Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Comment
  • Published:

The catastrophic costs of chronic kidney disease

Chronic kidney disease (CKD) is associated with the highest occurrence of catastrophic healthcare expenditure (CHE) both globally and across all diseases. However, CHE alone does not provide a complete measure of the financial burdens of CKD on a household, especially for those with very low incomes or who forego therapy altogether. A more comprehensive assessment of direct, indirect and long-term costs is crucial to advancing equitable and effective universal health coverage.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Direct and indirect costs of KRT in CKD.

References

  1. Brauer, M. et al. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 403, 2162–2203 (2024).

    Article  Google Scholar 

  2. Bikbov, B. et al. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 395, 709–733 (2020).

    Article  Google Scholar 

  3. Jha, V. et al. Global economic burden associated with chronic kidney disease: a pragmatic review of medical costs for the Inside CKD research programme. Adv. Ther. 40, 4405–4420 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  4. World Health Organization. Noncommunicable diseases. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases#cms (2024).

  5. Vanholder, R. et al. Reducing the costs of chronic kidney disease while delivering quality health care: a call to action. Nat. Rev. Nephrol. 13, 393–409 (2017).

    Article  PubMed  Google Scholar 

  6. Lanewala, A. A. A. & Shekhani, S. S. Indirect costs associated with “free” paediatric haemodialysis: experience from Karachi, Pakistan. Indian J. Med. Ethics 8, 13–23 (2023).

    Article  Google Scholar 

  7. Vanholder, R. et al. Inequities in kidney health and kidney care. Nat. Rev. Nephrol. 19, 694–708 (2023).

    Article  PubMed  Google Scholar 

  8. Ashuntantang, G. et al. Outcomes in adults and children with end-stage kidney disease requiring dialysis in sub-Saharan Africa: a systematic review. Lancet. Glob. Health 5, e408–e417 (2017).

    Google Scholar 

  9. SDG 3.8.2 Catastrophic health spending (and related indicators). https://www.who.int/data/gho/data/themes/topics/financial-protection/GHO/financial-protection

  10. Essue, B. M. et al. Economic Burden of Chronic Ill Health and Injuries for Households in Low- and Middle-Income Countries. Disease Control Priorities, Third Edition (Volume 9): Improving Health and Reducing Poverty 121–143 (2017)

  11. Halle, M. P. et al. Cost of care for patients on maintenance haemodialysis in public facilities in Cameroon. Afr. J. Nephrol. 20, 230–237 (2017).

    Google Scholar 

  12. Reddy, S., Scholes-Robertson, N., Raj, J. M. & Pais, P. Catastrophic healthcare expenditure and caregiver burden in pediatric chronic kidney disease — a mixed methods study from a low resource setting. Pediatr. Nephrol. 39, 3079–3093 (2024).

    Article  PubMed  Google Scholar 

  13. Sangthawan, P. et al. The hidden financial catastrophe of chronic kidney disease under universal coverage and Thai “peritoneal dialysis first policy”. Front. Public Health 10, 965808 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  14. Bradshaw, C. et al. Paying for hemodialysis in Kerala, India: a description of household financial hardship in the context of medical subsidy. Kidney Int. Rep. 4, 390–398 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  15. Paffett, M. et al. Economic evaluation of an integrated care program compared to conventional care for patients with chronic kidney disease in rural communities of Thailand. Kidney Int. Rep. 9, 2546–2558 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Priya Pais.

Ethics declarations

Competing interests

The authors declare no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pais, P., Luyckx, V., Chatterjee, S. et al. The catastrophic costs of chronic kidney disease. Nat Rev Nephrol 21, 580–581 (2025). https://doi.org/10.1038/s41581-025-00978-7

Download citation

  • Published:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41581-025-00978-7

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing