Prevalence, risk factors, and outcomes of kidney failure. A comprehensive analysis

Nº de DOI: 10.34896/RSI.2026.74.95.001

AUTHORS

1. Gema Nathaly Molina Ormaza. General Practitioner and Master’s Degree in Occupational Health and Safety. Attached to the Technical University of the North. Graduate of the University of Guayaquil. (Quito-Ecuador). https://orcid.org/0009-0001-3267-0258
2. Eduardo Enrique Arbelaez Toala. General Practitioner. Attached to Private Clinics in Ecuador. Graduate of the University of Guayaquil. (Durán-Ecuador). https://orcid.org/0009-0000-1813-323X
3. Michelle Estefania Aisabucha Heredia. General Practitioner. Attached to Private Clinics of Ecuador. Graduated from the Regional Autonomous University of the Andes. (Ambato-Ecuador). https://orcid.org/0009-0003-6679-320X
4. Marcos Gabriel Velasco Rea. General Practitioner and Master’s Degree in Occupational Health and Safety. Attached to Pablo Arturo Suárez Hospital. Graduate of the Central University of Ecuador. (⁠Quito-Ecuador). https://orcid.org/0009-0003-9975-7184
5. Byron Daniel Guevara Rovalino. General Practitioner. Attached to MSR Atocha Hospital. Graduate of the Technical University of Ambato. (Ambato-Ecuador). https://orcid.org/0009-0004-6823-6199

ABSTRACT

Kidney failure, encompassing both acute and chronic forms, represents a significant global health challenge due to its profound impact on individual morbidity, mortality, and healthcare systems worldwide. Renal failure is characterized by a marked decline in kidney function, with the capacity of the kidneys reduced to less than 15% of normal levels, leading to the accumulation of waste products and fluid imbalances that manifest as symptoms such as vomiting, edema, fatigue, and cognitive disturbances.

KEY WORDS

Kidney failure, acute kidney injury, chronic kidney disease, end-stage renal disease, epidemiology, risk factors, nephrotoxic drugs.

RESUMEN

La insuficiencia renal, que abarca tanto las formas agudas como crónicas, representa un importante problema de salud global debido a su profundo impacto en la morbilidad, la mortalidad y los sistemas de atención sanitaria en todo el mundo. La insuficiencia renal se caracteriza por una disminución grave de la función renal, generalmente cuando la tasa de filtración glomerular se reduce a menos del 15 % de la capacidad normal. Este deterioro conduce a la acumulación de productos de desecho metabólicos, alteraciones electrolíticas y desequilibrios de líquidos, lo que da lugar a manifestaciones clínicas como náuseas y vómitos, edema, fatiga y deterioro cognitivo. Comprender la epidemiología, los factores de riesgo y los mecanismos subyacentes de la insuficiencia renal es esencial para su detección temprana, prevención y manejo eficaz.

PALABRAS CLAVE

Insuficiencia renal, lesión renal aguda, enfermedad renal crónica, enfermedad renal terminal, epidemiología, factores de riesgo, fármacos nefrotóxicos.

OBJECTIVE

Elucidate the current epidemiological landscape, identify key risk determinants, and explore the clinical and long-term outcomes of kidney failure to inform better prevention, early detection, and management strategies.

INTRODUCTION

The prevalence of kidney failure varies considerably across regions and populations, influenced by demographic factors such as age, gender, and ethnicity, with recent epidemiological data indicating an alarming increase in both acute kidney injury (AKI) and chronic kidney disease (CKD). These trends are compounded by evolving lifestyles, rising rates of comorbid conditions like hypertension and diabetes, and increased exposure to nephrotoxic medications, all of which serve as primary risk factors for renal deterioration. Acute kidney failure often results from precipitants such as hypotension, urinary tract obstructions, hemolytic uremic syndrome, or medication toxicity, while chronic kidney failure typically develops gradually due to longstanding conditions like diabetes, hypertension, and glomerulonephritis. The consequences of kidney failure extend beyond impaired renal function, leading to serious complications such as hyperkalemia, volume overload, uremia, anemia, cardiovascular disease, and ultimately, end-stage renal disease (ESRD), which necessitates dialysis or transplantation. These complications significantly diminish patients’ quality of life and elevate mortality rates, underscoring the urgency of understanding the prevalence, risk factors, and outcomes associated with kidney failure. This comprehensive analysis aims to elucidate the current epidemiological landscape, identify key risk determinants, and explore the clinical and long-term outcomes of kidney failure to inform better prevention, early detection, and management strategies.

