Global trends of chronic kidney disease from 1990 to 2021: a systematic analysis for the global burden of disease study 2021

Abstract

Background: Chronic kidney disease (CKD) is a significant global public health issue. However, the burden of CKD by etiology and trends over time remains inadequately studied.

Methods: Data from the Global Burden of Disease Study 2021 (GBD 2021) were analyzed, including cases by region, etiology, age, and sex. Metrics included age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), age-standardized prevalence rate (ASPR), disability-adjusted life years (DALYs), and age-standardized DALYs rate (ASDR) between 1990 and 2021. The Joinpoint regression analysis was used to calculate the average annual percentage change (AAPC), and age-period-cohort (APC) analysis was performed to assess trends.

Results: In 2021, CKD posed a substantial global burden, with 673,722,703 cases and 19,935,038 new cases. The incidence rate was 233.6 with an AAPC of 0.634. CKD caused 1,527,639 deaths, corresponding to a mortality rate of 18.5 and an AAPC of 0.745. DALYs associated with CKD totaled 44,453,684, with an AAPC of 0.322. CKD burden was primarily attributed to diabetes mellitus type 2 (DMT2), hypertension, and unspecified causes, affecting individuals aged 50 years and older. ASIR and ASPR were higher among females, while males had higher ASMR and ASDR. At regional and national levels, the incidence of CKD was positively correlated with the socio-demographic index (SDI), while mortality, DALYs, and prevalence negatively correlated with SDI. APC analysis revealed an elevated mortality risk (Net Drift = 0.3), increasing with age and over successive periods. Birth cohort analysis indicated higher mortality risks among individuals born after 1992.

Conclusion: The global burden of CKD continued to rise due to aging populations, increasing risk factors, and improved detection. While some regions showed success in reducing CKD mortality, widening disparities demanded urgent attention. Early-stage disease and modifiable risks offered prevention opportunities, but realizing this required sustained healthcare investment, especially in resource-limited settings. Therefore, coordinated efforts addressing both risk factors and disease management would be essential to reduce its growing burden.

Keywords: Age-period-cohort analysis; Average annual percentage change; Chronic kidney disease; Global disease burden; Joinpoint regression analysis.

Fig. 1

AAPC of CKD in incidence, mortality, DALYs, and prevalence rates, globally, 1990–2021. (A) AAPC of CKD in incidence from 1990 to 2021. (B) AAPC of CKD in mortality from 1990 to 2021. (C) AAPC of CKD in DALYs from 1990 to 2021. (D) AAPC of CKD in prevalence from 1990 to 2021

Fig. 2

Age-standardized incidence, mortality, DALYs, and prevalence rates of CKD from 1990 to 2021. (A) Age-standardized incidence rate of CKD from 1990 to 2021. (B) Age-standardized mortality rate of CKD from 1990 to 2021. (C) Age-standardized DALYs rate of CKD from 1990 to 2021. (D) Age-standardized prevalence rate f CKD in prevalence from 1990 to 2021

Fig. 3

The difference of sex and age in age-standardized incidence, mortality, DALYs, and prevalence rates of CKD, globally, in 2021. (A) The difference of sex and age in number and age-standardized incidence rate of CKD. (B) The difference of sex and age in number and age-standardized mortality rate of CKD; (C) The difference of sex and age in number and age-standardized DALYs rate of CKD; (D) The difference of sex and age in number and age-standardized prevalence rate of CKD

Fig. 4

Age-standardized incidence, mortality, DALYs, and prevalence rates of CKD, globally and for 21 GBD regions, by SDI, 1990–2021. (A) The relationship between age-standardized incidence rate of CKD and SDI. (B) The relationship between age-standardized mortality rate of CKD and SDI. (C) The relationship between age-standardized DALYs rate of CKD and SDI. (D) The relationship between age-standardized prevalence rate of CKD and SDI. Expected values, based on SDI and disease rates in all locations, were shown as a solid line; expected values based on a calculation accounting for the SDI and disease rates across all locations. 31 points were plotted for each region and showed the observed age-standardized incidence, mortality, DALYs or prevalence rates for each year from 1990 to 2021 for that region. The shaded area indicated the 95% CI of the expected values. Points above the solid line represented a higher-than-expected burden, and those below the line showed a lower-than-expected burden

Fig. 5

Age-standardized incidence, mortality, DALYs, and prevalence rates of CKD, globally and for 204 countries and territories, by SDI, in 2021. (A) The relationship between age-standardized incidence rate of CKD and SDI. (B) The relationship between age-standardized mortality rate of CKD and SDI. (C) The relationship between age-standardized DALYs rate of CKD and SDI. (D) The relationship between age-standardized prevalence rate of CKD and SDI. Expected values, based on SDI and disease rates in all locations, were shown as a spot; expected values based on a calculation accounting for the SDI and disease rates across all locations. The shaded area indicated the 95% CI of the expected values. Points above the solid line represented a higher-than-expected burden, and those below the line showed a lower-than-expected burden

Fig. 6

Local drift with net drift values on CKD and five causes of CKD mortality rate, globally, from 1992 to 2021. Local drift with net drift values for CKD mortality from 1992 to 2021. (B) Local drift with net drift values for CKD due to DMT2 mortality from 1992 to 2021. (C) Local drift with net drift values for CKD due to hypertension mortality from 1992 to 2021. (D) Local drift with net drift values for CKD due to glomerulobephritis mortality from 1992 to 2021. (E) Local drift with net drift values for CKD due to other and unspecified causes mortality from 1992 to 2021. (F) Local drift with net drift values for CKD due to DMT1 mortality from 1992 to 2021. Net drift represents the overall annual percentage change with the corresponding 95% CI (some were too narrow to show). The values were > 0, indicating substantial increases in mortality across the study period. The values were < 0, indicating substantial reductions in mortality across the study perio