Chronic and end-stage kidney disease in Indonesia: epidemiological insights and policy directions for health system strengthening

Abstract

Chronic kidney disease (CKD) is a growing health problem worldwide, and Indonesia carries a particularly high burden. However, reliable national data are limited, and many people are diagnosed late, often only when dialysis is needed. This thesis aimed to better understand CKD burden in Indonesia and how the healthcare system respond to this condition.

Using national survey data, at least 0.5% of the population has CKD, although this figure likely underestimates the true prevalence. We identified key risk factors, including male, low education, physical inactivity, hypertension, diabetes, and viral hepatitis.

A key-finding comes from diabetes and hypertension population. In this high-risk group, nearly 15% had CKD, and almost half were at moderate to very-high-risk of serious outcomes, including kidney failure and cardiovascular events. Screening in this group proved very effective: screening just seven people was enough to find one CKD case.

Diabetic kidney disease was found as the leading cause of kidney failure, and similar patterns were seen across Southeast Asia. Major gaps remain in primary care, including limited knowledge, poor guideline implementation, and weak referral systems. Overall, this thesis highlights the urgent need for earlier screening, better long-term disease management, and stronger prevention strategies tailored to Indonesia’s healthcare system.