METHODOLOGY

This narrative review was conducted to synthesize current evidence on the epidemiology, risk determinants, and clinical outcomes of kidney failure, encompassing both acute kidney injury (AKI) and chronic kidney disease (CKD) progressing to end-stage renal disease (ESRD). A comprehensive literature search was performed in PubMed, Scopus, Web of Science, and Google Scholar, covering articles published between 1990 and 2024 in order to capture long-term trends and recent developments in kidney failure research.

Search terms included combinations of: “acute kidney injury,” “acute renal failure,” “chronic kidney disease,” “kidney failure,” “end-stage renal disease,” “ESRD,” “epidemiology,” “incidence,” “prevalence,” “risk factors,” “diabetes,” “hypertension,” “nephrotoxicity,” “NSAIDs,” “outcomes,” “morbidity,” “mortality,” “dialysis,” “kidney transplantation.” Reference lists of key reviews and population-based studies were also examined manually to identify additional relevant publications.

Inclusion criteria comprised:

1. Peer-reviewed original studies, systematic reviews, and major epidemiological reports addressing AKI, CKD, or ESRD.
2. Articles reporting data on prevalence, incidence, demographic patterns, or risk factors.
3. Studies describing clinical complications, long-term outcomes, or management strategies (dialysis, transplantation, conservative care).
4. English-language publications with clearly described methodology.

Exclusion criteria included:

1. Case reports, small case series, and studies with insufficient sample size or unclear diagnostic criteria.
2. Articles focused exclusively on pediatric populations when adult data were not provided.
3. Publications centered solely on basic science or experimental models without clinical or epidemiological relevance.

Extracted information was organized into the following thematic domains: (1) global and regional prevalence and incidence of kidney failure, (2) demographic influences (age, gender, ethnicity), (3) medical and lifestyle risk factors for AKI, (4) chronic conditions predisposing to CKD and progression to kidney failure, (5) nephrotoxic medications and external agents, and (6) complications, morbidity, mortality, and long-term outcomes in ESRD. Due to substantial heterogeneity in study design, definitions of kidney failure, and outcome measures, quantitative meta-analysis was not performed. Instead, a qualitative, narrative synthesis was used to identify consistent patterns, highlight gaps in knowledge, and derive implications for prevention, early detection, and management.

RESULTS

Prevalence of Kidney Failure:

What are the current global and regional rates of acute and chronic kidney failure?

Globally, chronic kidney disease (CKD) remains a significant public health concern, with the most recent data indicating a prevalence of 359 million cases in 2021¹. Despite a slight decline in prevalence rates, the burden of CKD has escalated in terms of incidence, mortality, and disability-adjusted life years (DALYs) since 1990, highlighting a troubling paradox where advances in prevention or diagnosis have not translated into reduced overall impact¹. In 2021 alone, there were 11.13 million new CKD cases reported, underscoring the persistent influx of affected individuals each year and straining health systems worldwide¹. Furthermore, the toll of CKD is evident in the mortality statistics, with 1.53 million deaths attributed to the disease globally, reflecting its fatal potential and the urgent need for improved management and intervention strategies¹. The burden, quantified by DALYs, reached 44.45 million in 2021, demonstrating the profound effect of CKD not only on mortality but also on long-term quality of life and economic productivity¹. Importantly, these global figures obscure substantial regional, age, and gender disparities, as some populations experience higher burdens due to socioeconomic, environmental, and healthcare access factors, necessitating a more nuanced and targeted approach to CKD prevention and treatment¹. While current data robustly describe the scale and heterogeneity of chronic kidney disease, there is a notable lack of comprehensive global statistics on acute kidney failure, pointing to a critical gap in surveillance and research that must be addressed to enable holistic kidney health policy planning¹. This underscores the urgency for intensified global and regional efforts in data collection, targeted interventions, and resource allocation to mitigate the rising impact of both acute and chronic kidney diseases.

