Global, regional, and national burden of chronic kidney disease and its underlying etiologies from 1990 to 2021: a systematic analysis for the Global Burden of Disease Study 2021 | BMC Public Health

Global level

In 2021, the worldwide number of CKD cases was 673,722,703 (95% UI: 629,095,119–722,364,096), with an age-standardized prevalence rate (ASPR) of 8006.00 per 100,000 persons (7482.12–8575.62). The global incidence of CKD involved 19,935,038 cases (18,702,793–21,170,794), with an age-standardized incidence rate (ASIR) of 233.56 per 100,000 persons (220.02–247.24). The number of deaths was 1,527,639 (1,389,377–1,638,914), with an age-standardized mortality rate (ASMR) of 18.50 per 100,000 persons (16.72–19.85). The global DALYs for CKD was 44,453,684 (40,840,762–48,508,462), with an age-standardized DALYs rate of 529.62 per 100,000 persons (486.25–577.42) (Table 1).

SDI level

In 2021, the ASPR of CKD was highest in regions with a Low-middle SDI, at 9,171.03 per 100,000 persons (95% UI: 8543.99–9848.15), and lowest in regions with a High SDI at 6733.55 per 100,000 (6322.09–7159.65). The ASIR of CKD was highest in regions with a High SDI, at 277.75 per 100,000 persons (260.70–295.01), and lowest in regions with a Low SDI at 155.00 per 100,000 (143.40–167.34). The ASMR of CKD was found to be highest in regions with a Low SDI, recorded at 29.43 per 100,000 persons (26.13–33.79), and lowest in High-middle SDI regions at 12.02 per 100,000 (10.68–13.38). The age-standardized DALYs rate for CKD was highest in regions with a Low SDI, at 791.80 per 100,000 persons (704.14–909.10), and lowest in regions with a High-middle SDI, at 324.64 per 100,000 (293.58–360.92) (Table 1).

During the period from 1990 to 2021, a slight downward trend of ASPR was observed in regions with a Middle SDI, at −0.02 per 100,000 persons (95% UI:−0.03 to −0.01) (Table 1, Supplementary Table S2, Fig. 1A). The highest increasing trend of ASIR was observed in regions with a Middle SDI, at 0.36 per 100,000 persons (0.29–0.44) (Table 1, Supplementary Table S3, Fig. 1B). The most significant increases in the ASMR and age-standardized DALYs rate were observed in High SDI regions, at 0.53 per 100,000 persons (0.46–0.60) (Table 1, Supplementary Table S4, Fig. 1C) and 0.29 per 100,000 persons (0.24–0.34) (Table 1, Supplementary Table S5, Fig. 1), respectively.

Global chronic kidney disease burden by SDI quintiles from 1990 to 2021. (A) Age-standardized prevalence rate (ASPR); (B) Age-standardized incidence rate (ASIR); (C) Age-standardized mortality rate (ASMR); (D) Age-standardized disability-adjusted life years (DALYs) rate. SDI, Socio-demographic Index. CKD, chronic kidney disease

Regional level

In 2021, the ASPR was highest in Central Asia, at 10,698.24 per 100,000 persons (95% UI: 10,022.94–11,348.10). By contrast, the region with the lowest ASPR was Western Europe at 5226.19 per 100,000 persons (4924.43–5544.20) (Table 2 and Fig. 2A). The ASIR was highest in Central Latin America, at 411.41 per 100,000 persons (390.17–431.32). The region with the lowest ASIR was Eastern Sub-Saharan Africa at 118.08 per 100,000 persons (108.97–127.55) (Table 2 and Fig. 2B). The region with the highest ASMR was Central Sub-Saharan Africa at 43.69 per 100,000 persons (33.26–56.29), the region with the lowest ASMR was Eastern Europe at 5.22 per 100,000 persons (4.73–5.82) (Table 2 and Fig. 2C). The age-standardized DALYs rate was highest in Central Latin America, at 1171.14 per 100,000 persons (1054.82–1316.26), lowest in Eastern Europe, at 204.68 per 100,000 persons (180.40–232.13) (Table 2 and Fig. 2D).

Global distribution of chronic kidney disease burden in 2021. (A) Age-standardized prevalence rate; (B) Age-standardized incidence rate; (C) Age-standardized mortality rate; (D) Age-standardized DALYs rate. DALYs, disability-adjusted life-years

From 1990 to 2021, East Asia exhibited the most significant downward trend of ASPR, at −0.12 per 100,000 persons (95% UI: −0.13 to −0.10). Andean Latin America exhibited the most significant increasing trend of ASIR, at 0.85 per 100,000 persons (0.71–1.00). High-income North America experienced the most significant upward trends in ASMR and age-standardized DALYs rate, at 1.47 per 100,000 persons (1.39–1.55) and 0.91 per 100,000 persons (0.82–1.00), respectively (Table 2).

National level

In 2021, Republic of Mauritius (11,411.55 per 100,000 persons; 95% UI: 10,649.12–12,263.72) had the highest ASPR of CKD. Conversely, French Republic (4368.82 per 100,000 persons; 4085.59–4698.68) exhibited the lowest ASPR (Fig. 2A and Supplementary Table S6). From 1990 to 2021, the Republic of Guatemala (0.10 per 100,000 persons; 0.06–0.14) experienced the most substantial relative increase in ASPR (Supplementary Table S7). In 2021, the country with the highest ASIR was the Kingdom of Saudi Arabia at 495.83 per 100,000 persons (465.09–529.64). Republic of Uganda (106.71 per 100,000 persons; 97.77–116.52) exhibited the lowest ASIR (Fig. 2B and Supplementary Table S8). Significant changes of ASIR from 1990 to 2021 were particularly evident in Republic of Estonia (1.07 per 100,000 persons; 0.93–1.23) (Supplementary Table S9). In 2021, Republic of Mauritius (80.13 per 100,000 persons; 74.12–84.55) had the highest ASMR. Republic of Belarus (2.35 per 100,000 persons; 1.94–2.78) had the lowest ASMR (Fig. 2C and Supplementary Table S10). From 1990 to 2021, the country with the largest increase in ASMR was Ukraine (17.15 per 100,000 persons; 12.5–22.21) (Supplementary Table S11). For more information about DALYs of CKD, see Fig. 2D and Supplementary Tables S12 and S13.

