78·8) | 14 900 (14 100–15 800) | 60 000 (59 200–60 800) | |
| Sweden | 44·2 (42·0–46·6) | 67·6 (65·9–69·3) | 5190 (4920–5500) | 10 900 (10 500–11 200) | |
| Switzerland | 38·4 (37·0–40·2) | 55·9 (54·8–57·4) | 3430 (3290–3590) | 7990 (7820–8200) | |
| UK | 55·4 (48·9–62·8) | 67·4 (59·3–77·7) | 41 800 (37 100–47 000) | 69 000 (61 100–77 700) | |
| Latin America and Caribbean | 36·7 (32·5–42·6) | 61·2 (55·0–69·7) | 98 300 (87 800–115 000) | 406 000 (365 000–464 000) | |
| Andean Latin America | 18·3 (16·0–20·7) | 24·8 (22·2–29·2) | 4580 (4040–5150) | 16 700 (14 900–19 700) | |
| Bolivia | 13·3 (8·30–15·7) | 22·3 (19·3–29·2) | 551 (366–643) | 2520 (2190–3280) | |
| Ecuador | 14·8 (12·3–17·3) | 23·1 (20·1–29·0) | 962 (818–1120) | 4180 (3640–5250) | |
| Peru | 21·3 (19·3–23·5) | 26·5 (24·0–30·0) | 3060 (2790–3380) | 10 000 (9060–11 400) | |
| Caribbean | 29·7 (26·5–33·9) | 34·4 (31·1–39·1) | 8390 (7490–9520) | 19 100 (17 200–21 800) | |
| Antigua and Barbuda | 41·3 (33·9–50·2) | 41·0 (33·9–49·9) | 21·1 (17·5–25·7) | 47·0 (38·5–57·4) | |
| The Bahamas | 46·9 (38·9–56·6) | 46·1 (38·7–56·2) | 86·3 (72·0–104) | 220 (181–270) | |
| Barbados | 46·8 (39·0–56·7) | 47·1 (38·5–58·4) | 123 (103–150) | 222 (177–280) | |
| Belize | 39·4 (32·8–47·7) | 37·8 (31·1–46·3) | 41·6 (35·4–49·2) | 135 (111–164) | |
| Bermuda | 46·5 (37·9–56·9) | 49·2 (41·3–60·0) | 30·6 (25·1–37·6) | 55·5 (45·5–68·7) | |
| Cuba | 14·7 (13·8–16·4) | 20·0 (18·4–21·6) | 1560 (1460–1730) | 3490 (3220–3770) | |
| Dominica | 37·3 (31·0–46·0) | 37·3 (30·7–46·3) | 24·6 (20·5–30·3) | 33·3 (27·3–41·8) | |
| Dominican Republic | 29·2 (24·2–34·9) | 25·9 (23·5–29·4) | 1300 (1090–1550) | 2830 (2580–3220) | |
| Grenada | 36·9 (30·7–44·7) | 37·0 (30·5–44·7) | 28·2 (23·6–34·2) | 53·9 (43·5–65·8) | |
| Guyana | 33·6 (27·7–40·8) | 32·5 (27·1–39·8) | 158 (132–188) | 256 (210–314) | |
| Haiti | 29·8 (24·8–36·0) | 28·7 (23·4–35·3) | 1160 (972–1380) | 2790 (2330–3420) | |
| Jamaica | 26·8 (22·1–32·8) | 25·8 (21·2–31·6) | 479 (395–587) | 825 (674–1010) | |
| Puerto Rico | 69·6 (63·9–76·0) | 102 (93·5–110) | 2530 (2320–2770) | 6360 (5800–6980) | |
| Saint Kitts and Nevis | 35·2 (28·9–43·2) | 36·0 (29·9–44·5) | 12·4 (10·3–15·0) | 22·0 (17·7–27·4) | |
| Saint Lucia | 38·0 (31·9–46·2) | 38·6 (32·4–47·6) | 36·4 (30·8–43·6) | 92·4 (76·6–115) | |
| Saint Vincent and the Grenadines | 37·5 (31·2–45·1) | 37·4 (31·1–45·2) | 28·7 (24·1–34·3) | 55·9 (46·2–67·8) | |
| Suriname | 35·9 (29·4–43·6) | 34·5 (28·9–42·3) | 107 (88·4–127) | 232 (191–285) | |
| Trinidad and Tobago | 34·1 (28·2–40·8) | 34·1 (28·5–41·8) | 314 (262–374) | 643 (529–804) | |
