Lab-grown kidneys and the future of chronic kidney disease in Asia

A middle-aged man in Dhaka notices swelling in his feet. He feels unusually fatigued. Weeks later, a clinical diagnosis confirms kidney failure. By then, the damage is largely irreversible.

This is how Chronic Kidney Disease often manifests. It progresses silently, with symptoms emerging only at advanced stages. What was once considered a specialised medical concern has now become one of the fastest-growing global health threats.

According to the Global Burden of Disease Study published in The Lancet, an estimated 788 million adults were living with CKD in 2023, representing nearly one in ten people worldwide. This marks a dramatic increase from 378 million in 1990. The global age-standardised prevalence is approximately 14.2 percent, with the majority of cases in early to moderate stages.

CKD is now the ninth leading cause of death globally, responsible for about 1.48 million deaths annually, and ranks twelfth in disability-adjusted life years, with an age-standardised rate of roughly 769 per 100,000 population.

CKD sits at the centre of the broader non-communicable disease burden. High fasting plasma glucose contributes around one-third of CKD-related DALYs, while hypertension accounts for nearly a quarter and elevated body mass index for more than one-fifth. Kidney dysfunction itself is implicated in over 10 percent of global cardiovascular mortality, reinforcing its systemic impact.

Despite this scale, CKD remains underdiagnosed and underprioritized in many health systems. At the same time, biomedical science is advancing in ways that could reshape the future of treatment.

Researchers at the University of Southern California’s Keck School of Medicine have developed advanced lab-grown kidney assembloids. These structures integrate nephrons, the kidney’s microscopic filtration units, with collecting duct systems responsible for urine formation. Published in Cell Stem Cell, the work led by Zhongwei Li represents one of the most sophisticated kidney organoid models to date.

These assembloids, measuring roughly one millimetre in diameter, have demonstrated the ability to connect with blood vessels when transplanted into animal models. They have shown early functional characteristics such as protein reabsorption, hormone secretion, and partial filtration. Human-derived versions exhibit filtration capacity but have not yet achieved full urine production, highlighting both progress and remaining biological constraints.

Importantly, these models are already being used to simulate diseases such as polycystic kidney disease and to test drug responses. They signal a shift from observing organ failure to attempting to engineer organ function.

For Asia, this scientific shift intersects with a rapidly escalating public health crisis. Across the region, CKD prevalence typically ranges between 10 and 20 percent. China is estimated to have over 150 million cases, while India has approximately 130 to 140 million. Southeast Asian countries report similarly rising trends, driven by diabetes, hypertension, environmental exposure, and demographic change.

In Japan, CKD prevalence is estimated at around 13 percent, reflecting an ageing population but supported by strong screening systems. South Korea reports comparable prevalence levels but benefits from early detection and universal health coverage. In contrast, many lower- and middle-income countries in South Asia face limited diagnostic capacity, resulting in late-stage presentation and higher mortality.

A distinct pattern has also emerged in parts of South and Southeast Asia, where chronic kidney disease of unknown etiology has been reported among agricultural workers, particularly in regions of Sri Lanka and parts of India. These cases are often associated with heat stress, dehydration, and environmental toxins, underscoring the complex interaction between occupation, climate, and health.

In Bangladesh, CKD represents a growing but under-recognized public health emergency. Estimates suggest that between 16 and 22 percent of the population may be affected, with some systematic reviews placing prevalence at over 22 percent. With a population exceeding 170 million, this translates into tens of millions of individuals living with some stage of kidney disease.

Each year, approximately 35,000 to 40,000 patients progress to end-stage kidney disease. However, treatment capacity remains severely constrained. The country has only a few hundred nephrologists and fewer than 200 dialysis centres, most concentrated in major cities. As a result, geographic and financial barriers significantly limit access.

Hemodialysis remains the dominant treatment modality, while peritoneal dialysis is underutilized. Kidney transplantation rates remain low, at roughly 1 to 1.2 per million population, far below global averages. It is estimated that only 10 to 20 percent of patients requiring renal replacement therapy are able to receive it.

The financial burden is substantial. Dialysis costs, transplant expenses, and long-term medication requirements create significant out-of-pocket expenditure in a system with limited insurance coverage. For many households, treatment leads to catastrophic health spending.

In high-income settings, the trajectory of kidney disease differs significantly. In the United States, approximately 15 per cent of adults are estimated to have CKD, but widespread screening and insurance coverage through programs such as Medicare enable earlier intervention. The country performs more than 20,000 kidney transplants annually and maintains one of the largest dialysis networks globally.

In United Kingdom, CKD prevalence is estimated at around 10 per cent. The publicly funded health system supports early diagnosis, routine monitoring, and equitable access to dialysis and transplantation. Similarly, countries such as Germany and Australia maintain high treatment coverage rates, supported by robust healthcare financing systems.
Even in these contexts, however, demand for donor organs far exceeds supply. Waiting lists remain long, and the global transplant system continues to depend heavily on organ donation.

Lab-grown kidneys offer a potential alternative to this donor-dependent system. In principle, organs could be engineered using a patient’s own cells, reducing the risk of immune rejection and eliminating the need for lifelong immunosuppressive therapy.

Such technology could also address ethical concerns associated with organ trafficking and black-market transplants, which remain persistent issues in parts of Asia.

However, the transition from laboratory models to clinically transplantable organs remains a significant scientific challenge. Scaling up organoids, ensuring full vascular integration, achieving long-term functionality, and meeting regulatory standards will require sustained research and investment.

Equally important are questions of access and affordability. Advanced biomedical technologies often emerge within high-cost research ecosystems. Without deliberate policy intervention, they risk becoming accessible only to a small segment of the global population.

For Asian countries, the implications are both urgent and strategic.
Investment in biotechnology and regenerative medicine must expand, not only through national initiatives but also through regional collaboration. Strengthening public research institutions, building clinical trial capacity, and developing ethical regulatory frameworks will be essential.
At the same time, CKD prevention must remain a priority. Controlling diabetes and hypertension, improving water quality, reducing environmental exposure, and expanding early screening programs are critical components of any sustainable response.

Health financing reforms are equally important. Expanding insurance coverage, subsidizing dialysis, and supporting transplant programs can reduce the economic burden on households while improving survival outcomes.

The emergence of lab-grown kidney structures signals a broader shift in medical thinking. Organ failure is no longer viewed solely as an irreversible endpoint. Increasingly, it is being approached as a condition that may be managed, repaired, or even reversed through technological intervention.
These kidney assembloids are still at an early stage of development. They measure only a millimetre in size and cannot yet replace a functioning human organ. Yet their significance lies in what they represent.

In a region where millions face limited treatment options, rising healthcare costs, and preventable mortality, they point toward a future in which organ failure may no longer be synonymous with fatal decline.

For Asia, the challenge is not only to observe this transformation, but to shape it.

* Nafew Sajed Joy is a writer, researcher, and environmentalist. He can be reached at [email protected].