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. 2022 Oct 10;16(2):312-321.
doi: 10.1093/ckj/sfac218. eCollection 2023 Feb.

Temporal trends in prevalence and mortality for chronic kidney disease in China from 1990 to 2019: an analysis of the Global Burden of Disease Study 2019

Yang Li  1   2   3 , Yichun Ning  1   2   3 , Bo Shen  1   2   3 , Yiqin Shi  1   2   3 , Nana Song  1   2   3 , Yi Fang  1   2   3 , Xiaoqiang Ding  1   2   3
Affiliations

Temporal trends in prevalence and mortality for chronic kidney disease in China from 1990 to 2019: an analysis of the Global Burden of Disease Study 2019

Yang Li et al. Clin Kidney J. .

Abstract

Background: This study aimed to characterize the temporal trends of chronic kidney disease (CKD) burden in China during 1990-2019, evaluate their age, period and cohort effects, and predict the disease burden for the next 10 years.

Methods: Data were obtained from the Global Burden of Disease (GBD) 2019 study. Join-point regression model was used to estimate the average annual percentage change (AAPC) of CKD prevalence and mortality, and the age-period-cohort analysis was used to estimate the age, period and cohort effects. We extended the autoregressive integrated moving average (ARIMA) model to predict the disease burden of CKD in 2020-2029.

Results: In 2019, there were 150.5 million cases of (10.6%) and 196 726 deaths from (13.8 per 100 000 general population) CKD in China. Between 1990 and 2019, the prevalence and mortality rate of CKD increased significantly from 6.7% to 10.6%, and from 8.3/100 000 to 13.8/100 000. The AAPC was estimated as 1.6% and 1.8%, respectively. Females had a higher CKD prevalence of CKD but a lower mortality rate. Setting the mean level of age, period and cohort as reference groups, the risk of developing CKD increased with age [RRage(15-19) = 0.18 to RRage(85-89) = 2.45]. The cohort risk was significantly higher in the early birth cohort [RRcohort(1905-1909) = 1.56]. In contrast, the increase in age-specific CKD mortality rate after 60-64 years was exponential [RRage(60-64) = 1.24]. The cohort-based mortality risk remained high prior to the 1945-1949 birth cohorts (RRcohort ranging from 1.69 to 1.89) and then declined in the 2000-2004 birth cohort [RRcohort(2000-2004) = 0.22]. The CKD prevalence and mortality are projected to rise to 11.7% and 17.1 per 100 000, respectively, by 2029.

Conclusions: To reduce the disease burden of CKD, a comprehensive strategy that includes risk factors prevention at the primary care level, CKD screening among the elderly and high-risk population, and access to high-quality medical services is required.

Keywords: ARIMA model; age-period-cohort analysis; chronic kidney disease; disease burden; join-point regression.

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Figures

Figure 1:
Figure 1:
Trends of CKD prevalence and mortality rate in China during 1990–2019. (A) CKD prevalence; (B) age-standardized CKD prevalence; (C) CKD prevalence for different causes; (D) join-point model of CKD prevalence; (E) CKD mortality rate; (F) age-standardized CKD mortality rate; (G) CKD mortality rate for different causes; and (H) join-point model of CKD mortality rate.
Figure 2:
Figure 2:
Trends of age-specific, period-based and cohort-based variation of CKD prevalence and mortality rate in China. (A, B) Age-specific CKD prevalence and mortality rate; (C, D) period-based CKD prevalence and mortality rate; (E, F) cohort-based CKD prevalence and mortality rate.
Figure 3:
Figure 3:
Age, period and cohort effects on CKD prevalence and mortality rate in China during 1990–2019. (A–C) The red dot line represents the 95% CI of age, period and cohort effects for CKD prevalence; (D–F) the green dot line represents the 95% CI of age, period and cohort effects for CKD mortality rate.
Figure 4:
Figure 4:
Trends of CKD mortality rate and DALY rate attributable to the major risk factors in China during 1990–2019.
Figure 5:
Figure 5:
Predicted trends of CKD prevalence and mortality rate in China over the next 10 years (2020–29). Red and green lines represent the true trend of CKD prevalence and mortality rate during 1990–2019; yellow dot lines and shaded regions represent the predicted trend and its 95% CI.
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