| Virgin Islands | 66·9 (55·4–82·8) | 86·2 (67·7–110) | 64·0 (52·8–78·9) | 145 (109–192) | |
| Central Latin America | 40·0 (35·9–45·5) | 80·1 (71·0–91·5) | 41 600 (37 700–47 800) | 220 000 (196 000–252 000) | |
| Colombia | 22·6 (21·0–24·3) | 35·2 (32·0–38·6) | 4970 (4630–5390) | 20 700 (18 800–22 700) | |
| Costa Rica | 19·8 (18·7–21·0) | 30·9 (28·6–33·6) | 427 (402–450) | 1890 (1740–2050) | |
| El Salvador | 24·3 (13·3–29·0) | 37·5 (34·4–42·2) | 847 (487–1000) | 2340 (2150–2640) | |
| Guatemala | 18·6 (16·0–21·1) | 25·9 (23·6–29·2) | 868 (763–979) | 3430 (3100–3850) | |
| Honduras | 15·7 (8·20–20·3) | 21·5 (19·3–24·9) | 420 (234–523) | 1790 (1600–2070) | |
| Mexico | 55·3 (48·8–64·7) | 126 (111–146) | 29 600 (26 200–34 600) | 178 000 (156 000–206 000) | |
| Nicaragua | 10·1 (8·30–12·5) | 9·90 (9·00–11·2) | 197 (163–241) | 583 (528–662) | |
| Panama | 24·5 (19·0–29·6) | 33·3 (30·2–36·9) | 426 (333–510) | 1500 (1360–1660) | |
| Venezuela | 32·9 (31·5–34·2) | 32·2 (29·1–35·6) | 3890 (3740–4050) | 10 100 (9100–11 200) | |
| Tropical Latin America | 39·6 (34·7–47·0) | 56·4 (50·8–64·0) | 43 700 (38 300–52 500) | 150 000 (135 000–171 000) | |
| Brazil | 40·3 (35·3–47·8) | 57·4 (51·7–65·2) | 43 400 (38 000–52 200) | 149 000 (134 000–170 000) | |
| Paraguay | 12·7 (12·2–13·2) | 13·2 (11·8–14·6) | 327 (314–342) | 816 (731–905) | |
| North Africa and Middle East | 24·0 (21·7–26·6) | 41·4 (38·1–45·8) | 51 900 (47 200–58 400) | 230 000 (212 000–255 000) | |
| North Africa and Middle East | 24·0 (21·7–26·6) | 41·4 (38·1–45·8) | 51 900 (47 200–58 400) | 230 000 (212 000–255 000) | |
| Afghanistan | 21·5 (18·3–25·7) | 19·7 (16·7–23·6) | 1590 (1330–1920) | 3480 (3010–4150) | |
| Algeria | 13·1 (12·0–14·4) | 17·7 (14·8–21·5) | 2050 (1850–2300) | 7550 (6240–9270) | |
| Bahrain | 32·7 (27·6–39·4) | 33·7 (28·7–40·7) | 102 (87·9–126) | 519 (433–629) | |
| Egypt | 23·6 (21·8–25·9) | 31·4 (26·0–38·4) | 8030 (7420–8840) | 26 300 (21 600–32 400) | |
| Iran | 33·5 (29·5–38·9) | 45·8 (40·7–53·4) | 11 500 (10 100–13 400) | 42 500 (37 500–49 500) | |
| Iraq | 26·7 (22·4–31·9) | 26·6 (22·6–31·7) | 2680 (2290–3140) | 8800 (7450–10 600) | |
| Jordan | 35·8 (30·3–42·7) | 38·3 (35·0–42·2) | 686 (586–799) | 4380 (3990–4850) | |
| Kuwait | 27·9 (15·5–32·6) | 53·4 (45·9–59·3) | 271 (157–316) | 2290 (1940–2560) | |
| Lebanon | 9·60 (5·70–11·5) | 20·4 (17·3–24·5) | 248 (156–296) | 1260 (1070–1510) | |
| Libya | 18·1 (16·4–20·4) | 27·5 (23·1–33·8) | 441 (397–500) | 1840 (1530–2280) | |
| Morocco | 10·0 (9·10–11·6) | 17·0 (14·4–20·6) | 1820 (1630–2120) | 6590 (5550–8020) | |
| Oman | 40·6 (34·3–48·7) | 64·4 (63·1–65·9) | 440 (373–528) | 2370 (2320–2440) | |
