Hyderabad: Telangana shares India’s highest burden of impaired kidney function (IKF) at 7.4 per cent, more than double the national average, according to the country’s largest kidney health study, conducted by the Indian Council of Medical Research (ICMR).
Goa matches this rate, while Kerala and Odisha follow at 6.1 per cent and 6.2 per cent, respectively.
The contrast is stark: Chandigarh records just 0.6 per cent prevalence while Bihar reports 0.8 per cent. This means kidney impairment occurs more than 12 times more frequently in Telangana than in Chandigarh.
Survey details
The findings emerge from the ICMR-INDIAB project, which assessed over 25,000 adults across all 31 states and union territories.
Among the 25,408 study participants, 47.5 per cent had neither hypertension nor diabetes, 20.2 per cent had hypertension alone, 13.1 per cent had diabetes alone, and 19.2 per cent carried both conditions.
Diabetes poses greater threat than hypertension
The study reveals that diabetes carries a significantly higher risk for kidney damage than high blood pressure.
Patients with type-2 diabetes (T2D) alone are 3.2 times more likely to develop kidney impairment compared to those without these conditions, while hypertension (HTN)—high blood pressure—increases the likelihood 2.4 times. People with both conditions face six times the risk.
“Presence of T2D alone was associated with significantly higher risk of IKF compared to HTN alone,” the study states.
This finding reverses the global pattern, where hypertension typically presents the greater risk. According to the Indian CKD registry, diabetic kidney disease stands as the leading cause of chronic kidney disease nationwide at 31.1 per cent.
The national prevalence stands at 3.2 per cent, meaning roughly three out of every 100 adults in India have impaired kidney function. Urban and rural areas show nearly identical rates at 3.3 per cent and 3.2 per cent, respectively, indicating the problem affects cities and villages equally.
High diabetes burden drives regional variation
The study notes that states with higher kidney impairment rates were linked to poorer blood sugar control. Tamil Nadu reports 4.3 per cent prevalence, Puducherry 4.2 per cent, while West Bengal and Himachal Pradesh both exceed 4 per cent. Andhra Pradesh sits at 3 per cent, matching the national average, and Karnataka records just 2.1 per cent.
Researchers attribute these variations to multiple factors. “Differences in healthcare infrastructure in different states, along with environmental factors like nephrotoxin exposure and extreme temperatures or humidity, may also play a role,” they write.
Nephrotoxins include certain medications, chemicals, and environmental pollutants that damage the kidneys.
Longer uncontrolled disease duration harms kidney function
Disease duration significantly impacts kidney health.
Among people living with diabetes for less than five years, only 2.2 per cent show kidney impairment. That figure climbs steadily—in those carrying diabetes for over 20 years, 13 per cent demonstrate kidney damage. Hypertension follows a similar pattern, with people having high blood pressure lasting over two decades showing impaired kidney function in nearly one in five cases.
The prevalence varies dramatically based on condition status. People without diabetes or hypertension show kidney impairment in just 1.2 per cent of cases. Those with hypertension alone register 2.8 per cent, diabetes alone pushes the rate to 3.7 per cent, but when both combine, prevalence jumps to 8.1 per cent.
Awareness matters too. The study found significantly higher kidney impairment prevalence among those with self-reported diabetes and hypertension compared to those with newly detected conditions, suggesting that longer uncontrolled disease duration compounds kidney damage.
Kidney function declines with age
The study measured kidney health through estimated glomerular filtration rate (eGFR), which reflects how efficiently kidneys filter waste from blood. Values below 60 indicate impairment—the lower the number, the worse the kidney function.
People without diabetes or hypertension maintain healthier kidney filtration rates around 113.7, while those with both conditions drop to 94.3, approaching the impairment threshold.
The analysis reveals that 47.5 per cent of eGFR variability stems from ageing alone, with kidney function dropping approximately 1 millilitre per minute per square meter each year starting in the third decade of life.
Gender factors
Men face a higher overall risk at 3.8 per cent compared to women at 2.6 per cent. However, the yearly decline in kidney function proves steeper for women, particularly those living in urban areas with both diabetes and hypertension.
The study found that people with both hypertension and diabetes had the worst metabolic parameters for blood sugar and fat processing. Weight, waist circumference, body mass index, obesity measures, and fasting and post-meal blood glucose levels all ran significantly higher in people with diabetes, regardless of hypertension status.
Blood pressure, smoking and alcohol use were significantly higher in individuals with hypertension alone compared to those with only diabetes. These findings underscore how metabolic conditions cluster together, compounding health risks.
Call for targeted screening programs
“IKF is a significant public health concern in India, particularly among those with T2D and/or HTN,” the authors conclude. They advocate integrating serum creatinine testing into the existing National Programme for Prevention & Control of Non-Communicable Diseases, which already screens for diabetes and hypertension.
Given the relatively low cost and wide availability of creatinine testing, such an approach is scalable within the public health system. Essential enhancements include strengthening primary care infrastructure, enabling automated eGFR reporting in laboratories, and training healthcare providers in chronic kidney disease risk assessment and management.
Public health campaigns, regular screening programs, and improved healthcare access are essential steps. Educating people about lifestyle changes—managing blood pressure and blood glucose, maintaining healthy diets, and avoiding nephrotoxins—can play a key role in reducing kidney impairment prevalence and impact.
The authors note that effective evidence-based interventions are now available for reducing progression and risk of adverse outcomes, particularly in type-2 diabetes patients, offering hope for addressing this growing public health challenge.
