The national prevalence stands at 3.2 percent, with urban areas recording 3.3 percent and rural areas 3.2 percent.
Published Oct 24, 2025 | 7:00 AM ⚊ Updated Oct 24, 2025 | 7:00 AM
Representational image. Credit: iStock
Synopsis: India’s largest kidney health study by ICMR reveals Telangana and Goa have the highest impaired kidney function rates at 7.4%, doubling the national average of 3.2%. Southern states dominate, with diabetes as the leading risk factor, especially when combined with hypertension. The study urges integrated screening and public health measures to curb this growing issue.
Telangana and Goa share the dubious distinction of recording India’s highest rates of impaired kidney function at 7.4 percent, more than double the national average, according to a massive nationwide study by the Indian Council of Medical Research (ICMR).
Kerala follows close behind at 6.1 percent, while Odisha rounds out the top four states at 6.2 percent. The findings emerge from India’s largest kidney health assessment, which examined over 25,000 adults across all 31 states and union territories as part of the ICMR-INDIAB project.
The study establishes a clear pattern: southern states dominate the list of regions grappling with kidney problems. Tamil Nadu reports 4.3 percent prevalence, Puducherry 4.2 percent, whilst Andhra Pradesh sits at 3.0 percent, matching the national average. Karnataka bucks the southern trend, recording just 2.1 percent.
The national prevalence stands at 3.2 percent, with urban areas recording 3.3 percent and rural areas 3.2 percent. Prevalence refers to how common a condition is in a population — in this case, roughly three out of every 100 adults in India have impaired kidney function. Men face higher risk at 3.8 percent compared to women at 2.6 percent. The WHO age-standardised prevalence settles at 2.7 percent.
The numbers translate into crores. India houses over 10 crore people living with type-2 diabetes (T2D) and 31.5 crore with hypertension (HTN), the medical term for high blood pressure. The study reveals that people carrying both conditions face six times the risk of developing kidney impairment compared to those with neither.
“Presence of T2D alone was associated with significantly higher risk of IKF compared to HTN alone (Odds Ratio 3.2 vs. 2.4); however, the risk was six fold higher in individuals with both HTN and T2D,” the study reads.
An odds ratio measures how much more likely one group is to develop a condition compared to another. A ratio of 3.2 means diabetes patients are 3.2 times more likely to develop kidney impairment than people without these conditions, whilst hypertension increases the likelihood 2.4 times.
Among the 25,408 individuals studied, 12,061 (47.5 percent) had neither hypertension nor diabetes. Another 5,213 (20.2 percent) had hypertension without diabetes, whilst 3,333 (13.1 percent) had diabetes without hypertension. The remaining 4,891 (19.2 percent) carried both conditions.
The data paints a stark picture. People without diabetes or hypertension show kidney impairment in just 1.2 percent of cases. Those with hypertension alone register 2.8 percent. Diabetes alone pushes the rate to 3.7 percent. But when both conditions combine, the prevalence jumps to 8.1 percent.
According to the Indian CKD registry, diabetic kidney disease stands as the leading cause of chronic kidney disease nationwide at 31.1 percent. Chronic kidney disease (CKD) refers to long-term kidney damage that progressively worsens over months or years. The registry confirms what the current study demonstrates: in India, diabetes poses a greater threat to kidneys than hypertension.
This reverses the global pattern, where hypertension typically presents the greater risk. A previous study reported that South Asians with diabetes carried higher kidney impairment risk than those with hypertension, with odds ratios of 2.25 versus 1.57.
Duration emerges as another critical factor. Among people living with diabetes for less than five years, only 2.2 percent show kidney impairment. That figure climbs steadily. In those who have carried diabetes for more than 20 years, 13 percent demonstrate kidney damage.
Hypertension follows a similar trajectory. People with high blood pressure lasting over two decades show impaired kidney function in nearly one in five cases.
“Of those with only HTN, 28.5 percent had self-reported HTN with a median HTN duration of 2.0 (0.9 – 4.7) yr. Among those with only T2D, 48.8 percent had self-reported diabetes with a mean diabetes duration of 6.2±5.8 yr,” the study states. The median represents the middle value in a range, whilst the mean refers to the average duration.
For people carrying both conditions, awareness runs higher. “Among those who had both the conditions, 54 percent (n=2646, mean duration of HTN: 6.0±6.6 yr) and 61.2 percent (n=2992, mean duration of T2D: 7.2±6.4 yr) were already known to have HTN and T2D, respectively.” The plus-minus figures (±) indicate the standard deviation, showing how much individual cases vary from the average.
