Dietary Risks Tied to Rising Global CKD Burden

Low fruit and vegetable intake and high sodium consumption remain the leading dietary contributors to chronic kidney disease (CKD) worldwide, though they vary substantially across socioeconomic regions, according to a study recently published in Medicine.¹

Assessing the Global Burden of Diet-Related CKD

CKD is closely associated with diet-related conditions such as type 2 diabetes (T2D) and hypertension, as well as noncommunicable diseases, such as glomerulonephritis (GN), with dietary factors also playing a role in CKD management. The growing prevalence of these underlying causes contributes to the increasing incidence of CKD, as well as substantial complications, morbidity and mortality burdens, health care spending, and widening socioeconomic disparities.

Because of this relationship, there is growing interest in the influence of dietary risks on CKD as a modifiable lifestyle factor in the prevention and management of disease progression. However, no previous study had provided a comprehensive assessment of CKD’s global burden attributable to dietary factors and associated disparities. To address this gap, investigators assessed the global, regional, and national burden of CKD attributable to dietary risks based on estimates from the Global Burden of Disease Study (GBD) 2021.

Specifically, the study examined disability-adjusted life-years (DALYs) attributable to 7 dietary risk factors, stratifying CKD burden by 4 underlying causes: T2D, hypertension, GN, and other unspecified causes. Estimates of disability-adjusted life-years (DALYs) of CKD attributable to dietary risks were stratified by age, sex, location, and Socio-Demographic Index (SDI) from 1990 to 2021 across 204 countries and territories.

Diet-Attributable CKD Burden Varies by Region, Age, and Income

In 2021, the global age-standardized DALY rate for diet-attributable CKD was 93.52 per 100,000 population (95% uncertainty interval, 54.29-134.38), up from 84.12 (95% uncertainty interval, 49.75-120.66) in 1990. Low fruit intake (DALY rate, 38.68 per 100,000; 95% uncertainty interval, 20.15-57.77) and low vegetable intake (DALY rate, 30.84; 95% uncertainty interval, 14.80-50.20) were the top contributors, followed by high sodium intake (DALY rate, 19.81; 95% uncertainty interval, 2.51-54.57). Although these 3 risks remained the leading contributors throughout the study period, the burden attributable to low whole grain intake, along with high processed meat, red meat, and sugar-sweetened beverage (SSB) intake, also increased.

Burden also rose sharply with age across dietary factors, with higher rates among men. Specifically, rates increased exponentially after age 65, peaking among individuals aged 95 years and older, when DALY rates for low fruit intake reached 920.46 in males and 840.16 in females.

Regionally, central sub-Saharan Africa recorded the highest total CKD burden (DALY rate, 229.23; 95% uncertainty interval, 128.39-350.76), roughly 6 times the rate in Eastern Europe, the region with the lowest burden (DALY rate, 38.27; 95% uncertainty interval, 21.62-56.27).

Consequently, socioeconomic status shaped which dietary risks dominated. Low-SDI regions, such as sub-Saharan Africa, bore a substantially greater burden from inadequate intake of protective foods, fruit, vegetables, and whole grains, alongside high sodium intake, contributing to elevated CKD burden due to hypertension. By contrast, high-SDI regions showed a greater burden of CKD due to T2D attributable to highly processed meat, as well as relatively high burdens associated with red meat and SSB consumption.

High-income North America had some of the sharpest increases of any region, with the burdens associated with high sodium intake climbing 188.63% and that associated with high SSB intake increasing 181.85% from 1990 to 2021. However, high-income Asia Pacific was a notable outlier, experiencing reductions across all dietary contributors, including a 51.46% reduction in the burden associated with high sodium intake.

Rising CKD Prevalence Highlights Need for Upstream Prevention

The findings arrive as global CKD prevalence continues to climb. A separate GBD 2023 analysis published in The Lancet found the number of adults living with CKD worldwide had more than doubled since 1990, reaching 788 million in 2023, with metabolic risk factors such as elevated fasting plasma glucose, body mass index, and systolic blood pressure identified as the leading drivers of CKD-related DALYs.² The analysis also flagged persistent gaps in early screening and CKD's outsized contribution to cardiovascular mortality, underscoring the stakes of upstream prevention.

At the same time, the authors acknowledged several limitations, including a lack of consideration for potential interactions between dietary and non-dietary risk factors, such as physical inactivity, obesity, smoking, and medication use, which may have resulted in an underestimation of the true dietary contribution to CKD¹; these risks frequently co-occur and share variance. In addition, focusing solely on dietary factors may have overlooked other behavioral, genetic, and environmental determinants, potentially oversimplifying CKD’s complex pathophysiology.

Despite these limitations, the researchers emphasized the need for dietary interventions tailored to regional and socioeconomic circumstances based on their findings.

“These findings underscore the urgent need for stratified dietary interventions and public health strategies to reduce the global burden of diet-related CKD,” they concluded.

References

1. Park J, Hwang SH, Oh J, et al. Global, regional, and national burden of chronic kidney disease attributable to dietary risks, 1990 to 2021: a systematic analysis for the Global Burden of Disease Study 2021. Medicine. 2026;105(33):e50207. doi:10.1097/MD.0000000000050207
2. Global CKD burden nearly doubles since 1990, reaching 788 million adults worldwide. AJMC^®. November 21, 2025. Accessed August 18, 2026. https://www.ajmc.com/view/global-ckd-burden-nearly-doubles-since-1990-reaching-788-million-adults-worldwide