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. 2025 Dec;57(12):4209-4220.
doi: 10.1007/s11255-025-04595-y. Epub 2025 Jun 8.

Temporal trends in cross-country inequalities of chronic kidney disease attributable to temperature exposure from 1990 to 2021

Jie Kou  1 , Tengda Wei  2 , Haohao Liu  2 , Liuqiao Sun  3 , Dong Ding  4 , Shuaixing Song  5
Affiliations

Temporal trends in cross-country inequalities of chronic kidney disease attributable to temperature exposure from 1990 to 2021

Jie Kou et al. Int Urol Nephrol. 2025 Dec.

Abstract

Background: Urbanization and climate change have increased temperature extremes contributing to chronic kidney disease (CKD) risks. Using 1990-2021 Global Burden of Disease (GBD) data, we analyzed trends and disparities in CKD burden attributable to non-optimal temperatures across regions, genders, and time.

Methods: Data on CKD mortality and disability-adjusted life years (DALYs) were extracted from GBD 2021. Trends were evaluated using estimated annual percentage change (EAPC). Age-period-cohort (APC) modeling quantified age, period, and cohort effects. Age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) expressed burden per 100,000 population. Concentration indices assessed socioeconomic health inequalities, while demographic decomposition disentangled contributions of population aging, growth, and epidemiological changes.

Results: Low-temperature-attributable CKD dominated globally in 2021 (ASMR: 0.99 [0.84-1.12]; ASDR: 20.27 [17.11-23.53]), exceeding high-temperature-attributable burden (ASMR: 0.21 [- 0.01 to 0.49]; ASDR: 5.74 [0.13-12.99]). Over three decades, high-temperature burden increased markedly, while low-temperature effects remained persistently elevated. Males and older adults showed disproportionate vulnerability. Low-SDI regions exhibited heightened sensitivity to heat, whereas high-SDI regions were more affected by cold. Decomposition revealed epidemiological changes as key drivers for heat-related burden versus population aging for cold-related burden. Health inequalities intensified for heat-related outcomes but declined for cold-related impacts.

Conclusions: Non-optimal temperatures impose differential CKD burdens globally, shaped by socioeconomic disparities and demographic shifts. Targeted interventions addressing gender-, age-, and SDI-stratified vulnerabilities, coupled with climate-resilient health policies, are urgently needed to mitigate temperature-driven kidney disease risks.

Keywords: Chronic kidney disease; Global burden of disease; High-temperature; Low-temperature.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests. Ethical approval and consent to participate: Ethical approval and informed consent were waived since the GBD is a publicly available summary-level database, and no identifiable information was involved. Consent for publication: All the authors approved the final version of the manuscript for submission.

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