| Palestine | 28·7 (24·1–34·7) | 29·0 (24·3–34·8) | 314 (268–371) | 1060 (888–1260) | |
| Qatar | 41·3 (34·6–49·7) | 48·6 (44·9–52·1) | 110 (91·2–137) | 1150 (1040–1250) | |
| Saudi Arabia | 54·1 (51·2–57·2) | 69·1 (61·7–81·1) | 4760 (4520–5040) | 17 200 (15 600–19 700) | |
| Sudan | 9·70 (5·80–11·5) | 14·0 (11·9–17·1) | 1120 (753–1330) | 3910 (3310–4720) | |
| Syria | 28·2 (23·6–33·3) | 27·7 (23·4–33·1) | 1890 (1600–2200) | 4530 (3790–5530) | |
| Tunisia | 40·9 (38·0–44·3) | 28·1 (17·9–32·7) | 2420 (2260–2610) | 3980 (2510–4640) | |
| Türkiye | 21·5 (19·6–24·0) | 80·9 (78·8–83·1) | 9490 (8600–10 700) | 81 900 (79 800–84 100) | |
| United Arab Emirates | 32·5 (27·5–38·6) | 33·9 (28·5–41·9) | 340 (287–423) | 3690 (2860–4620) | |
| Yemen | 24·4 (20·7–29·2) | 23·5 (20·1–28·3) | 1600 (1370–1890) | 4880 (4250–5900) | |
| South Asia | 9·80 (8·50–11·5) | 11·5 (10·6–12·7) | 79 500 (69 400–94 300) | 210 000 (192 000–232 000) | |
| South Asia | 9·80 (8·50–11·5) | 11·5 (10·6–12·7) | 79 500 (69 400–94 300) | 210 000 (192 000–232 000) | |
| Bangladesh | 6·40 (6·00–6·80) | 14·7 (13·9–15·6) | 4580 (4280–4930) | 23 500 (22 400–25 200) | |
| Bhutan | 10·4 (8·80–12·6) | 10·5 (8·90–12·8) | 42·8 (36·6–52·4) | 79·3 (67·4–97·0) | |
| India | 10·1 (8·70–11·9) | 11·4 (10·4–12·6) | 65 700 (56 400–78 500) | 165 000 (150 000–182 000) | |
| Nepal | 9·60 (8·10–11·6) | 9·60 (8·10–11·6) | 1330 (1120–1600) | 2840 (2390–3420) | |
| Pakistan | 10·2 (9·10–12·0) | 9·70 (8·70–11·5) | 7890 (7010–9130) | 18 100 (16 000–21 400) | |
| Southeast Asia, east Asia, and Oceania | 43·9 (38·8–50·6) | 51·6 (45·4–59·5) | 555 000 (489 000–638 000) | 1 580 000 (1 380 000–1 830 000) | |
| East Asia | 47·0 (41·5–54·2) | 55·4 (48·7–64·2) | 454 000 (402 000–523 000) | 1 280 000 (1 110 000–1 500 000) | |
| China | 44·9 (39·5–52·2) | 53·1 (46·5–61·8) | 419 000 (368 000–485 000) | 1 180 000 (1 030 000–1 390 000) | |
| North Korea | 74·2 (62·8–87·8) | 76·3 (63·9–92·2) | 12 700 (10 700–15 100) | 26 300 (21 900–32 100) | |
| Taiwan (province of China) | 130 (119–141) | 160 (149–171) | 22 700 (20 800–24 700) | 67 500 (62 500–72 500) | |
| Oceania | 48·3 (40·1–59·0) | 47·5 (39·0–58·1) | 1670 (1380–2010) | 4470 (3660–5470) | |
| American Samoa | 52·5 (43·6–64·3) | 50·9 (42·1–62·6) | 14·2 (11·8–17·2) | 25·7 (20·8–31·9) | |
| Cook Islands | 59·2 (48·5–73·0) | 61·0 (50·8–74·8) | 7·92 (6·45–9·75) | 11·8 (9·63–14·6) | |
| Federated States of Micronesia | 43·9 (36·4–54·3) | 42·9 (35·5–53·2) | 23·9 (20·0–29·5) | 36·6 (30·0–45·8) | |
| Fiji | 47·8 (39·6–58·6) | 46·5 (38·8–57·5) | 205 (171–249) | 401 (329–495) | |
| Guam | 61·1 (50·9–75·3) | 60·2 (49·2–72·9) | 55·7 (46·5–68·3) | 125 (100–154) | |
