The number of adults living with chronic kidney disease more than doubled between 1990 and 2023 to reach nearly 800 million people worldwide, according to a new study. Despite the global trend, Canada’s chronic kidney disease prevalence rate is down almost seven per cent over the same period, where nearly 3.8 million people were affected in 2023. “The growth in chronic kidney disease is predominantly driven by population aging and rising rates of diabetes, hypertension and cardiovascular disease,” study co-author and University of Calgary medical professor Dr. Marcello Tonelli told CTVNews.ca. “Worldwide, as the risk of death from infectious illnesses, death in childbirth, etc. fall, people are living longer and are more likely to develop these noncommunicable diseases like chronic kidney disease.” Tonelli, who is also the president of the International Society of Nephrology, says although disease prevalence has dropped slightly in Canada, the country’s mortality rate for chronic kidney disease has actually jumped significantly in the same period. “The overall proportion of people with chronic kidney disease in the population is stable (in Canada), which means that we may be doing a reasonable job with controlling the upstream drivers like diabetes and hypertension,” Tonelli explained. “But we are missing the boat among people who do develop kidney disease, and I suspect that is largely because we are not detecting cases until too late, and likely not optimally treating the cases we know about.” The rise of chronic kidney disease Drawing from data from 204 countries, researchers found that the prevalence of chronic kidney disease had reached 14.2 per cent of adults in 2023, or 788 million people worldwide, which was a 3.5 per cent increase over 1990. According to the study, chronic kidney disease was also the ninth leading cause of death in 2023, claiming 1.5 million lives worldwide, and the twelfth leading cause for disability. Published this month in the medical journal The Lancet, the study was led by researchers from the University of Washington, New York University and the University of Glasgow. Co-author Lauryn Stafford, a researcher at the University of Washington’s Institute for Health Metrics and Evaluation, calls chronic kidney disease “a growing global health crisis” that can be prevented. “Diabetes and obesity rates continue to increase globally, and we’re seeing that the regions with the highest chronic kidney disease burden also have the highest diabetes burden,” Stafford told CTVNews.ca. “Climate change, through increasing global temperatures and increased frequency of extreme weather events, has also been linked to kidney dysfunction.” The highest prevalence rates for chronic kidney disease were found in North Africa and the Middle East (18.0 per cent), South Asia (15.8 per cent), sub-Saharan Africa (15.6 per cent) and Latin America and the Caribbean (15.4 per cent). Countries with the highest prevalence rates included Iran (22.7 per cent), Haiti (22.1 per cent), Panama (20.9 per cent), Nigeria (20.4 per cent), Mexico (18.9 per cent), Libya (18.8 per cent) and Costa Rica (18.7 per cent). Unlike many other leading causes of death, chronic kidney disease mortality rates are also on the rise globally. How Canada compares Canada’s chronic kidney disease prevalence rate was 9.6 per cent in 2023, putting it below the U.S. (11.7 per cent) but above other high-income countries like the U.K. (8.4 per cent) and Australia (8.8 per cent). Canada also ranked better than the global average (14.2 per cent) and the average for high-income countries (10.8 per cent). But while the chronic kidney disease prevalence rate in Canada was down to 6.9 per cent between 1990 and 2023, Tonelli says this should not be a cause for celebration. “I wouldn’t read too much into the small decline,” he said. “I’d characterize it as stable and not worse. I don’t think it represents a huge victory.” Canada’s mortality rate for chronic kidney disease has also increased, reaching an age-standardized rate of 17.5 people per 100,000 in 2023, up 73.3 per cent since 1990, which means a larger share of people with chronic kidney disease are dying from the condition. Tonelli says the rising mortality rate should be “an important wake-up call for Canada.” “What accounts for this increase? … The most likely hypothesis is that we are failing when it comes to early detection and timely treatment of (relatively) younger patients specifically,” Tonelli said. “The fix is to invest in more early detection and timely treatment, focusing on people with known risk factors. “ Tonelli says Canada needs to boost screening for at-risk groups like Indigenous people and “younger” Canadians, ages 45 to 60. He is also urging the federal government to create a national action plan, like it previously did for diabetes. “We know from the tremendous progress that the diabetes community has observed (in diabetes burden and outcomes) that a national action plan is critical,” Tonelli said. “We know that every dollar invested in early detection of chronic kidney disease can yield up to $45 in averted costs, so it’s time to get started.”
