Chronic Kidney Disease Burden Declines In India, But Sharp State Disparities Persist: Study

India may be making gradual progress in reducing the burden of chronic kidney disease (CKD)—a long-term, progressive loss of kidney function—but the gains are far from uniform, according to a new study.

It found that while CKD incidence, mortality and disability have declined over the past three decades, large disparities persist between states, with poorer regions continuing to bear a disproportionately higher burden of deaths and disability.

Haryana reported the highest age-standardised incidence and prevalence of CKD, while Telangana recorded the highest mortality and disability burden.

Punjab, Chhattisgarh and some Union Territories also continued to report high levels of disability despite overall national improvements.

By contrast, states such as Kerala and Tamil Nadu recorded relatively lower mortality and disability despite having a high prevalence of CKD, suggesting that stronger health systems, earlier diagnosis and better access to treatment have improved survival, according to the findings by researchers from the Department of Nephrology at the Institute of Liver and Biliary Sciences (ILBS) and Fortis Hospital, both situated in Delhi.

The study is based on an analysis of the Global Burden of Disease (GBD) 2023 database covering the period from 1990 to 2023.

Nephrologists Dr. Hari Shankar Meshram and Dr. Saurabh Puri from ILBS and Dr. Sanshriti Chauhan from Fortis Hospital described CKD as one of India's most neglected NCDs despite its growing contribution to premature deaths and disability.

They argued that the disease has not received the policy attention accorded to other major NCDs such as cancer, diabetes and cardiovascular illnesses, even though it is now among the leading causes of death globally.

"India bears one of the world's highest absolute burdens of chronic kidney disease, largely driven by the rising prevalence of diabetes, hypertension, ageing, and environmental and occupational risk factors," the authors noted.

The study examined age-standardised incidence, prevalence, mortality and disability-adjusted life years (DALYs) across all states and union territories and found encouraging national trends. Between 1990 and 2023, incidence declined by an estimated 0.45 per cent annually, prevalence by 0.22 per cent, mortality by 0.9 per cent and DALYs by 1.1 per cent each year.

However, the researchers cautioned that these improvements should not obscure the country's growing absolute burden of kidney disease. India's expanding population, increasing life expectancy and better survival of patients with CKD mean that the number of people living with the disease continues to rise, placing mounting pressure on healthcare services.

In 2023, CKD prevalence exceeded 10,000 cases per 1 lakh population in every state, highlighting the enormous pool of people requiring long-term monitoring and treatment.

The researchers observed that India's kidney disease burden increasingly reflects differences in healthcare access rather than disease occurrence alone.

"In more developed states, CKD is increasingly being managed as a chronic disease, allowing patients to survive longer. In less-developed states, delayed diagnosis, inadequate access to nephrology services and financial barriers continue to translate into avoidable deaths and disability," the study said.

One of the study's most significant findings relates to socioeconomic inequality.

Using the Socio-demographic Index (SDI), which incorporates income, education and fertility levels, the researchers found that mortality and disability from CKD were concentrated disproportionately among poorer states.

The analysis showed a clear "pro-poor inequality", indicating that economically disadvantaged populations continue to experience higher death rates and greater disability from kidney disease despite improvements in national averages.

States with higher SDI generally reported lower mortality and DALY rates, although they often recorded higher incidence because of better disease detection and screening.

The findings suggested that improved healthcare systems enable earlier diagnosis and better long-term management rather than reflecting a greater underlying disease burden.

The study also highlighted important differences in the causes of kidney disease across the country.

While diabetes and hypertension remain the principal drivers of CKD, hypertension accounted for a disproportionately high share of deaths compared with its contribution to disease prevalence, indicating poor control and delayed treatment.

At the same time, nearly two-thirds of CKD cases were grouped under "other or unspecified causes", pointing to major diagnostic gaps and the need for better disease surveillance.

Researchers noted considerable state-level variation in disease patterns. Telangana reported among the highest diabetes-related kidney disease mortality, while West Bengal showed a relatively greater burden of glomerulonephritis-related CKD. In glomerulonephritis, glomeruli, which are the tiny, microscopic blood vessels in the kidney, are damaged.

The authors said these findings reinforce the need for state-specific prevention strategies rather than a uniform national approach.

Another important observation was that several states with moderate socioeconomic development failed to translate economic progress into better kidney health outcomes.

The researchers found wide variations in mortality and disability among states with similar development levels, suggesting that health system performance, availability of dialysis services, specialist care and early screening programmes play a critical role in determining patient outcomes.

The researchers have recommended integrating CKD into the national NCDP, strengthening state-level kidney disease registries and expanding screening for diabetes, hypertension and early kidney damage at the primary healthcare level.

They also called for greater investment in dialysis facilities, kidney transplantation programmes and specialist nephrology services, particularly in underserved states where access remains limited.

The study emphasised that relying solely on national averages masks substantial regional inequalities and may lead to inefficient allocation of healthcare resources.

Instead, it recommended that states use locally generated data to forecast future demand for dialysis and transplantation services and design interventions based on their own epidemiological profiles.