| Kiribati | 40·7 (33·7–50·4) | 39·1 (32·6–47·9) | 17·0 (14·1–21·1) | 34·3 (28·3–41·6) | |
| Marshall Islands | 44·1 (36·4–54·7) | 43·5 (36·0–53·9) | 8·61 (7·14–10·6) | 13·0 (10·7–16·1) | |
| Nauru | 42·6 (35·1–52·2) | 40·5 (33·6–49·6) | 1·90 (1·56–2·32) | 2·80 (2·31–3·38) | |
| Niue | 50·7 (41·7–62·5) | 49·1 (40·2–60·0) | 1·08 (0·900–1·34) | 1·11 (0·890–1·38) | |
| Northern Mariana Islands | 58·3 (48·8–72·0) | 56·0 (46·5–68·2) | 14·6 (12·2–18·2) | 30·5 (24·5–37·5) | |
| Palau | 49·5 (40·5–61·1) | 49·4 (40·9–60·9) | 5·36 (4·41–6·56) | 11·7 (9·39–14·5) | |
| Papua New Guinea | 47·9 (39·5–58·6) | 47·5 (38·7–58·2) | 1020 (833–1230) | 3130 (2570–3840) | |
| Samoa | 51·4 (42·3–62·7) | 51·0 (42·3–62·7) | 48·5 (39·9–58·8) | 86·3 (70·5–107) | |
| Solomon Islands | 46·0 (38·0–56·7) | 43·9 (36·9–54·2) | 73·2 (60·2–90·1) | 226 (188–277) | |
| Tokelau | 50·5 (41·6–63·0) | 49·9 (41·5–61·0) | 0·682 (0·561–0·856) | 0·838 (0·694–1·03) | |
| Tonga | 53·4 (43·8–65·0) | 52·4 (43·7–64·7) | 32·4 (26·6–39·3) | 45·9 (38·2–56·9) | |
| Tuvalu | 43·1 (35·4–53·0) | 44·7 (37·1–55·3) | 3·08 (2·49–3·79) | 4·43 (3·58–5·46) | |
| Vanuatu | 46·5 (38·9–56·8) | 44·3 (36·8–54·1) | 36·0 (30·4–44·3) | 97·6 (80·7–118) | |
| Southeast Asia | 33·1 (28·6–38·3) | 39·6 (35·3–45·2) | 98 900 (86 000–115 000) | 296 000 (263 000–340 000) | |
| Cambodia | 35·2 (29·9–42·2) | 36·3 (31·1–43·8) | 1900 (1630–2240) | 5500 (4700–6610) | |
| Indonesia | 23·1 (20·3–27·1) | 17·7 (15·6–20·6) | 27 400 (24 100–32 000) | 52 400 (45 700–61 900) | |
| Laos | 34·7 (29·8–41·6) | 36·3 (31·1–43·5) | 836 (720–976) | 2140 (1840–2530) | |
| Malaysia | 72·0 (60·8–86·7) | 130 (124–137) | 7960 (6790–9490) | 44 300 (42 400–46 700) | |
| Maldives | 46·3 (39·3–55·8) | 51·9 (44·2–62·2) | 51·6 (44·1–61·4) | 248 (209–298) | |
| Mauritius | 66·5 (56·1–81·0) | 66·5 (56·6–80·6) | 558 (471–673) | 1200 (997–1470) | |
| Myanmar | 35·4 (30·3–41·5) | 36·1 (30·8–43·1) | 9420 (8080–11 000) | 20 100 (17 100–24 100) | |
| Philippines | 33·3 (29·4–38·7) | 38·3 (33·7–44·4) | 12 100 (10 700–14 100) | 36 800 (32 400–42 700) | |
| Seychelles | 42·9 (37·1–51·8) | 44·7 (38·4–54·0) | 25·0 (21·6–30·1) | 57·6 (48·9–70·3) | |
| Sri Lanka | 46·4 (39·3–55·0) | 48·1 (40·8–57·7) | 5750 (4910–6740) | 13 900 (11 800–16 800) | |
| Thailand | 31·9 (18·6–39·0) | 61·6 (54·1–71·9) | 13 300 (7950–16 400) | 66 400 (57 600–77 800) | |
| Timor-Leste | 39·6 (33·8–47·5) | 39·8 (33·9–48·1) | 152 (129–178) | 391 (336–471) | |
| Viet Nam | 43·5 (37·1–51·7) | 46·0 (39·7–54·2) | 19 300 (16 500–22 700) | 52 300 (44 700–62 100) | |
| Sub-Saharan Africa | 2·70 (2·40–3·20) | 3·80 (3·30–4·50) | 8010 (6940–9630) | 28 000 (24 400–33 400) | |
