Global, regional, and national burden inequality of chronic kidney disease, 1990-2021: a systematic analysis for the global burden of disease study 2021

Abstract

Background: Chronic kidney disease (CKD) is a significant global health issue, often linked to diabetes, hypertension, and glomerulonephritis. However, aggregated statistics can obscure heterogeneity across subtypes, age, gender, and regions. This study aimed to analyze global CKD trends from 1990 to 2021, focusing on age, gender, socio-demographic index (SDI), and regional variations.

Methods: Data were extracted from the Global Burden of Disease (GBD) 2021 database, covering prevalence, incidence, mortality, and disability-adjusted life years (DALYs). These were presented as counts per 100,000 population and age-standardized rates, with uncertainty intervals (UIs) to highlight variability. Joinpoint regression was used to assess trends over the 30-year period.

Results: In 2021, global CKD prevalence was 359 million, with 11.13 million new cases, 1.53 million deaths, and 44.45 million DALYs-up 92, 156, 176, and 114% since 1990. While prevalence slightly declined, incidence, mortality, and DALYs increased significantly. CKD burden varied by region and age, with notable gender disparities.

Conclusion: The study highlights a dramatic rise in CKD burden linked to population growth and aging, emphasizing the need for targeted treatment and effective global healthcare policies.

Keywords: chronic kidney disease; disability-adjusted life years; global burden of disease; incidence; mortality; prevalence.

Figure 1

The current subtypes of CKD featured in GBD 2021 and the complications that lead to other systemic diseases (created with BioRender.com).

Figure 2

Global distribution of the burden of chronic kidney disease in 2021. (A) Age standardized prevalence rate (per 100,000 population), both sexes; (B) Age standardized incidence rate (per 100,000 population), both sexes; (C) Age standardized mortality rate (per 100,000 population), both sexes; (D) Age standardized disability-adjusted life rate (per 100,000 population), both sexes.

Figure 3

Contribution of T1DM, T2DM, glomerulonephritis, hypertension, and other causes to the disease burden of CKD, both sexes, globally and by region, in 1990 and 2021. (A) Contribution to prevalence cases of CKD; (B) Contribution to incidence cases of CKD; (C) Contribution to mortality cases of CKD; (D) Contribution to DALYs cases of CKD. CKD, chronic kidney disease; DALYs, disability-adjusted life years; T1DM, type 1 diabetes mellitus; T2DM, type 2 diabetes mellitus.

Figure 4

Heat map and development trends for the five subtypes disease indicators of CKD from 1990 to 2021. (A) The prevalence of five subtypes of CKD; (B) The incidence of five subtypes of CKD; (C) The mortality of five subtypes of CKD; (D) The DALYs of five subtypes of CKD; (E) Changes in the prevalence of five subtypes of CKD; (F) Changes in the incidence of five subtypes of CKD; (G) Changes in the mortality of five subtypes of CKD; (H) Changes in the DALYs of five subtypes of CKD. CKD, chronic kidney disease; DALYs, disability-adjusted life years; T1DM, type 1 diabetes mellitus; T2DM, type 2 diabetes mellitus.

Figure 5

Global temporal trends in CKD disease burden, 1990–2021. (A) ASPR in different sexes; (B) ASIR in different sexes; (C) ASMR in different sexes; (D) ASDR in different sexes. CKD, chronic kidney disease; DALY, disability-adjusted life year; ASPR, Age standardized prevalence rate; ASIR, Age standardized incidence rate; ASMR, Age standardized mobility rate; ASDR, Age standardized DALYS rate.

Figure 6

Sex and age-structured analysis of CKD disease burden in 2021. (A) Prevalence rates; (B) Incidence rates; (C) Mortality rates; (D) DALYs rates. CKD, chronic kidney disease; DALYs, disability-adjusted life years.

Figure 7

Joinpoint regression analysis of the CKD disease burden temporal trends, 1990–2021. (A) ASPR; (B) ASIR; (C) ASMR; (D) ASDR. CKD, chronic kidney disease; DALYs, disability-adjusted life years; ASPR, Age standardized prevalence rate; ASIR, Age standardized incidence rate; ASMR, Age standardized mobility rate; ASDR, Age standardized DALYS rate.