Chronic kidney disease: Pakistan’s hidden economic burden

Pakistan is not only underdiagnosing chronic kidney disease; it is also undercounting its economic cost.

For most families, chronic kidney disease does not arrive as a medical statistic. It often remains unnoticed until it reaches an advanced stage, turning a manageable health condition into a serious health and financial burden.

Globally, chronic kidney disease is now both a clinical and economic challenge. The latest global analysis estimates that around 788 million adults worldwide had chronic kidney disease in 2023, equal to about 14 percent of the adult population. It was the ninth leading cause of death globally, causing 1.48 million deaths in the same year.

For Pakistan, the problem is sharper because the disease is widespread but largely hidden. Some studies indicate chronic kidney disease prevalence of around 12–13 percent among adults. Yet most patients remain undiagnosed in the initial stages because routine screening is limited, awareness is low, and the disease is weakly integrated into primary healthcare. Many are identified only when they reach advanced disease and need dialysis.

That means the visible burden — patients in dialysis centres and hospitals — is only the tip of the iceberg. Beneath it is a larger economic burden: undiagnosed patients, delayed treatment, lost income, caregiver time, household debt, and preventable progression to kidney failure.

Chronic kidney disease becomes much more expensive as it gets worse. In the early stages, costs are mostly for tests, medicines, diabetes and blood pressure control, and regular check-ups. But once the disease reaches an advanced stage, the costs rise sharply because patients may need dialysis, hospital care, treatment for complications, and repeated travel for care.

This is where Pakistan ends up paying far more later because it fails to invest early. Chronic kidney disease can often be controlled early through basic steps such as managing blood pressure and diabetes, improving lifestyle, taking low-cost medicines, and doing simple blood and urine tests. These tests usually cost around PKR 2,500–3,500, so the bigger problem is not affordability but the lack of regular screening and awareness.

Once chronic kidney disease advances, the burden rises sharply: treatment becomes more complex, complications increase, dialysis may be needed, and costs can rise three to four times, along with more hospitalisations and productivity loss.

Dialysis is the most visible cost, but it is not the full story. Pakistan’s dialysis cost may appear lower than many developing countries. The estimated annual dialysis cost in subsidised settings is around $1,500–2,000 per patient, compared with annual costs of up to $20,000 or more in some developing countries. But a lower dollar cost does not mean treatment is affordable for Pakistani households.

With weak disposable incomes, even subsidised dialysis can be financially devastating. Families still pay for medicines, tests, transport, and repeated visits, forcing many to borrow, sell assets, cut essential spending, or even stop treatment. This is the human face of the economic burden. Chronic kidney disease does not only affect the patient. It rearranges the finances of the entire household.

Global evidence shows that lower chronic kidney disease spending in poorer countries does not mean a lower burden. It often means patients are diagnosed late, receive incomplete care, pay out of pocket, or never get treatment at all. That applies directly to Pakistan. The country may not be seeing the full cost of chronic kidney disease in official health spending because many patients never enter formal care, enter too late, or drop out because treatment is unaffordable. The economic burden is therefore not only what the state spends. It is also what households quietly lose.

The second major cost is productivity. Advanced chronic kidney disease reduces productivity. Patients may miss work, work fewer hours, or leave the workforce altogether, while family members often lose time and income providing care. In Pakistan, this burden is worse because many workers are informal and lack paid leave, insurance, or income protection. For daily-wage workers, dialysis can mean losing income for the day, while missing treatment can put their life at risk.

There is also a fiscal cost. Pakistan’s public health system is already stretched. Late-stage chronic kidney disease puts more pressure on hospitals, dialysis centres, emergency care, medicines, and subsidies, leading to expensive treatment instead of cheaper prevention and early diagnosis.

This is why chronic kidney disease should be part of Pakistan’s primary healthcare and non-communicable disease strategy, not treated only as a specialist kidney-care issue. The focus should be on early detection among high-risk groups such as people with diabetes, hypertension, heart disease, obesity, family history of kidney disease and older adults. The country does not need expensive universal screening to begin with. It needs routine testing for high-risk patients, better diabetes and blood pressure control, public awareness, affordable medicines, and financial protection for patients who need dialysis.

While prevention should remain the priority, Pakistan also needs to keep dialysis affordable for patients who reach kidney failure. Local manufacturers and suppliers, led by companies such as Renacon Pharma Limited, a Treet Corp company, have helped reduce dependence on imported dialysis inputs by producing haemodialysis concentrates and related renal-care products locally. This matters because local capacity can lower treatment costs, improve supply reliability, and help hospitals, charities, public programmes, and patients manage the burden more affordably.

That matters because every reduction in dialysis cost eases pressure on families and stretches limited public health resources further. But affordability at the dialysis stage should not distract from the larger economic point: the best way to reduce the burden is to prevent more patients from reaching dialysis in the first place.

The economic choice is clear: prevention is better than cure. The real question is not how many dialysis machines the country can add, but how many patients can be prevented from reaching dialysis in the first place — and how much financial pain can be reduced for those who still need it.

Pakistan’s chronic kidney disease burden is a hidden economic liability. The country saves too little by not screening early and pays far more later through late-stage treatment, lost labour, caregiver burden, and household poverty. The real cost of chronic kidney disease is not only what the country spends on kidney disease. It is what families lose because the disease is detected too late.