Effects of social determinants of health on the landscape of kidney disease.

Chronic kidney disease (CKD) and acute kidney injury (AKI) are highly prevalent and are associated with high morbidity and mortality. Although diabetes and hypertension are important drivers of CKD, it can result from diverse aetiologies, including autoimmune conditions, infections, genetic factors and environmental exposures. Similarly, AKI can result from diverse aetiologies. Dynamic changes within human societies and the natural environment are shaping the landscape of AKI and CKD. Urbanization, climate change, pollution and lifestyle changes are increasingly recognized for their effects on kidney health. These macro-level social determinants of health (SDH) do not affect all regions uniformly or simultaneously; rather, variations in their intensity and timing drive changes in the etiologies and epidemiology of kidney disease. Rapidly urbanizing regions in low- and middle-income countries face more challenging and complex issues from these SDHs, which are further exacerbated by inadequate healthcare infrastructures and resource constraints. An improved understanding of the influence of SDH on kidney health is crucial not only to address challenges in disease diagnosis and management but also to predict future trends across different regions. Achieving this calls for multidisciplinary strategies that integrate measures of SDH into research, policy, and healthcare models, harness digital technologies and advance equitable global collaboration.