The study measured kidney health through estimated glomerular filtration rate (eGFR), which reflects how efficiently kidneys filter waste from blood. The measurement uses units of millilitres per minute per 1.73 square metres of body surface area. Values below 60 indicate impairment — the lower the number, the worse the kidney function.
Mean eGFR readings tell the progression story.
“The mean eGFR was highest among those without HTN or T2D (113.7 mL/min/1.73 m2) and lowest in those with both HTN and T2D (94.3 mL/min/1.73 m2),” the study notes. In simpler terms, people without diabetes or hypertension maintain healthier kidney filtration rates around 113.7, whilst those with both conditions drop to 94.3 — approaching the threshold for impairment.
“The decrease in eGFR for every year increase in age was around 1.0 ml/min/1.73 m2; this was greater in urban areas, females, and in those with both HTN and T2D,” the researchers report.
Age drives kidney decline across all groups. The analysis reveals that 47.5 per cent of eGFR variability stems from ageing alone. Starting in the third decade of life, kidney function drops by approximately 1 millilitre per minute per square metre each year.
The geographical variations demand attention. At the opposite end from Telangana and Kerala, Chandigarh records just 0.6 percent prevalence, whilst Bihar reports 0.8 percent. West Bengal and Himachal Pradesh join the high-prevalence group at above 4 percent. These disparities mean kidney impairment is more than 12 times more common in Telangana than in Chandigarh.
“The wide variation in IKF prevalence across Indian States/UTs warrants further investigation. It is interesting to note that states with higher IKF rates were linked to poorer glycaemic control,” the study notes.
Healthcare infrastructure differences between states may play a role.
“Differences in healthcare infrastructure in different states, along with environmental factors like nephrotoxin exposure and extreme temperatures or humidity, may also play a role, as these have been associated with increased CKD burden in in different parts of India,” the researchers write. Nephrotoxins are substances harmful to kidneys, including certain medications, chemicals, and environmental pollutants.
Weight, waist circumference, body mass index, generalised and abdominal obesity, and fasting and 2-hour blood glucose levels all ran significantly higher in people with diabetes, regardless of hypertension status, compared to other groups.
“Blood pressure (systolic and diastolic), smoking and alcohol use were significantly higher in individuals with only HTN compared to individuals with only T2D (P<0.001). Of all the three groups, the group with HTN and T2D had the worst metabolic (glycaemic and lipid) parameters,” the study states.
Systolic pressure measures the force when the heart beats, whilst diastolic measures the pressure between beats. Metabolic parameters refer to how the body processes sugar (glycaemic) and fats (lipids). The P value indicates statistical significance — numbers below 0.05 mean the findings are unlikely due to chance.
“The prevalence of IKF was significantly higher among those with self-reported HTN and those with self-reported T2D compared to those who had newly detected HTN and T2D,” the researchers found.
“In conclusion, IKF is a significant public health concern in India, particularly among those with T2D and/or HTN. Given the high burden of T2D, HTN, and other risk factors for IKF in the population, focusing on testing high-risk individuals is a practical and effective strategy,” the authors state.
The researchers advocate integrating serum creatinine testing into the existing National Programme for Prevention & Control of Non-Communicable Diseases.
“In the Indian context, the integration of serum creatinine testing into existing National Programme for Prevention & Control of Non-Communicable Diseases (NP-NCD), which is already facilitating routine screening for major CKD risk factors such as diabetes and HTN, offers a feasible and potentially effective strategy for the early detection of IKF, particularly among high-risk individuals,” they write.
“Given the relatively low cost and wide availability of creatinine testing, such an approach is likely to be scalable within the public health system. Additionally, strengthening primary care infrastructure, enabling automated eGFR reporting in laboratories, and training healthcare providers in CKD risk assessment and management are essential system-level enhancements.”
The study calls for broader public health measures. “Public health campaigns, regular screening programs, and improving access to healthcare are essential steps in addressing this issue. Educating people about lifestyle changes, such as managing blood pressure and blood glucose levels, maintaining a healthy diet, and avoiding nephrotoxins, can also play a key role in reducing the prevalence and impact of IKF,” the authors conclude.
“Also, there are now effective evidence-based interventions available for reducing the progression and risk of adverse outcomes of IKF, particularly in T2D,” they add, noting that early detection through screening programmes offers the best chance of preventing millions of Indians from progressing to severe kidney disease, dialysis, or transplant.
(Edited by Amit Vasudev)
