Time series analysis of chronic kidney disease prevalence and dialysis demand for sustainable healthcare planning

Introduction: Chronic Kidney Disease (CKD) prevalence and dialysis demand in India have surged steadily over the past decade, propelled by rapid aging populations, escalating hypertension (HTN), diabetes mellitus (DM), and broader non-communicable disease (NCD) epidemics. These converging factors overwhelm India's strained healthcare infrastructure, which struggles with limited dialysis centers, workforce shortages, and uneven rural access. High-burden states like Bihar face acute challenges, where rural populations endure delayed diagnoses and 2.8-fold higher demand relative to urban Delhi, exacerbating mortality and economic burdens. Methodology: This comprehensive time-series analysis synthesizes secondary data from National Family Health Surveys (NFHS-4/5, 2015-21), ICMR-INDIAB longitudinal studies (2014-22), and National Cancer Registry Programme (NCRP) dialysis registries (2012-24). Focusing on interstate variations in Delhi, Maharashtra, and Bihar, it employs Seasonal Auto Regressive Integrated Moving Average (ARIMA) models incorporating HTN/DM covariates (correlation r=0.87). Complementary Granger causality tests assess DM/HTN drivers, while age-period-cohort decomposition disentangles temporal effects. Projections extend to 2035 using ARIMA forecasts validated against GBD trends. Findings: CKD prevalence climbed from 9.2% in 2015 to 14.8% in 2024 across analyzed regions, with projections reaching 18-22% by 2035. Bihar's rural dialysis demand exceeds Delhi's by 2.8-fold, driven by underserved populations and delayed diagnoses. Models yield Average Annual Percent Change (AAPC) of 3.2% for prevalence and 4.1% for dialysis initiations; DM incidence explains 68% of prevalence variance. Elderly (≥60 years) face 28% prevalence due to cohort NCD exposures. Policy Recommendations: By 2030, India requires 1.2 million additional dialysis slots amid population growth. Policymakers should prioritize integrated NCD platforms merging NFHS with real-time hospital data, alongside mobile screening units and subsidized dialysis targeting high-burden areas like Bihar for equitable, sustainable healthcare.