Manifesto

KIDNEY HEALTH MATTERS
DRIVING GLOBAL ACTION WITH EVIDENCE AND IMPACT

INTRODUCTION

This Call for Global Action emphasizes the need for UN Member States to prioritize kidney health within global NCD strategies and highlights the silent epidemic that affects over 850 million people worldwidei. The International Society of Nephrology (ISN) presents this document ahead of the Fourth UN High-Level Meeting in September 2025. The document advances key advocacy messages and policy recommendations specifically directed at UN Member States and policymakers at national, regional and local levels.

By implementing evidence-based interventions, progress on global Non-Communicable Diseases (NCD) targets for 2025ii and related commitments in Sustainable Development Goals 3.4 and 3.8 can be accelerated for an equitable and healthier world. However, progress will require strong leadership that transforms commitments into action.

Act Now for Kidney Health: A Global Call to UN Member States

  • Keep advocating for better access to kidney care
  • Improve primary and secondary prevention of kidney disease and its adverse consequences (including kidney failure) worldwide
  • Develop sustainable models of kidney care
  • Nurture education and awareness of kidney disease and its major risk factors
  • Enhance early detection and treatment of kidney disease, particularly in low-resource settings
  • Yield increased investments in research and innovation for optimal kidney care.

WHY KIDNEY DISEASE NEEDS GLOBAL ACTION

  1. Increasing numbers of people affected: Kidney disease affects over 850 million people, representing more than 10% of the world’s populationiii, especially in low- and lower-middle-income countries (LLMICs). Kidney disease is a major cause of premature mortality and is anticipated to become the fifth leading cause of death worldwide by 2050iv. Further, kidney failure has a huge societal impact with associated costs consuming ~5% of healthcare budgets, an unsustainable expenditure particularly for low-resource settings.
  2. High economic burden: Kidney disease imposes crushing financial burdens on families and healthcare systems worldwide. In LLMICs, 90% of those requiring dialysis cannot afford it, leading to millions of deaths per yearv. Kidney replacement therapy (KRT- dialysis and transplant) already accounts for 2-4% of health budgets in high-income countries, and the need for KRT is expected to double by 2030.v
  3. Intersection with other NCDs: Kidney disease significantly amplifies the risks associated with hypertension, diabetes and cardiovascular disease. In LLMICs, 1 in 5 people with hypertension and 4 in 10 people with diabetes develop kidney disease. However, most do not have access to timely diagnosis and treatmentvii viii, and kidney failure is a death sentence for many due to lack of access to KRT. The status quo underscores the urgent need for effective treatment of kidney disease in people with other chronic conditions.
  4. Social and environmental dimensions: Kidney health is deeply influenced by social determinants, environmental factors and climate change, particularly in LLMICs. Poverty, malnutrition and limited prenatal care significantly increase susceptibility to kidney disease, while limited access to kidney care and inadequate treatment coverage further exacerbate health inequalities. Each 1°C increase in global temperature predicts a 30% increase in kidney disease morbidity due to heat stress and dehydrationix. Kidney replacement therapies (KRT) have significant environmental impact including high energy consumption, excessive water use and plastic waste.

THE TIME TO ACT IS NOW

To tackle the rising burden of kidney disease, we call on UN Member States to commit to:

Keep improving access to kidney care

  1. Prioritize kidney disease within national and regional NCD programs and set national deadlines for NCD plan implementation, aligning strategies with SDG 3.4 to ensure reduction of mortality by 2030. This includes implementing WHO’s NCD “best buys” outlined in the WHO Global NCD Action Plan Appendix 3x.
  2. Set specific kidney care targets, such as a 20% reduction in kidney disease-related mortality by 2030, aligned with the WHO NCD Global Monitoring Frameworkxi.
  3. Ensure access to the full continuum of kidney care by strengthening health systems to provide integrated services across prevention, early detection, and specialized treatments, including dialysis and kidney transplantation.

Improve primary and secondary prevention of kidney disease and its adverse consequences (including kidney failure) worldwide

  1. Strengthen public health initiatives to address key risk factors for kidney disease, including obesity, diabetes, hypertension, cardiovascular diseases, eclampsia, physical inactivity, dietary habits, and tobacco use.
  2. Promote early detection and timely management of kidney disease, focusing on evidence-based interventions in primary care to reduce the risk of complications.
  3. Implement programs that consider gender-specific health risks, such as higher susceptibility to kidney disease in women due to recurrent urinary tract infections and pregnancy-related complications.

Develop sustainable models of kidney care

  1. Improve access to kidney transplantation and other key kidney-related therapies, including the inclusion of proven, cost-effective kidney medicationsxii on the WHO Essential Medicines List and the Universal Health Coverage package.
  2. Promote multisectoral collaborations to adapt and share innovative, evidence-based practices for integrating kidney care into primary healthcare.
  3. Address the environmental impact of kidney replacement therapies by investing in green technologies, optimizing resource efficiency, and reducing waste.
  4. Establish and promote green certification standards for kidney care facilities.

Nurture education and awareness of kidney health and its major risk factors

  1. Prioritize the prevention of kidney disease by investing in public health campaigns.
  2. Engage patients, communities, and healthcare providers in co-designing evidence-based health promotion strategies that support prevention and control of kidney disease and other NCDs.
  3. Incorporate culturally relevant kidney health education into school curricula, workplace wellness programs, and community outreach.

Enhance early detection and treatment of kidney disease, particularly in low-resource settings

  1. Prioritize investment in early detection for high-risk populations, such as those with diabetes, hypertension and cardiovascular disease.
  2. Adapt existing early detection programs for use in primary care settings, enabling cost-effective, evidence-based intervention and better clinical outcomes.
  3. Implement tailored programs to improve kidney care access for vulnerable groups, ensuring gender equity, support for indigenous populations, and inclusive healthcare delivery in underserved regions.
  4. Integrate kidney health initiatives into public health strategies for poverty reduction, clean water access, and environmental protection.

Yield increased investments in research and innovation for optimal kidney care.

  1. Establish and maintain national kidney registries to track incidence, prevalence, and outcomes, and thus inform evidence-based policymaking.
  2. Support research that identifies and addresses regional risk factors, while building local capacity to effectively translate research findings into action.
  3. Strengthen international and public-private partnerships to expand access to affordable, innovative, sustainable dialysis technologies, prioritizing equitable solutions for low-resource settings.

i Francis, A., Harhay, M.N., Ong, A.C.M. et al. chronic kidney disease and the global public health agenda: an international consensus. Nat Rev Nephrol 20, 473–485 (2024)

ii WHO. Sixty-Fifth World Health Assembly Resolutions, Decisions, Annexes. 2012 May 21–26

iii IBIDEM

iv Francis, A., Harhay, M.N., Ong, A.C.M. et al. chronic kidney disease and the global public health agenda: an international consensus., Ibid

iv Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021, Vollset, Stein Emil et al.

v Liyanage, Thaminda et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Ibid

vi WHO Global report on Hypertension

vii WHO HEARTS D package

viii A Strasma, CKDu: Health, Health and Harm, ASN Kidney News, April 2024

ix Updated Appendix 3 of the WHO Global NCD Action Plan 2013-2030

x WHO NCD Global Monitoring Framework

xi Including kidney transplant immunosuppressive therapies