Burden of chronic kidney disease and its risk-attributable burden in 137 low-and middle-income countries, 1990-2019: results from the global burden of disease study 2019

Abstract

Background: Chronic kidney disease (CKD) is a global public health concern, but its disease burden and risk-attributable burden in CKD has been poorly studied in low - and middle-income countries (LMICs). This study aimed to estimate CKD burden and risk-attributable burden in LMICs from 1990 to 2019.

Methods: Data were collected from the Global Burden of Disease (GBD) Study 2019, which measure CKD burden using the years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs) and calculate percentage contributions of risk factors to age-standardized CKD DALY using population attributable fraction (PAF) from 1990 to 2019. Trends of disease burden between 1990 and 2019 were evaluated using average annual percent change (AAPC). The 95% uncertainty interval (UI) were calculated and reported for YLDs, YLLs, DALYs and PAF.

Results: In 2019, LICs had the highest age-standardized DALY rate at 692.25 per 100,000 people (95%UI: 605.14 to 785.67), followed by Lower MICs (684.72% (95%UI: 623.56 to 746.12)), Upper MICs (447.55% (95%UI: 405.38 to 493.01)). The age-standardized YLL rate was much higher than the YLD rate in various income regions. From 1990 to 2019, the age-standardized DALY rate showed a 13.70% reduction in LICs (AAPC = -0.5, 95%UI: - 0.6 to - 0.5, P < 0.001), 3.72% increment in Lower MICs (AAPC = 0.2, 95%UI: 0.0 to 0.3, P < 0.05). Age-standardized YLD rate was higher in females than in males, whereas age-standardized rates of YLL and DALY of CKD were all higher in males than in females in globally and LMICs. Additionally, the YLD, YLL and DALY rates of CKD increased with age, which were higher in aged≥70 years in various income regions. In 2019, high systolic blood pressure, high fasting plasma glucose, and high body-mass index remained the major causes attributable age-standardized CKD DALY. From 1990 to 2019, there were upward trends in the PAF of age-standardized DALY contributions of high fasting plasma glucose, high systolic blood pressure, and high body-mass index in Global, LICs, Lower MICs and Upper MICs. The greatest increase in the PAF was high body-mass index, especially in Lower MICs (AAPC = 2.7, 95%UI: 2.7 to 2.8, P < 0.001). The PAF of age-standardized DALY for high systolic blood pressure increased the most in Upper MICs (AAPC = 0.6, 95%UI: 0.6 to 0.7, P < 0.001).

Conclusions: CKD burden remains high in various income regions, especially in LICs and Lower MICs. More effective and targeted preventive policies and interventions aimed at mitigating preventable CKD burden and addressing risk factors are urgently needed, particularly in geographies with high or increasing burden.

Keywords: Burden of disease; Chronic kidney disease; Disability-adjusted life years; Population attributable faction; Risk factors.

Fig. 1

Age-specific numbers and rates of YLDs (A), YLLs (B) and DALYs (C) of CKD, 2019. YLD=Years lived with disability. YLL = Years of life lost. DALY=Disability-adjusted life-years

Fig. 2

Age-standardized YLD (A), YLL (B) and DALY (C) rates of CKD across 137 low-and middle-income countries, 2019. YLD=Years lived with disability. YLL = Years of life lost. DALY=Disability-adjusted life-years

Fig. 3

PAF (%) of age-standardized DALY for CKD risk factors, 2019. PAF = Population-attributable faction. DALY=Disability-adjusted life-years. LICs = Low-income countries. Lower MICs = Lower-middle income countries. Upper MICs = Upper-middle income countries. HICs = High-income countries

Fig. 4

Percentage change (%) in PAF contributions of major risk factors of CKD in specific region, 1990–2019. PAF = Population-attributable faction. LICs = Low-income countries. Lower MICs = Lower-middle income countries. Upper MICs = Upper-middle income countries. HICs = High-income countries