Global, regional, and national trends in chronic kidney disease burden (1990-2021): a systematic analysis of the global burden of disease in 2021.

Abstract

Background: Chronic kidney disease (CKD) is a global health challenge with diverse etiologies. However, research on the incidence trends of CKD attributable to specific causes remains limited, and the incidence and mortality rates vary across regions. This study aims to identify the patterns and temporal trends of CKD incidence, providing valuable information for the development of targeted prevention strategies and interventions.

Methods: CKD data from the 2021 Global Burden of Disease Study (1990-2021) were analyzed by sex, region, country, cause, and Socio-demographic Index (SDI). Disease burden was assessed using age-standardized incidence (ASIR), mortality rates (ASMR), and estimated annual percentage changes (EAPC). Decomposition analysis evaluated population aging, growth, and epidemiological impacts. The autoregressive integrated moving average (ARIMA) model was used to predict the burden of CKD from 2021 to 2031, and the age-period-cohort (APC) model was employed to assess the effects of age, time, and cohort. Health inequality was analyzed using Slope Index of Inequality (SII) and Concentration Index (CI).

Results: In 2021, Saudi Arabia had the highest ASIR, while Mauritius had the highest mortality. China and India contributed the most cases and deaths. ARIMA forecasts CKD cases will rise to 22.21 million and deaths to 1.81 million by 2031. Epidemiological changes drove incidence growth in medium SDI regions and mortality in high SDI regions. EAPC correlated with ASIR and ASMR. APC analysis showed incidence peaked between 70-80 years, with earlier cohorts facing higher risks. Unknown causes, type 2 diabetes, and hypertension were the leading CKD etiologies. From 1990-2021, health inequality in CKD incidence and mortality worsened, especially in high SDI regions, where the mortality CI shifted from 0.05 to - 0.09.

Conclusions: This study estimated the temporal trends of CKD incidence and mortality globally, as well as at the national and regional levels, from 1990 to 2021. It was observed that countries with higher socio-demographic index (SDI) exhibited unfavorable trends, suggesting that these countries should develop more targeted and specific strategies to address the growing burden of CKD.