Chronic kidney disease (CKD) affects approximately 850 million people globally, with CKD projected to become the fifth leading cause of years of life lost by 2040. The incidence and prevalence of end-stage kidney disease (ESKD) vary significantly across regions, with Asia experiencing some of the highest rates. Despite advancements in kidney replacement therapy (KRT), access remains inequitable, with low-income countries facing significant treatment gaps. In 2010, an estimated 2.284 million people died prematurely due to lack of KRT access, predominantly in Asia and Africa. By 2030, the global demand for KRT is projected to more than double, reaching 5.439 million patients, with Asia accounting for nearly half of this growth.
The economic burden of dialysis is substantial, consuming 2–3% of healthcare budgets in high-income countries while serving less than 0.03% of the population. Cost disparities exist between hemodialysis (HD) and peritoneal dialysis (PD), with PD often being more cost-effective, particularly in high-income countries. For instance, Hong Kong's "PD First" policy has demonstrated the sustainability of home-based therapies, with 68% of dialysis patients on PD. However, in low-income countries, PD costs remain prohibitively high, exacerbating accessibility challenges. Home based dialysis therapies are optimal modalities balancing the cost as well as the quality of life and outcome of the patients
Addressing the global burden of kidney disease requires multifaceted strategies, including policy interventions to promote cost-effective therapies, investments in healthcare infrastructure, and international collaboration to expand KRT access in underserved regions. Sustainable solutions must balance economic constraints, patient preferences, and clinical outcomes to ensure equitable care for the growing ESKD population. Prevention of CKD and use of kidney transplantation are important means to help address the long term problem of this global epidemics
