You might be interested in…Chronic Kidney Disease

Dr Ray O’Connor takes a look at Chronic Kidney Disease (CKD), including if dietary choice affects its prevalence, and whether there’s an association between CKD and cancer

Chronic kidney disease (CKD) is common and ranks among the leading causes of mortality and morbidity. This analysis1 aimed to present global CKD estimates using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023. The authors focused on adults aged 20 years and older over the period 1990 to 2023, from 204 countries. The findings were that, globally, in 2023, 788 million people aged 20 years and older were estimated to have CKD This number is up from 378 million in 1990.

Dr Ray O’Connor

The global age-standardised prevalence of CKD in adults was 14·2 per cent, a relative rise of 3·5 per cent from 1990. The region with the highest age standardised prevalence was north Africa and the Middle East at 18·0 per cent. Most people had stage 1–3 CKD, with a combined prevalence of 13·9 per cent. In 2023, CKD was the ninth leading cause of death globally, accounting for 1·48 million deaths, and the 12th leading cause of Disability Adjusted Life Years (DALYs), with an age-standardised DALY rate of 769·2 per 100 000. Impaired kidney function as a risk factor accounted for 11·5 per cent of cardiovascular deaths.

High fasting plasma glucose, body-mass index, and systolic blood pressure were all leading risk factors for CKD DALYs. The authors’ conclusion is that 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.

They recommend that a better understating of aetiology, appropriate screening, and implementation programmes are needed to translate advances in CKD treatment into improved patient outcomes.

Does dietary choice affect the prevalence of CKD? The authors of this systematic review and meta-analysis2 evaluated the impact of plant-based diet (PBD) on CKD. A systematic search of PubMed and Embase was conducted from inception to August 2023 to evaluate the association between adopting a PBD and the incidence, progression, and mortality of CKD.

A total of 121,927 participants were included, aged between 18 and 74 years, and were followed up for a weighted average of 11.2 years. The findings were that adopting PBD is associated with a significantly reduced risk of developing CKD of 26 per cent (Odds ratio or OR = 0.75) across 93,857 participants. Similar results were observed in subgroup analyses that examined higher quintiles/quartiles. When adjusting for CKD-related comorbidities in patients following PBD, significant findings were also observed, with an overall OR of 0.86. Higher intake of PBD showed a dose-dependent relationship with lower risk of CKD incidence and slower CKD progression. Unhealthy PBD may not confer renal protective effects compared to healthy PBD.

Is there an association between CKD and cancer? This question was examined in the next paper. The study3 was an individual participant data meta-analysis including 54 international cohorts contributing to the CKD Prognosis Consortium. Included cohorts had data on albuminuria [urine albumin-to-creatinine ratio (ACR)], estimated glomerular filtration rate (eGFR), overall and site-specific cancer incidence, and established risk factors for cancer. Included participants were aged 18 years or older, without previous cancer or kidney failure.

The results were that among 1,319,308 individuals, the incidence rate of overall cancer was 17.3 per 1,000 person-years. Higher ACR was positively associated with cancer risk [adjusted hazard ratio 1.08 per 8-fold increase in ACR]. No association of eGFR with overall cancer risk was seen. The authors concluded that albuminuria, but not necessarily eGFR, was independently associated with the subsequent risk of cancer.

Something we don’t often think about is the itch (or pruritus) associated with CKD. Chronic kidney disease-associated pruritus (CKD-aP) is a debilitating symptom that can significantly impact patients’ daily activities and quality of life. This systematic review4 aimed to assimilate the latest evidence on the relationship between CKD-associated pruritis and patient-centred outcomes. The authors conducted a systematic search for relevant studies from 2000 to June 2024. The review included 29 studies with a total of 147,174 CKD patients, including those on haemodialysis (HD) and peritoneal dialysis (PD).

The most frequently reported patient-centred outcomes included quality of life (n = 21), sleep quality (n = 17), anxiety/depression (n = 11) and mortality (n = 7). The authors found that the impact of CKD-associated pruritus on outcomes was contingent on the severity of the pruritus. There was an association between increased medication usage, decreased compliance with HD treatments and higher rates of hospitalisation in patients experiencing severe pruritus. The authors concluded that their findings underscore the pernicious impact of CKD-associated pruritus on patient outcomes and emphasises the importance of effective management to improve patient-centred outcomes.

Finally, an updated clinical guideline on management of CKD from the US Department of Veterans Affairs.5 They make the point that management of CKD has been rapidly evolving, now involving many interventions that can be managed in the primary care setting.

The guideline reviews updated recommendations for the diagnosis, assessment, and monitoring of CKD; general management strategies including team management and education; shared decision making and indications for referral to nephrology for consideration of kidney replacement therapy or conservative management; management of hypertension; pharmacotherapy to reduce the risk for major adverse cardiovascular events, progression of kidney disease, and mortality; and prevention of contrast-associated acute kidney injury.

New and updated recommendations about pharmacotherapy, such as angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, sodium–glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, nonsteroidal mineralocorticoid receptor antagonists, and statins, are highlighted.

References:

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: 2461–82 Published Online November 7, 2025. https://doi.org/10.1016/S0140-6736(25)01853-7.
Dang Z et al. Plant-Based Diet and Chronic Kidney Disease: A Systematic Review and Meta-Analysis. J Ren Nutr . 2025 Jul;35(4):517-530. DOI:10.1053/j.jrn.2025.03.002.
Mok Y et al. Chronic kidney disease and incident cancer risk: an individual participant data meta-analysis. British Journal of Cancer (2025) 133:1535–1543; https://doi.org/10.1038/s41416-025-03140-z.
Wang T et al. Chronic kidney disease‑associated pruritus and patient‑centred outcomes: a systematic review. Journal of Nephrology (2025) 38:371–391 https://doi.org/10.1007/s40620-025-02221-9.
Schwartz A et al. 2025 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline for the Primary Care Management of Chronic Kidney Disease. Ann Intern Med. DOI:10.7326/ANNALS-25-03499 (Published online December 2025).