Burden of Chronic Kidney Disease in India: Past, Present, and Future Projections to 2040 from the Global Burden of Disease 2021 Study

Background: Chronic kidney disease (CKD) is among the fastest-rising causes of mortality in India, yet national projections of its future burden are scarce. We quantified the current CKD burden and forecast trajectories to 2040 under alternative scenarios. Methods: Using Global Burden of Disease (GBD) 2021 estimates, we assessed CKD outcome data. Projections to 2040 were generated under: (i) flat-rate (stable age-specific rates), (ii) trend (continuing average annual percent change from 2010–2021), and (iii) policy scenario (achieving risk factor control targets), with population forecasts from the Institute for Health Metrics and Evaluation. Results: In 2021, CKD caused 175,637 deaths (ASR 12.4 per 100,000; 95% UI 10.4–14.9) and 6.49 million DALYs (ASR 459 per 100,000; UI 393–534). Prevalence reached 128.0 million cases (9.3% of the population), with 2.24 million incident cases. Under flat-rate projections, CKD deaths will rise to 396,000 (UI 332,000–473,000) and DALYs to 14.6 million (UI 12.5–17.0 million) by 2040. In the trend scenario, deaths escalate to 556,000 (UI 465,000–671,000) and DALYs to 17.8 million (UI 15.4–20.7 million). Compared with the trend, achieving policy targets could avert 83,000 deaths and 2.3 million DALYs annually by 2040. Conclusion: By 2040, CKD is projected to become a top-five cause of death in India, with mortality potentially exceeding half a million annually. The contrast between trend and policy scenarios highlights a substantial preventable burden. Strengthening diabetes and hypertension control, integrating an early CKD detection program, and ensuring equitable access to renal replacement therapy are urgently needed to bend the trajectory.