| Central sub-Saharan Africa | 4·50 (3·80–5·50) | 4·40 (3·70–5·40) | 1430 (1220–1750) | 3970 (3330–4760) | |
| Angola | 3·80 (3·20–4·80) | 3·80 (3·20–4·70) | 227 (190–278) | 785 (651–955) | |
| Central African Republic | 4·00 (3·30–4·90) | 3·80 (3·10–4·70) | 64·6 (53·3–78·9) | 135 (112–165) | |
| Congo (Brazzaville) | 2·40 (2·10–2·70) | 3·10 (2·60–3·80) | 35·9 (31·8–41·7) | 122 (103–151) | |
| Democratic Republic of the Congo | 4·70 (3·90–5·80) | 4·60 (3·90–5·70) | 1040 (882–1270) | 2750 (2310–3290) | |
| Equatorial Guinea | 4·50 (3·70–5·50) | 4·90 (4·20–5·90) | 11·4 (9·38–14·0) | 46·9 (39·3–57·5) | |
| Gabon | 8·80 (7·40–10·8) | 8·90 (7·50–10·9) | 60·7 (50·9–73·5) | 129 (108–157) | |
| Eastern sub-Saharan Africa | 1·40 (1·20–1·70) | 1·50 (1·30–1·80) | 1600 (1360–1920) | 4310 (3700–5210) | |
| Burundi | 1·30 (1·10–1·60) | 1·40 (1·10–1·70) | 44·5 (37·4–54·7) | 122 (101–149) | |
| Comoros | 1·50 (1·20–1·80) | 1·50 (1·30–1·90) | 4·32 (3·54–5·26) | 10·2 (8·42–12·4) | |
| Djibouti | 1·50 (1·20–1·80) | 1·50 (1·30–1·90) | 3·65 (2·98–4·43) | 16·2 (13·3–19·7) | |
| Eritrea | 1·30 (1·00–1·50) | 1·30 (1·10–1·60) | 25·7 (21·1–31·3) | 65·5 (54·6–79·9) | |
| Ethiopia | 1·40 (1·20–1·60) | 1·50 (1·30–1·80) | 421 (366–502) | 1130 (981–1340) | |
| Kenya | 1·50 (1·30–1·70) | 1·80 (1·60–2·10) | 206 (179–243) | 667 (582–796) | |
| Madagascar | 1·40 (1·20–1·80) | 1·50 (1·20–1·80) | 106 (87·0–128) | 295 (243–356) | |
| Malawi | 1·30 (1·10–1·60) | 1·30 (1·10–1·60) | 77·9 (65·5–95·3) | 176 (145–213) | |
| Mozambique | 1·30 (1·10–1·60) | 1·30 (1·10–1·60) | 113 (93·2–137) | 257 (215–313) | |
| Rwanda | 1·10 (1·00–1·40) | 1·20 (1·00–1·50) | 49·5 (40·9–60·3) | 126 (104–154) | |
| Somalia | 1·30 (1·10–1·60) | 1·20 (1·00–1·50) | 59·2 (48·9–72·4) | 158 (130–194) | |
| South Sudan | 1·50 (1·20–1·80) | 1·40 (1·20–1·70) | 53·9 (44·6–64·9) | 93·7 (77·8–114) | |
| Tanzania | 1·40 (1·20–1·80) | 1·50 (1·20–1·80) | 228 (186–276) | 631 (518–763) | |
| Uganda | 1·40 (1·20–1·70) | 1·40 (1·20–1·70) | 140 (118–171) | 390 (325–471) | |
| Zambia | 1·30 (1·10–1·60) | 1·30 (1·10–1·70) | 60·7 (50·6–74·1) | 170 (141–206) | |
| Southern sub-Saharan Africa | 5·90 (5·30–6·80) | 15·9 (14·1–18·5) | 2150 (1910–2470) | 12 300 (10 900–14 500) | |
| Botswana | 1·10 (0·900–1·40) | 1·40 (1·10–1·70) | 9·40 (7·82–11·3) | 27·9 (22·9–34·5) | |
| Eswatini | 2·20 (1·80–2·60) | 2·20 (1·90–2·60) | 10·1 (8·49–11·9) | 19·9 (16·9–24·0) | |
| Lesotho | 2·10 (1·80–2·50) | 2·10 (1·70–2·50) | 22·4 (18·9–26·5) | 30·7 (26·0–36·7) | |
| Namibia | 2·30 (2·10–2·40) | 2·50 (2·20–2·80) | 21·1 (19·3–23·1) | 57·1 (50·9–64·6) | |
