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The impact of social determinants of health on acute kidney injury

Nature Reviews Nephrology (2026)Cite this article

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Abstract

Acute kidney injury (AKI) is a common condition globally associated with substantial morbidity, mortality and costs to health-care systems. The epidemiology and outcomes of AKI differ within and between countries, and depend on multiple factors. Social determinants of health (SDoHs) are the circumstances in which people are born, grow, work, live and age, including the broader set of forces and systems that influence the conditions of everyday life. Despite advances in medical care, many inequities, including those associated with socioeconomic status, race, ethnicity, gender and environment, persist and are increasingly recognized to influence health outcomes. Superimposed on these inequities are differences in access to health care and health resources, including public health prevention, access to screening, early diagnosis and treatment (including kidney replacement therapy), and quality of care, which vary within and between high- and low-resource settings. Over the past few years, these disparities have intensified as societies have emerged from a global pandemic and are challenged with accelerating climate change and escalating levels of global conflict. However, the role of SDoHs remains poorly defined for people with or at risk of AKI. Targeted policies addressing SDoHs are essential to reduce AKI burden globally. Here, we examine the effects of SDoHs on the incidence, recognition, management, follow-up and outcomes of adult and paediatric populations at risk of or with AKI.

Key points

  • Social determinants of health influence acute kidney injury (AKI) incidence, management and outcomes substantially. Consequently, factors such as economic deprivation, education gaps and health-care access barriers drive AKI disparities globally.

  • Environmental exposures, climate change and conflict exacerbate AKI risks, especially in low-resource settings, where increased risks are typically also accompanied by limitations in health-care provision.

  • Paediatric and adolescent populations face unique AKI vulnerabilities owing to systemic inequities, with gaps in research exacerbating the ability to implement adequate interventions and improve patient outcomes.

  • Addressing social determinants of health aligns with Sustainable Development Goals and is essential for reducing AKI incidence globally, achieving equitable AKI care and reducing its long-term health implications, which include adverse effects at individual and societal levels.

  • Interdisciplinary strategies, education and policy reforms that are tailored to local needs and resources, as well as being integrated into current efforts to address non-communicable diseases, are needed to reduce AKI burden worldwide.

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Fig. 1: Acute kidney injury stressors related to climate change.
Fig. 2: Conceptual framework linking environmental hazards to kidney disease progression.

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Authors and Affiliations

  1. Division of Population Health and Genomics, University of Dundee, Dundee, UK

    Samira Bell

  2. IIBISMED, Universidad Mayor de San Simón School of Medicine, Cochabamba, Bolivia

    Rolando Claure-Del Granado

  3. Division of Nephrology, Hospital Obrero No 2 – Caja Nacional de Salud, Cochabamba, Bolivia

    Rolando Claure-Del Granado

  4. Excellence Centre in Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand

    Nuttha Lumlertgul

  5. Paediatric Nephrology, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa

    Mignon McCulloch

  6. Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA

    Amira Mohamed

  7. Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada

    Neesh Pannu

  8. Department of Nephrology, Osmania General Hospital & Osmania Medical College, Hyderabad, India

    Manisha Sahay

  9. Department of Pediatrics, Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA

    Danielle E. Soranno

  10. Department of Intensive Care, Guy’s & St Thomas’ Hospital, King’s College London, London, UK

    Marlies Ostermann

  11. Department of Medicine, University of California San Diego, San Diego, CA, USA

    Ravindra Mehta

  12. Division of Nephrology, Department of Pediatrics, Stanford University, Palo Alto, CA, USA

    Shina Menon

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on behalf of the 33rd ADQI expert panel

  • Samira Bell
  • , Rolando Claure-Del Granado
  • , Nuttha Lumlertgul
  • , Mignon McCulloch
  • , Amira Mohamed
  • , Neesh Pannu
  • , Manisha Sahay
  • , Danielle E. Soranno
  • , Marlies Ostermann
  • , Ravindra Mehta
  •  & Shina Menon

Contributions

All authors researched data for the article, made substantial contributions to discussions of the content and wrote, reviewed or edited the manuscript before submission.

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Correspondence to Samira Bell.

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Competing interests

S.B. has received consultancy fees from AstraZeneca, GSK, Novo Nordisk and Stada UK unrelated to this work. M.O. received research funding from Baxter and BioMérieux (paid to their institution). The other authors declare no competing interests.

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Bell, S., Claure-Del Granado, R., Lumlertgul, N. et al. The impact of social determinants of health on acute kidney injury. Nat Rev Nephrol (2026). https://doi.org/10.1038/s41581-026-01063-3

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