Diabetes Now Fuels Rising Chronic Kidney Disease Despite New Treatments
CKD affects 36 million U.S. adults and diabetes-driven cases are climbing, even as kidney-protective drugs reach the market.
Summary
Chronic kidney disease affects roughly 36 million U.S. adults and its overall prevalence has barely budged over the past decade, hovering near 14.8%. But underneath that stable surface, a troubling shift is happening: kidney disease caused by diabetes increased from 4.7% to 5.7% between 2013 and 2023, even as newer kidney-protective drugs like SGLT2 inhibitors became widely available. Heart failure is also strongly linked to CKD, and researchers warn that kidney disease increasingly travels alongside heart and metabolic conditions. Critically, 87% of adults with CKD don't know they have it, making early screening — especially albuminuria testing — a key priority for anyone with diabetes, high blood pressure, or heart disease.
Detailed Summary
Chronic kidney disease is not improving in the United States despite a decade of therapeutic advances, and diabetes is increasingly driving the condition. A new analysis published in the New England Journal of Medicine, drawing on National Health and Nutrition Examination Survey data from 2013 to 2023, finds that CKD prevalence held nearly flat at around 14.8%, representing roughly 36 million adults. However, this apparent stability masks a meaningful and worrying internal shift.
The proportion of CKD cases linked to diabetes rose from 4.7% to 5.7% over the study period. Diabetes carried the highest adjusted prevalence ratio of 2.49, meaning people with diabetes were more than twice as likely to have CKD compared to those without. Heart failure was a close second, with an adjusted prevalence ratio of 2.47 by 2021–2023, reinforcing a growing pattern researchers call cardiovascular-kidney-metabolic syndrome — a dangerous cluster of interacting conditions.
Perhaps most striking is that these trends emerged despite the introduction of SGLT2 inhibitors and finerenone, medications specifically approved to protect kidney function. Blood pressure control, blood sugar management, and appropriate prescribing of kidney-protective drugs all remained suboptimal throughout the decade, the authors note. The drugs exist, but they are not reaching patients at the scale needed to move population-level outcomes.
A staggering 87% of adults with CKD are unaware they have the condition, according to CDC data. The study authors highlight albuminuria testing as an underused but powerful early-detection tool, particularly for people with diabetes, hypertension, or cardiovascular disease. Widening access to this simple urine test could meaningfully shift outcomes.
For health-conscious adults, the message is clear: if you have diabetes, high blood pressure, or heart disease, proactive kidney screening is not optional — it is essential. Early detection and appropriate treatment remain the most actionable levers available today.
Key Findings
- CKD prevalence held steady at 14.8%, affecting an estimated 36 million U.S. adults from 2013 to 2023.
- Diabetes-driven CKD rose from 4.7% to 5.7% despite availability of SGLT2 inhibitors and finerenone.
- Diabetes carried the highest CKD risk ratio at 2.49; heart failure was nearly as strong at 2.47.
- 87% of adults with CKD are unaware they have it, highlighting a critical screening gap.
- Albuminuria testing identified as a key underused tool for early kidney disease detection in high-risk adults.
Methodology
This is a news report summarizing a research letter published in the New England Journal of Medicine, a top-tier peer-reviewed journal. The underlying data come from the National Health and Nutrition Examination Survey (NHANES), a nationally representative U.S. population survey spanning 2013–2023. Cross-sectional survey design limits causal inference but provides strong population-level prevalence estimates.
Study Limitations
The NHANES data are cross-sectional, so causality cannot be established and trends reflect associations rather than mechanisms. The news article does not detail how CKD was defined or staged across survey cycles, which could affect comparability. Readers should consult the primary NEJM publication for full methodology and statistical adjustments.
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