How do demographic factors (age, gender, ethnicity) influence prevalence rates?

Demographic factors such as age, gender, and ethnicity play a pivotal role in shaping the prevalence rates of chronic kidney disease (CKD), influencing both the observed patterns and underlying risk profiles among populations. Stratifying the study sample by these core characteristics allowed for the calculation of weighted prevalence estimates, ensuring that differences across age, sex, and race/ethnicity were accurately captured and not masked by aggregate data^2,3. For instance, the overrepresentation of certain age groups, such as the 21-31 years cohort making up 42% of participants, may skew prevalence rates, underscoring the importance of adjusting for age when interpreting findings³. Gender distribution also matters, as females constituted 66% of the sample, suggesting that potential gender-related differences—whether biologically or behaviorally driven—could influence the prevalence assessments of CKD³. Ethnicity further complicates the landscape, with the majority and minority groups represented at 66% and 34%, respectively, highlighting the need to consider cultural and genetic factors that may contribute to disparate CKD outcomes³. These demographic interconnections are not only statistically significant but also clinically relevant, as they shape health outcomes and disease risk at both the individual and population levels⁴. Taken together, a nuanced understanding of demographic influences is essential for designing targeted interventions, refining public health strategies, and reducing disparities in CKD burden across diverse communities.

What trends have been observed in the incidence of kidney failure over recent years?

The global trends in the incidence of kidney failure over recent years reflect complex interconnections between demographic factors, regional disparities, and broader public health dynamics. Notably, chronic kidney disease (CKD)—a key precursor to kidney failure—has demonstrated a significant upward trend worldwide, with the incidence increasing by 144% from 1990 to 2019, and nearly 19 million individuals affected by CKD in 2019 alone, underscoring its emergence as a critical global health issue^5,6. The rise in CKD-related indicators, particularly over the past five years, suggests an overall upward trajectory in kidney-related health issues, with middle and high sociodemographic index (SDI) regions experiencing the most pronounced increases, primarily driven by aging populations^5,6. In contrast, in low SDI regions, while the change in incidence rates has been more modest, population growth has played a dominant role in shaping the burden of kidney failure, illustrating how demographic shifts and regional contexts interact to influence health outcomes⁶. These patterns highlight the urgent need for targeted interventions that address both the underlying demographic drivers and the systemic disparities in healthcare access and disease prevention, particularly as the rising incidence of CKD continues to amplify the global burden of kidney failure^5,6.

Risk Factors Associated with Kidney Failure:

What are the primary medical and lifestyle risk factors for acute kidney failure?

The interplay between medical and lifestyle risk factors for acute kidney failure underscores the complexity of its etiology, as several domains converge to elevate individual susceptibility. Advanced age, particularly in individuals over 75 years old, not only represents a significant lifestyle factor but also intensifies the effects of underlying medical conditions, making elderly populations especially vulnerable to acute kidney injury^7,8. Chronic diseases such as diabetes and preexisting chronic kidney disease are major medical determinants, with diabetes posing a dual threat: it directly impairs renal function and, in patients with baseline renal insufficiency, dramatically heightens the likelihood of acute kidney failure^7,8. Compounding these risks, impaired cardiovascular health—manifested as left ventricular systolic dysfunction or heart failure—can further disrupt renal perfusion, thereby predisposing affected individuals to acute renal events^7,8. Lifestyle-related factors such as dehydration are closely intertwined with these medical risks, as insufficient fluid intake or excessive fluid loss can precipitate kidney injury, especially in those already compromised by age or comorbidities⁷. Given these interconnections, comprehensive risk mitigation requires integrated interventions that address both modifiable lifestyle behaviors and meticulous management of chronic medical conditions, particularly among high-risk groups such as the elderly and those with underlying renal or cardiovascular disease.

