Global trends of chronic kidney disease from 1990 to 2021: a systematic analysis for the global burden of disease study 2021.

BACKGROUND

Chronic kidney disease (CKD) is a significant global public health issue. However, the burden of CKD by etiology and trends over time remains inadequately studied.

METHODS

Data from the Global Burden of Disease Study 2021 (GBD 2021) were analyzed, including cases by region, etiology, age, and sex. Metrics included age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), age-standardized prevalence rate (ASPR), disability-adjusted life years (DALYs), and age-standardized DALYs rate (ASDR) between 1990 and 2021. The Joinpoint regression analysis was used to calculate the average annual percentage change (AAPC), and age-period-cohort (APC) analysis was performed to assess trends.

RESULTS

In 2021, CKD posed a substantial global burden, with 673,722,703 cases and 19,935,038 new cases. The incidence rate was 233.6 with an AAPC of 0.634. CKD caused 1,527,639 deaths, corresponding to a mortality rate of 18.5 and an AAPC of 0.745. DALYs associated with CKD totaled 44,453,684, with an AAPC of 0.322. CKD burden was primarily attributed to diabetes mellitus type 2 (DMT2), hypertension, and unspecified causes, affecting individuals aged 50 years and older. ASIR and ASPR were higher among females, while males had higher ASMR and ASDR. At regional and national levels, the incidence of CKD was positively correlated with the socio-demographic index (SDI), while mortality, DALYs, and prevalence negatively correlated with SDI. APC analysis revealed an elevated mortality risk (Net Drift = 0.3), increasing with age and over successive periods. Birth cohort analysis indicated higher mortality risks among individuals born after 1992.

CONCLUSION

The global burden of CKD continued to rise due to aging populations, increasing risk factors, and improved detection. While some regions showed success in reducing CKD mortality, widening disparities demanded urgent attention. Early-stage disease and modifiable risks offered prevention opportunities, but realizing this required sustained healthcare investment, especially in resource-limited settings. Therefore, coordinated efforts addressing both risk factors and disease management would be essential to reduce its growing burden.