Chronic kidney disease (CKD) is widely described as a growing global health problem.
Most developed countries report rising numbers, screening programs are expanding, and public health agencies frequently warn of an epidemic.
In fact it is said that 10% of the population have CKD. This seems unlikely. And even if its true, the diagnosis may really be more of a risk factor than a disease. Fortunately only 1 in 100 people with what the computer says is ‘CKD’ go on to get kidney failure – and require dialysis or a kidney transplant.
But (if it is) why does CKD appear to be getting more common?
The answer
The answer is complex. Some reasons reflect a true rise in kidney damage. Others relate to how CKD is defined, classified, and diagnosed.
Below are five key explanations — including two that critically examine whether the apparent increase represents real disease or changing definitions.
One of the strongest drivers of CKD is the increase in type 2 diabetes.
Organisations such as the World Health Organization (WHO) report a dramatic global rise in diabetes over the past few decades. High blood glucose damages the small blood vessels in the kidneys, leading to diabetic kidney disease — now a leading cause of CKD worldwide.
As obesity, sedentary lifestyles, and processed diets become more common, more people develop diabetes — and consequently, more develop kidney impairment. This is a genuine epidemiological increase, not just a diagnostic artefact.
Kidney function naturally declines with age. Glomerular filtration rate (GFR) decreases gradually over time, even in healthy individuals.
As life expectancy rises globally, more people live into older age brackets where reduced kidney function is common. Countries with aging populations — such as Japan, parts of Europe, and North America — therefore report higher CKD prevalence.
In many cases, however, this represents physiological aging rather than progressive kidney disease. However, under current definitions, many older adults meet criteria for CKD solely due to age-related GFR decline.
Thus, demographic shifts significantly contribute to the apparent rise in CKD prevalence.
Modern medicine screens more aggressively than in the past.
Routine blood tests now frequently include serum creatinine, from which estimated GFR (eGFR) is automatically calculated.
Primary care guidelines encourage testing high-risk patients (diabetes, hypertension, cardiovascular disease), leading to more diagnoses.
Decades ago, mild reductions in kidney function may have gone unnoticed. Today, they are labeled and coded.
Increased awareness and surveillance inflate prevalence figures — not because kidneys are suddenly failing more often, but because mild abnormalities are now systematically captured.
One controversial factor is the widespread adoption of the 5-stage CKD classification system introduced by kidney disease guidelines such as those from Kidney Disease: Improving Global Outcomes (KDIGO).
Under this system:
In other words, ‘CKD’ is a computer generated diagnosis based on no clinical assessment. This is equivalent to diagnosing ‘prediabetes’ in someone is 78y old and has a HbA1c of 45, who has no symptoms and is perfectly well.
This is also not a disease. And it does not mean they have had, have, or will have diabetes – though it can be a useful warning of diabetes to come.
Critics argue that the CKD/GFR framework (and the prediabetes concept) blur the line between a risk factor and a disease.
A mildly reduced eGFR may indicate increased cardiovascular risk — similar to elevated cholesterol — but does not necessarily represent progressive kidney pathology.
By labeling all persistent eGFR <60 as “chronic kidney disease,” the system may convert a statistical risk factor into a medical diagnosis.
This definitional expansion has likely contributed to the surge in CKD prevalence, particularly in older populations.
Related to the classification issue is the question of normal GFR for a patient’s age.
Normal GFR declines approximately 0.8–1 mL/min/1.73m² per year after age 40. Thus an an 80-year-old with an eGFR of 55 may have entirely normal kidney function consistent with healthy aging – and does not have CKD3A as diagnosed by a computer.
However, current CKD thresholds apply a fixed cutoff (<60) regardless of age. This can lead to:
Some researchers argue for age-adjusted definitions of CKD to distinguish pathological kidney damage from normal senescence.
Without age calibration, many older adults are labeled as having Stage 3 CKD despite stable kidney function and extremely low lifetime risk of kidney failure.
The honest answer: partly yes, partly no.
True increases are driven by:
Apparent increases are driven by:
The result is a mixture of genuine public health concern and diagnostic expansion.
CKD is unquestionably a serious condition when progressive and symptomatic. However, many individuals labeled with CKD will not develop kidney failure, or complications.
Understanding why CKD appears more common requires separating:
As medicine becomes more data-driven, these definitional questions will continue to shape how common — or uncommon — CKD truly is.
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