How do chronic conditions contribute to the development of chronic kidney failure?

Chronic conditions serve as fundamental drivers in the pathogenesis of chronic kidney failure, with diabetes and hypertension standing out as the most prominent contributors across diverse populations⁹. These conditions exert their deleterious effects through distinct yet interconnected mechanisms: chronic hyperglycemia in diabetes leads to persistent damage of the kidney’s filtration apparatus, resulting in diabetic nephropathy, while sustained high blood pressure causes injury to the delicate renal vasculature and glomeruli, exacerbating the loss of functional nephrons¹⁰. The interplay between these chronic diseases and kidney pathology is further complicated by the fact that chronic kidney disease itself can elevate blood pressure, creating a self-perpetuating cycle of renal and vascular injury⁹. Additionally, autoimmune diseases such as lupus and chronic glomerulonephritis contribute to chronic kidney failure by inciting inflammatory processes that damage renal tissues and disrupt filtration, demonstrating the broad impact of immune-mediated and inflammatory chronic conditions on kidney health^9,10. Obstructive processes, including urinary tract blockages often associated with chronic health issues, further impair kidney function by increasing intrarenal pressure and promoting parenchymal damage, highlighting the multifaceted ways chronic conditions intersect to drive progressive renal decline⁹. Genetic factors, family history, age, and ethnicity—often linked with chronic disease susceptibility—also modulate an individual’s risk for developing chronic kidney failure, underscoring the complex web of interactions between intrinsic and extrinsic determinants⁹. Addressing these interconnections through early intervention, targeted management of primary chronic conditions, and personalized risk assessment is crucial in mitigating the global burden of chronic kidney failure.

What role do medications and external agents play in increasing renal risk?

Medications and external agents play a multifaceted and significant role in increasing renal risk, especially among vulnerable patient populations. Exposure to multiple nephrotoxins—substances that can adversely affect kidney function—significantly elevates the likelihood of renal damage, particularly when such exposures are concurrent or repeated over time¹¹. Nonsteroidal anti-inflammatory drugs (NSAIDs) exemplify this risk, their widespread use, both prescribed and over-the-counter, has been directly linked to renal toxicity, with as many as 5% of users experiencing adverse renal effects, a risk that escalates with higher dosages or prolonged usage¹². The danger is compounded in patients with preexisting conditions such as renal insufficiency, congestive heart failure, or cirrhosis, as these individuals are more susceptible to medication-induced renal injury due to compromised baseline kidney function¹². Medications that decrease renal perfusion, including NSAIDs and certain antihypertensives like ACE inhibitors and angiotensin receptor blockers, can precipitate acute renal failure by disrupting the delicate balance of blood flow and filtration within the kidneys^12,13. Additionally, external agents such as diuretics or substances causing dehydration (from overdiuresis or gastrointestinal losses) further reduce kidney perfusion, amplifying the risk of acute kidney injury, particularly when combined with nephrotoxic medications^12,13. These interconnections highlight the importance of comprehensive patient assessment and judicious medication management, particularly in those with underlying risk factors or concurrent exposures. Interventions such as careful monitoring of renal function, prompt removal of offending agents, and tailored dosing strategies are essential to mitigate renal risk and prevent long-term kidney damage¹³.

Outcomes and Complications of Kidney Failure:

What are the common clinical complications associated with acute and chronic kidney failure?

