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Chronic kidney disease (CKD) was forecast to increase by over 30% from 2022, while stroke and ischaemic heart disease would decrease by more than 40%. In western Europe, CKD would become the third cause of death by 2050. While proactive primary prevention has been key to addressing the burden of stroke and ischaemic heart disease, its role in CKD has been often neglected. In 2025, the World Health Organization and Kidney Disease: Improving Global Outcomes produced documents emphasizing maintenance of kidney health and GBD updated the global epidemiology estimates for CKD and kidney replacement therapy (KRT). The new data support the previous estimate that there are 850 million people with kidney disease globally, of whom 4.6 million are on KRT, and 1.5 million people annually (one every 20 seconds) die from CKD. In Europe, an estimated 93.1 million adults have CKD, of whom 750\u2009000 are on KRT, and 210\u2009000 people (one every 2.5 minutes) die from CKD. Of relevance for public health planning, diabetes and hypertension accounted for \u226430% of prevalent KRT in Europe. GBD estimates extend data currently available through the European Renal Association Registry by including additional countries where prevalence of KRT is high: Germany, for example, is home to over 77\u2009000 people on KRT. Overall, these updated data confirm the severity of the global and European CKD burden and call for urgent action to develop novel strategies that expand beyond screening, early diagnosis and treatment of CKD to also encompass proactive primary prevention.<\/jats:p>","DOI":"10.1093\/ndt\/gfag040","type":"journal-article","created":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T12:50:45Z","timestamp":1772023845000},"page":"1899-1908","source":"Crossref","is-referenced-by-count":31,"title":["The updated global burden of chronic kidney disease: one death every 20 seconds"],"prefix":"10.1093","volume":"41","author":[{"given":"Alberto","family":"Ortiz","sequence":"first","affiliation":[{"name":"Division of Nephrology and Hypertension, IIS-Fundaci\u00f3n Jim\u00e9nez D\u00edaz-Universidad Aut\u00f3noma Madrid ,","place":["Spain"]},{"name":"Universidad Autonoma de Madrid Department of Medicine, , Madrid 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