Secular trends of epidemiologic patterns of chronic kidney disease over three decades: an updated analysis of the Global Burden of Disease Study 2019

Abstract

Objectives: To assess the characteristics of the global death burden imposed by chronic kidney disease (CKD) and the attributable risk factors from 1990 to 2019 to help inform a framework for policy discussions, resource allocation and research priorities.

Design: A population-based observational study.

Setting: The death data and relative risk factors were obtained from the Global Burden of Disease (GBD) Study 2019 database.

Main outcome measures: Based on the GBD database, we estimated the death burden attributable to CKD stratified by sociodemographic index (SDI), geographic location, sex, age group, time period and risk factors from 1990 to 2019.

Results: Over three decade study period, the global number of CKD-related deaths increased from 0.60 million (95% uncertainty interval (UI): 0.57-0.63 million) in 1990 to 1.43 million (95% UI: 1.31-1.52 million) in 2019. The age-standardised death rate (ASDR) of CKD, among all causes, increased from 15th in 1990 to 10th in 2019. Globally, the ASDR in males was higher than that in females. CKD-related deaths mainly occurred in those aged over 50 years, especially in regions with higher SDIs. The ASDR was negatively related to SDI (ρ=-0.603, p<0.0001). Among risk factors, metabolic risk factors, especially systolic blood pressure, fasting plasma glucose and body mass index, were the main contributors to CKD-related deaths. Although the high-temperature-related death burden was low, the trend increased sharply in lower SDI regions.

Conclusions: CKD-related deaths continue to increase, with the majority occurring in elderly adults. The CKD-related death burden is higher in males than in females. Additionally, the increasing high-temperature-related death burdens in lower SDI regions should receive social attention.

Keywords: chronic renal failure; epidemiology; public health.

Figure 1

Global death cases and death rate of CKD from 1990 to 2019. (A) Death cases in global and SDI areas in 1990 and 2019. (B) Death cases and ASDRs in global and SDI areas from 1990 to 2019. (C) Relationship between ASDRs and SDI from 1990 to 2019. (D) Death cases and ASDRs in 21 geographic regions from 1990 to 2019. (E) Death cases in 204 countries and territories in 2019. (F) The ASDRs in 204 countries and territories in 1990 and 2019. (G) The EAPCs of ASDRs in 204 countries and territories from 1990 to 2019. ASDR, age-standardised death rate (per 100 000 population); CKD, chronic kidney disease; EAPCs, estimated annual percentage change; SDI, sociodemographic index.

Figure 2

Sex differences and trends of CKD deaths and ASDR from 1990 to 2019. (A) The ASDRs in males and females globally from 1990 to 2019. (B) Death cases ratio between females to males (left) and ASDR ratio between females to males (right), in global and SDI areas in 1990 and 2019. (C) Gender composition of death cases and ASDR in global and SDI areas in 1990 and 2019. (D) Death cases ratio between females to males (left) and ASDR ratio between females to males (right) in 204 countries and territories in 2019. ASDR, age-standardised death rate (per 100 000 population); CKD, chronic kidney disease; SDI, sociodemographic index.

Figure 3

The distribution of CKD death cases and rates in age groups, SDI areas and 21 geographic regions from 1990 to 2019. (A) Death cases in age groups in global and SDI areas from 1990 to 2019. (B) The change percentage of death cases (right) and rate (left) in age groups from 1990 to 2019. (C) Six age groups as percentages of total deaths in global, SDI areas and 21 geographic regions in 1990 and 2019. (D) Gender composition of death in global and SDI areas in 2019. CKD, chronic kidney disease; SDI, sociodemographic index.

Figure 4

Predominant contribution of risk factors to CKD-related deaths in global and SDI areas. (A) Death cases and ASDRs attributed to main risk factors by SDI region from 1990 to 2019. (B) The ASDRs trends in SDI regions attributed to each main risk factor. (C) Proportions of deaths in global and SDI regions attributed to each risk factors in 2019. ASDR, age-standardised death rate (per 100 000 population); CKD, chronic kidney disease; SDI, sociodemographic index.