Acute and chronic kidney failure are frequently accompanied by a spectrum of clinical complications that reflect the kidney’s central role in maintaining the body’s internal balance of fluids, electrolytes, and metabolic waste products. One of the most immediate and potentially life-threatening acute complications is hyperkalemia, or elevated serum potassium, which arises when the failing kidneys can no longer effectively excrete potassium, leading to serious cardiac arrhythmias¹⁴. Similarly, heart failure is a notable complication in chronic kidney disease (CKD), often driven by persistent fluid retention and hypertension as the kidneys lose their ability to regulate sodium and water levels¹⁴. Infections are another significant concern, especially in individuals undergoing dialysis, as impaired renal function and treatment modalities contribute to immune dysfunction, heightening susceptibility to bacterial and viral pathogens¹⁴. These complications are interconnected, for example, fluid overload not only precipitates heart failure but also exacerbates hypertension and increases infection risk by impairing tissue perfusion¹⁴. Additionally, chronic kidney failure commonly results in anemia and hyperphosphatemia due to decreased erythropoietin production and impaired phosphate excretion, respectively, both of which can further worsen cardiovascular health and bone disease¹⁵. Because clinical manifestations may be subtle or absent until advanced stages, vigilant monitoring and early intervention are essential to mitigate these complications and improve patient outcomes¹⁵.

How does kidney failure impact patient morbidity, mortality, and quality of life?

Kidney failure imposes a substantial burden on patient morbidity, mortality, and quality of life, with these domains deeply interconnected in shaping patient outcomes. The progressive loss of kidney function leads to the accumulation of toxins and waste products, which in turn exacerbates illness and impairs physical function, thereby increasing morbidity rates among affected individuals^16,17. This compromised physical health is frequently accompanied by a pronounced reduction in health-related quality of life (HRQoL), as patients struggle with fatigue, dietary restrictions, and the psychological impact of chronic illness^16,18. Moreover, kidney failure is unequivocally linked to higher mortality rates, particularly when left untreated, highlighting the life-threatening nature of the disease^16,17. The interplay between these domains is further complicated by the fact that poor quality of life may itself contribute to adverse health outcomes, creating a vicious cycle of declining health and increasing risk of death¹⁸. While there is no cure for kidney failure and the loss of kidney function is irreversible, effective management—including dialysis, transplantation, medications, and lifestyle modifications—can mitigate symptom burden, slow disease progression, and allow many patients to maintain a reasonable quality of life and longevity¹⁷. Thus, comprehensive and ongoing treatment is essential to reduce morbidity, decrease mortality, and enhance quality of life for patients with kidney failure, underscoring the urgent need for timely interventions and sustained patient support¹⁷.

What are the long-term health outcomes for patients with end-stage kidney disease?

Long-term health outcomes for patients with end-stage kidney disease (ESKD) are profoundly influenced by the irreversible loss of renal function, which results in life-threatening imbalances of fluids and electrolytes and the accumulation of toxins in the body¹⁹. These pathophysiological changes not only manifest as severe symptoms—such as persistent fatigue, fluid overload, shortness of breath, and uremia—but also contribute to secondary complications including anemia, bone disease, and cardiovascular issues, thereby compounding the overall disease burden¹⁹. The interconnection between these complications highlights a multidimensional impact on patients’ health, as cardiovascular events and bone disorders are often exacerbated by the underlying metabolic imbalances and chronic inflammation inherent to ESKD. Moreover, the high mortality rate associated with ESKD, as evidenced by the significant proportion of hospital deaths attributable to renal failure, underscores the urgent need for comprehensive management strategies that address not only the primary renal dysfunction but also its systemic sequelae¹⁹. Given these complex and interrelated outcomes, interventions such as kidney transplantation are critical, as they have been shown to significantly improve quality of life and longevity by alleviating many of the complications and reducing the dependency on dialysis¹⁹. Therefore, enhancing access to advanced therapies and supportive care remains essential to improve the long-term prognosis and quality of life for patients living with ESKD.

