Chronic Kidney Disease (CKD) has emerged as one of the most important public health challenges in India. Over the past two decades, its prevalence has increased steadily, paralleling the rising burden of non-communicable diseases across the country. Epidemiological studies, including the work of Singh AK and colleagues, estimate that approximately 11–12% of the Indian population may be living with some form of CKD. In a nation of more than 1.4 billion people, this represents an enormous absolute disease burden.
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The Silent Progression Of Chronic Kidney Disease
Globally, CKD affects nearly one in ten adults, making it one of the fastest growing causes of morbidity and mortality worldwide.
A particularly concerning aspect of CKD is the silent nature of the disease in its early stages. Many patients remain asymptomatic until significant renal impairment has already occurred. As a result, a large proportion of individuals in India are diagnosed only when the disease has progressed to advanced stages. This underscores the critical need for greater public awareness, early detection strategies, and systematic screening programs.
Among the etiological factors contributing to CKD, diabetes mellitus remains the single most important driver, followed closely by hypertension. India currently has one of the largest populations of individuals living with diabetes globally. According to the International Diabetes Federation (IDF), approximately 74–77 million adults in India are currently living with diabetes, and projections suggest that this number may exceed 120 million by 2045 if current trends persist. Additionally, a substantial proportion of the population has prediabetes, further amplifying the risk of future diabetic complications.
Pathophysiology Of Diabetic Kidney Disease
Diabetic kidney disease arises as a consequence of chronic hyperglycaemia, which leads to structural and functional alterations within the kidney. Persistent elevation of blood glucose results in glomerular hyperfiltration, endothelial dysfunction, and progressive injury to the glomerular filtration barrier. Over time, this manifests clinically as albuminuria and a progressive decline in glomerular filtration rate, eventually culminating in advanced CKD and end-stage kidney disease (ESKD).
The rapid increase in diabetes and CKD in India can also be viewed through the lens of evolutionary biology. The “thrifty gene” hypothesis suggests that certain genetic traits enabling efficient energy storage evolved as survival advantages during periods of food scarcity in human history. Our ancestors lived in environments characterized by inconsistent food availability and high levels of physical activity. Under such conditions, metabolic efficiency and energy conservation were beneficial adaptations.
However, in today’s environment, characterised by widespread availability of calorie-dense foods, rapid urbanization, and declining physical activity, these same metabolic traits may predispose individuals to obesity, insulin resistance, and type 2 diabetes. Consequently, the interaction between genetic predisposition and modern lifestyle patterns has contributed significantly to the rising burden of metabolic disease and diabetic kidney disease.
Despite these challenges, diabetic kidney disease remains one of the most preventable forms of CKD when detected early and managed appropriately. Early identification of kidney involvement in patients with diabetes is therefore essential.
Three simple and widely available tests can facilitate early detection:
- Serum creatinine with estimation of glomerular filtration rate (eGFR)
- Urine albumin-to-creatinine ratio (ACR) or detection of proteinuria
- Blood pressure measurement and control
These investigations are inexpensive, easily accessible, and capable of identifying kidney disease well before the onset of symptoms. Current international guidelines recommend annual screening for kidney disease in all individuals with diabetes.
Management Of Diabetic Kidney Disease
Once CKD is detected, slowing disease progression becomes the primary therapeutic goal. Optimal glycaemic control, effective blood pressure management, and blockade of the renin–angiotensin system remain the cornerstone of therapy. More recently, newer pharmacological agents, including SGLT2 inhibitors and non-steroidal mineralocorticoid receptor antagonists, have demonstrated substantial renoprotective benefits and are now integral components of contemporary management of diabetic kidney disease.
Lifestyle modification continues to play a pivotal role in both prevention and disease control. Regular physical activity, maintenance of a healthy body weight, and dietary patterns emphasizing whole grains, traditional cereals such as millets, fruits, and vegetables, while limiting refined carbohydrates and excess sugars, can significantly improve metabolic health and reduce the risk of kidney disease progression.
Equally important is the need for timely medical evaluation and intervention. Early testing and prompt treatment can substantially reduce the likelihood of kidney failure and the eventual need for dialysis or transplantation.
At a systemic level, addressing CKD in India requires strengthening healthcare infrastructure and improving access to advanced kidney care. The gap between the number of patients requiring renal replacement therapy and those who are able to receive it remains considerable. Dialysis and transplantation services, although expanding, continue to face challenges related to cost, accessibility, and infrastructure.
According to the National Organ and Tissue Transplant Organization (NOTTO), approximately 13,600 kidney transplants were performed in India in 2024. However, the estimated national requirement is nearly 1.7–2.2 lakh kidney transplants annually, highlighting a massive unmet need. This disparity underscores the urgent necessity to expand organ donation awareness, strengthen deceased donor programs, and improve equitable access to transplantation services across the country.
Disclaimer: The information provided in the article is shared by experts and is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition.
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