‘Chronic kidney disease’, in which damage to or reduced function of the kidneys persists for more than three months, is a condition whose number of domestic patients has quite literally been ‘surging’ in recent years. According to the Health Insurance Review and Assessment Service’s healthcare big data, the number of chronic kidney disease patients in South Korea, about 170,000 in 2015, surpassed 346,000 in 2024, more than doubling. Among them, the number of patients whose disease has worsened to the point that dialysis is required has already exceeded 100,000. With the country’s chronic kidney disease incidence the highest in the world, voices inside and outside the medical community are calling for urgent countermeasures.

At the ‘Chronic Kidney Disease Management System’ symposium jointly held on the 11th by the Korean Society of Nephrology and the Korea Medical-Bio Journalists Association, experts unanimously stated that a national, institutional management system must be established. Park Hyung-cheon, president of the Korean Society of Nephrology (professor of nephrology at Gangnam Severance Hospital), said, “With population aging and risk factors such as diabetes and hypertension surging, we are facing a grave crisis in which the number of chronic kidney disease patients has more than doubled over the past 10 years,” and added, “Because a national-level management system for chronic kidney disease is inadequate, appropriate diagnosis·treatment opportunities are being missed and a heavy burden is being placed on national finances.”

As Chair Park noted, diabetes and hypertension are the leading causes of chronic kidney disease. Diabetes is increasing even among younger age groups, and if this trend continues, not only will the number of chronic kidney disease patients rise, but the average duration of illness will inevitably lengthen. Moreover, because the kidneys do not improve on their own and only worsen if left untreated, the disease is greatly affected by the increase in the elderly population. Indeed, according to the ‘Chronic Kidney Disease-Dialysis Specialists Fact Sheet 2026’ released that day by the Korean Society of Nephrology, as of 2024 the prevalence of chronic kidney disease among all adults nationwide was 6.3%, but in those aged 70 and older it reached 25.9%.

This disease has the problem that there are almost no symptoms in the early stages, making it hard to notice. Signs such as markedly foamy urine or swelling of the body may appear, but many cases do not. As the kidneys gradually fail to perform their functions, the ability to regulate metabolism and blood pressure declines, anemia develops, and damage occurs to the bones and blood vessels, among other problems. If the disease becomes severe and progresses to end-stage renal failure, lifelong dialysis or a kidney transplant becomes necessary. It is for this reason that Chair Park emphasizes, “If the disease can be detected early when the stage is low and the start of dialysis can be delayed by even one year, we can offer patients a second life and avert a national fiscal crisis.”

Because once damaged kidneys are difficult to restore to their original state, slowing progression is most important. Fortunately, with appropriate treatment and management, even if chronic kidney disease has already developed, it may be possible to avoid reaching the stage where dialysis, which greatly reduces quality of life, is required. The underlying causative disease should be treated first, while simultaneously improving lifestyle habits such as a low-salt diet and appropriate protein intake, smoking cessation, and weight management. Even if dialysis becomes necessary, instead of hemodialysis that requires visiting a hospital three times a week, peritoneal dialysis that patients perform at home is also possible.

It is at this point that voices are calling for the introduction of a national management system to improve patients’ quality of life and reduce National Health Insurance expenditures. First, the view is that the Chronic Kidney Disease Management Act, introduced at the National Assembly early this year, should be passed to establish a government-level steering committee and build a patient registration system. The most essential elements are accreditation of dialysis centers at medical institutions and expansion of the proportion of home-based dialysis. The aim is to enhance the safety of dialysis while enabling patients to carry out dialysis at home, thereby reducing healthcare spending.

Kim Se-jung, director of registry at the Korean Society of Nephrology (professor of nephrology at Seoul National University Bundang Hospital), explained, “More than 90% of chronic kidney disease medical costs are spent on dialysis, and as of 2023, the cost for dialysis patients alone was 2.6 trillion KRW,” and continued, “Whereas the cost for patients in the early stages of chronic kidney disease is about 100,000 KRW per year, the cost for dialysis patients reaches 28 million KRW, which is 280 times higher, so detecting the disease early can save 150 million KRW per patient.”

Taiwan is a country that succeeded in turning patient numbers to a decline by introducing such a national chronic kidney disease management system. In Taiwan, as the management program was fully implemented beginning in 2011, the number of patients began to decrease in 2019. To share Taiwan’s experience, Wu Yi-wen, head of the Department of Internal Medicine at Taipei Medical University Hospital, who attended the symposium, explained, “By introducing a stage-based management program and multidisciplinary care for chronic kidney disease starting in 2006, we achieved a 40% reduction in the risk of chronic kidney disease progression, and in recent years we have broadened policy directions to management based on artificial intelligence.”

The problem of chronic kidney disease is also directly connected to regional and essential healthcare, which have recently been receiving increased attention. For patients whose disease has become severe enough to require dialysis, dialysis is a lifeline that can lead to death if halted for only a few days, yet in rural farming and fishing areas where the elderly make up most of the population due to regional decline, it is becoming increasingly difficult even to receive dialysis. Therefore, for patients at the stage requiring dialysis, experts say the proportion of home-based peritoneal dialysis, currently stuck in the 5% range domestically, should be raised to 33% to enhance patients’ quality of life and reduce National Health Insurance expenditures. Of course, because it can be difficult for older patients to perform dialysis alone at home, assisted peritoneal dialysis with the help of a trained helper is emerging as a realistic alternative. A national support system is needed to realize this.

Hwang Won-min, public relations director of the Korean Society of Nephrology (professor of nephrology at Konyang University Hospital), said, “In some regions, even if dialysis machines are installed, it can be impossible to recruit physicians or even to staff public medical centers,” and added, “In island·farming-and-fishing rural areas with many elderly patients and poor access to medical institutions, assisted peritoneal dialysis can be an important solution.”