DISCUSSION

The findings of this comprehensive analysis underscore the persistent and escalating global burden of kidney failure, particularly chronic kidney disease (CKD), which affects an estimated 359 million individuals worldwide. The marked increase in incidence, with a 144% rise from 1990 to 2019, highlights the influence of demographic shifts, aging populations, and regional disparities, especially in middle- and high-income countries. This trend underscores the critical need for tailored public health strategies that account for demographic and socioeconomic factors, as well as targeted prevention efforts that address modifiable risk factors such as diabetes, hypertension, autoimmune conditions, and lifestyle behaviors like dehydration. The observed regional variations suggest that healthcare access and environmental factors significantly influence disease prevalence and outcomes, emphasizing the importance of equitable healthcare delivery and resource allocation. Despite the rising prevalence, data on acute kidney failure remains limited globally, revealing a notable research gap that warrants enhanced surveillance and epidemiological studies to inform comprehensive kidney health policies. The multifactorial nature of risk factors, including medication-induced nephrotoxicity from NSAIDs and certain antihypertensives, highlights the necessity for careful medication management, especially in vulnerable populations. The diverse complications associated with kidney failure—ranging from electrolyte imbalances to cardiovascular disease—demonstrate the complex, systemic consequences of advanced disease stages and the importance of early detection and management. Although current treatment modalities such as dialysis and transplantation can extend survival and improve quality of life, challenges remain, including limited access to transplantation and disparities in treatment availability. The high mortality associated with end-stage kidney disease underscores the urgent need for innovative therapies and improved healthcare infrastructure. Limitations of this study include potential underreporting or disparities in data collection across regions, which may influence the accuracy of prevalence estimates. Future research should focus on elucidating the social determinants of health that contribute to disparities, developing predictive models for early detection, and exploring novel therapeutic approaches. Overall, this analysis highlights the necessity for coordinated global efforts involving policy, research, and clinical practice to effectively address the multifaceted challenges posed by kidney failure and to improve outcomes across diverse populations.

CONCLUSIONS

1. Kidney failure, encompassing both acute kidney injury and chronic progression to ESRD, represents a major and growing global health burden. Despite advances in diagnostic tools and treatment options, the incidence and overall impact of CKD have increased substantially in recent decades, driven by aging populations, the worldwide rise in diabetes and hypertension, and persistent inequities in healthcare access. The available data reveal substantial regional and demographic differences in prevalence, underscoring the influence of age, gender, ethnicity, and socioeconomic context on kidney disease risk and outcomes.
2. Risk factors for kidney failure are multifactorial and interrelated. Acute kidney injury frequently arises from hemodynamic disturbances, obstructive processes, infections, and exposure to nephrotoxic medications, particularly in older individuals and those with pre-existing renal or cardiovascular disease. Chronic kidney failure develops largely on the background of long-standing conditions such as diabetes, hypertension, and glomerulonephritis, with autoimmune diseases and obstructive uropathies contributing additional burden. Medications, especially NSAIDs and agents that alter renal perfusion, significantly amplify risk when used in susceptible patients or in the context of dehydration and polypharmacy.
3. The clinical consequences of kidney failure extend far beyond reduced glomerular filtration, affecting virtually every organ system. Complications such as hyperkalemia, volume overload, uremia, anemia, mineral and bone disorders, and cardiovascular disease markedly increase morbidity and mortality, while dialysis and ESRD impose profound physical, psychological, and socioeconomic burdens on patients and healthcare systems. Kidney transplantation offers improved survival and quality of life for eligible patients but remains limited by organ availability and access disparities.
4. Overall, the evidence highlights the urgent need for integrated strategies that emphasize primary prevention of CKD, early detection of kidney damage, aggressive management of underlying chronic conditions, and judicious use of potentially nephrotoxic medications. A coordinated approach involving public health policy, clinical practice, and patient education is essential to mitigate the rising global impact of kidney failure and improve outcomes across diverse populations.

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