Global, Regional, and National Burden of Diabetes-Related Chronic Kidney Disease From 1990 to 2019

Abstract

Background: Chronic kidney disease (CKD) is a public health problem largely caused by diabetes. The epidemiology of diabetes mellitus-related CKD (CKD-DM) could provide specific support to lessen global, regional, and national CKD burden.

Methods: Data were derived from the GBD 2019 study, including four measures and age-standardized rates (ASRs). Estimated annual percentage changes and 95% CIs were calculated to evaluate the variation trend of ASRs.

Results: Diabetes caused the majority of new cases and patients with CKD in all regions. All ASRs for type 2 diabetes-related CKD increased over 30 years. Asia and Middle socio-demographic index (SDI) quintile always carried the heaviest burden of CKD-DM. Diabetes type 2 became the second leading cause of CKD and CKD-related death and the third leading cause of CKD-related DALYs in 2019. Type 2 diabetes-related CKD accounted for most of the CKD-DM disease burden. There were 2.62 million incident cases, 134.58 million patients, 405.99 thousand deaths, and 13.09 million disability-adjusted life-years (DALYs) of CKD-DM worldwide in 2019. Age-standardized incidence (ASIR) and prevalence rate (ASPR) of type 1 diabetes-related CKD increased, whereas age-standardized death rate (ASDR) and DALY rate decreased for females and increased for males. In high SDI quintile, ASIR and ASPR of type 1 diabetes-related CKD remained the highest, with the slowest increase, whereas the ASDR and age-standardized DALY rate remained the lowest there. In high SDI quintile, ASIR of type 2 diabetes-related CKD was the highest, with the lowest increasing rate. In addition, type 2 diabetes-related CKD occurred most in people aged 80-plus years worldwide. The main age of type 2 diabetes-related CKD patients was 55-64 years in Asia and Africa. The prevalence, mortality, and DALY rate of type 2 diabetes-related CKD increased with age. As for incidence, there was a peak at 80 years, and after age of 80, the incidence declined. CKD-DM-related anemia was mainly in mild to moderate grade.

Conclusions: Increasing burden of CKD-DM varied among regions and countries. Prevention and treatment measures should be strengthened according to CKD-DM epidemiology, especially in middle SDI quintile and Asia.

Keywords: diabetes-related chronic kidney disease; disability-adjusted life-years; incidence; mortality; prevalence.

Figure 1

The incidence, prevalence, death, and DALY rate of CKD-DM burden from 1990 to 2019. CKD-DM1-1990 represents the incidence, prevalence, death, and DALY rate of type 1 diabetes–related CKD in 1990. CKD-DM1-2019 represents the incidence, prevalence, death, and DALY rate of type 1 diabetes–related CKD in 2019. CKD-DM2-1990 represents the incidence, prevalence, death, and DALY rate of type 2 diabetes–related CKD in 1990. CKD-DM2-2019 represents the incidence, prevalence, death, and DALY rate of type 2 diabetes-related CKD in 2019. CKD-DM, chronic kidney disease caused by diabetes; DALY, disability adjusted life-year. The vertical axis is the incidence, prevalence, death, and DALY rate (per 100,000 people), and the horizontal axis is the different age-groups (years).

Figure 2

The number of type 2 diabetes–related CKD incident cases over 30 years. The vertical axis is the incident cases of type 2 diabetes–related CKD in four world regions (America, Asia, Africa, and Europe). The horizontal axis represents 30 years (1990–2019). Each column is the total number of incident cases among five age-groups (>80 years, 65–80 years, 55–64 years, 20–54 years, and <20 years) that year. CKD, chronic kidney disease.

Figure 3

The age-standardized rates for CKD-DM among SDI quintiles over 30 years. The vertical axis is the age-standardized incidence, prevalence, death, and DALY rate (per 100,000 person-years), and the horizontal axis is the 30 years (1990–2019). Each point represents the age-standardized incidence, prevalence, death, and DALY rate (per 100,000 person-years) that year. Each color and shape represents an SDI quintile (Global, High SDI, High-middle SDI, Middle SDI, Low-middle SDI, and Low SDI). CKD-DM, type 1 diabetes–related chronic kidney disease; DALY, disability adjusted life-year; ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; ASDR, age-standardized death rate; SDI, socio-demographic index.

Figure 4

The age-standardized rates of CKD-DM among 21 regions based on SDI in 2019. The vertical axis is the age-standardized incidence, prevalence, death, and DALY rate (per 100,000 person-years), and the horizontal axis is the SDI value in 2019. Each combination of colors and shapes represents a region, 21 in total. Each point represents the age-standardized incidence, prevalence, death, and DALY rate (per 100,000 person-years) that year in this region. Each combination of the same color and shape, from front to back, is the data for each year from 1990 to 2019. (A) ASIR (per 100,000 population); (B) ASDR (per 100,000 population); (C) ASPR (per 100,000 population); (D) Age-standardized DALY rate (per 100,000 population). ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; ASDR, age-standardized death rate; CKD-DM, diabetes-related chronic kidney disease; DALY, disability adjusted life-year; SDI, socio-demographic index.

Figure 5

The prevalence and YLD rate of CKD-DM-related anemia at various age subgroups by gender. Each column represents the prevalence or YLD rate (per 100,000 people) of CKD-DM-related anemia (Three grades: mild, moderate, and severe). The upper column in each age-group is data for females, and the below column is for males. (A) Prevalence in 1990; (B) Prevalence in 2019; (C) YLD rate in 1990; (D) YLD rate in 2019. CKD, chronic kidney disease; YLD, years lived with disability.