| South Africa | 7·30 (6·50–8·40) | 19·7 (17·5–23·0) | 1980 (1750–2280) | 12 000 (10 600–14 200) | |
| Zimbabwe | 1·80 (1·60–2·00) | 1·80 (1·50–2·30) | 109 (94·4–127) | 197 (161–243) | |
| Western sub-Saharan Africa | 2·40 (2·10–2·80) | 2·40 (2·00–2·80) | 2820 (2420–3380) | 7440 (6340–8910) | |
| Benin | 3·80 (3·10–4·70) | 3·80 (3·20–4·60) | 104 (85·4–127) | 326 (277–395) | |
| Burkina Faso | 2·50 (2·10–3·10) | 2·40 (2·00–3·10) | 142 (115–173) | 351 (290–431) | |
| Cabo Verde | 3·10 (2·60–3·80) | 3·20 (2·70–4·00) | 7·53 (6·25–9·19) | 14·9 (12·6–18·3) | |
| Cameroon | 2·40 (2·00–3·00) | 2·40 (2·00–3·00) | 148 (124–180) | 495 (410–600) | |
| Chad | 2·50 (2·10–3·00) | 2·40 (2·00–3·00) | 89·8 (74·7–108) | 236 (192–291) | |
| Côte d'Ivoire | 3·30 (2·80–4·10) | 3·30 (2·70–4·10) | 220 (183–270) | 687 (574–851) | |
| The Gambia | 2·70 (2·20–3·30) | 2·60 (2·10–3·10) | 14·3 (11·9–17·6) | 39·6 (33·2–47·8) | |
| Ghana | 1·20 (0·900–1·40) | 1·20 (1·00–1·50) | 106 (84·2–129) | 273 (218–349) | |
| Guinea | 2·50 (2·10–3·10) | 2·50 (2·00–3·10) | 99·6 (82·6–124) | 209 (172–254) | |
| Guinea-Bissau | 2·20 (1·90–2·80) | 2·20 (1·80–2·70) | 12·7 (10·3–15·6) | 27·6 (22·5–34·0) | |
| Liberia | 2·60 (2·20–3·30) | 2·60 (2·20–3·30) | 41·1 (34·1–50·2) | 99·3 (82·7–121) | |
| Mali | 2·50 (2·10–3·10) | 2·50 (2·10–3·20) | 134 (111–163) | 348 (284–435) | |
| Mauritania | 5·80 (4·80–7·20) | 6·00 (5·10–7·40) | 77·1 (64·8–93·2) | 189 (161–231) | |
| Niger | 2·60 (2·10–3·20) | 2·50 (2·10–3·20) | 109 (89·1–133) | 342 (282–420) | |
| Nigeria | 2·30 (2·00–2·60) | 2·20 (2·00–2·60) | 1300 (1150–1540) | 3260 (2850–3860) | |
| São Tomé and Príncipe | 2·80 (2·40–3·60) | 2·90 (2·40–3·60) | 2·23 (1·83–2·74) | 4·83 (4·01–5·93) | |
| Senegal | 2·10 (1·70–2·60) | 2·10 (1·70–2·60) | 93·6 (77·0–114) | 253 (203–309) | |
| Sierra Leone | 2·60 (2·10–3·20) | 2·50 (2·10–3·10) | 68·7 (57·3–84·5) | 131 (109–162) | |
| Togo | 2·50 (2·10–3·10) | 2·50 (2·10–3·00) | 49·3 (40·9–60·2) | 145 (119–177) | |
Interpretation
KFRT affects approximately 5 million people globally, with high treatment and mortality costs. Our study unveiled considerable geographical variation in KFRT prevalence, which should be seen as indicators of health-care system opportunities. As the prevalence of the leading aetiologies of KFRT—type 2 diabetes and hypertension—continues to rise, there is a crucial need to prioritise the development and implementation of cost-effective strategies aimed at preventing CKD and its progression to KFRT, particularly in low-resource settings. These preventive efforts must happen in tandem with efforts to expand capacity for dialysis and transplant services.
Funding
Gates Foundation.