Burden of global CKD due to different causes

In 2021, the global ASPR of CKD due to T1DM, T2DM, hypertension, glomerulonephritis, other and unspecified causes were documented as 77.31 (95% UI: 66.91–87.58), 1259.63 (1161.99–1359.92), 291.19 (272.49–311.88), 129.94 (120.25–139.51), 6247.94 (5823.88- 6691.38), respectively. The global ASIR of CKD due to the above 5 causes were 1.31 (1.12–1.55), 23.07 (21.40–24.72), 14.97 (14.02–15.93), 4.84 (4.42–5.29), 189.36 (178.21- 200.61), respectively. The global AMIR of CKD due to different causes were 1.08 (0.83–1.38), 5.72 (4.83–6.79), 5.54 (4.68–6.41), 2.34 (1.96–2.74), 3.81 (3.20–4.41), respectively, and the age-standardized DALYs rate due to different causes were 45.20 (36.01–56.35), 131.08 (112.75–152.49), 128.41 (109.14–145.64), 84.47 (73.20–96.13), 140.45 (122.56–159.28), respectively (Table 3). It can be seen that the number one cause of death for CKD was T2DM, with the highest absolute number of deaths due to T2DM in 2021 at 454,359 (381,290–524,688). In addition to other and unspecified causes, the most common cause of prevalence, incidence, and DALYs for CKD was T2DM.

Regional disparities in the burden of CKD due to different causes

In 2021, throughout 21 GBD regions, the main reason for prevalent cases (Fig. 3A, Fig. 3E and Supplementary Table S14) and incident cases (Fig. 3B, Fig. 3F and Supplementary Table S15) of CKD was other and unspecified causes, followed by T2DM. The main causes of death and DALYs from CKD varied in different parts of the world. The leading cause of death in Andean Latin America, Caribbean, Tropical Latin America, South Asia, East Asia, and Oceania was T2DM; in High-income North America, Southeast Asia, Southern Sub-Saharan Africa, and Western Sub-Saharan Africa, it was hypertension; in Eastern Europe, Central Latin America, Central sub-Saharan Africa, and Eastern sub-Saharan Africa, it was glomerulonephritis (Fig. 3C, Fig. 3G and Supplementary Table S16). The leading cause of DALYs in High-income North America, Andean Latin America, the Caribbean, Tropical Latin America, East Asia, and Oceania was T2DM; in Southeast Asia, and Southern Sub-Saharan Africa, it was hypertension; in Central Latin America, Central Sub-Saharan Africa, Eastern Sub-Saharan Africa, and Western Sub-Saharan Africa, it was glomerulonephritis (Fig. 3D, Fig. 3H and Supplementary Table S17).

Number and proportion of chronic kidney disease contributed by 21 GBD regions, in 2021. (A) Number of prevalent cases; (B) Number of incident cases; (C) Number of mortality cases; (D) Number of DALYs; (E) Proportion of prevalent cases; (F)Proportion of incident cases; (G)Proportion of mortality cases; (H)Proportion of DALYs. DALYs, disability-adjusted life-years

Age and sex patterns

In 2021, the global prevalence of CKD increased with age (Fig. 4A and Supplementary Table S18). In most age groups, the prevalence was higher in females than in males (Fig. 4A and Supplementary Table S19). Overall, the global incidence of CKD increased with age. The incidence of new CKD cases was highest in older adults aged 80 to 84 years and lowest in the 5–9 age group children (Fig. 4B and Supplementary Table S20). Similarly, in most age groups, the incidence was higher in females than in males (Fig. 4B and Supplementary Table S21). The global mortality of CKD increased with age, except for those in the 5–9 and 10–14 age groups were lower than those under the age of 5 (Fig. 4C and Supplementary Table S22). The mortality of CKD was higher in males (21.91) compared to females (15.90). Likewise, the mortality was higher in males than females in all age groups (Fig. 4C and Supplementary Table S23). The DALYs rate analysis revealed a trend similar to that of mortality, with DALYs rate increasing with age. (Fig. 4D and Supplementary Table S24). Both in the overall population and across age groups, the age-standardized DALYs rate of CKD was higher in males compared to females (Fig. 4D and Supplementary Table S25).

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

Temporal joinpoint analysis

From 1990 to 2021, Joinpoint regression analysis revealed that the ASPR exhibited a global downward trend (AAPC = − 0.021%; 95% CI: − 0.025% to − 0.016%; P < 0.001). The trend for females was much the same as for the overall population (Fig. 5A and Supplementary Table S26). Global ASIR exhibited a steady upward trend (AAPC = 0.634%; 0.629% to 0.639%; P < 0.001). The ASIR was on the rise globally for both males and females (Fig. 5B and Supplementary Table S27). Similarly, the ASMR followed an upward trend (AAPC = 0.745%; 0.723% to 0.765%; P < 0.001), with the most notable increase during the 1997–2000 period (APC = 2.269%; 1.837% to 2.479%; P < 0.001) and females contributing largely to this change (Fig. 5C and Supplementary Table S28). The trend of age-standardized DALYs rate mirrored the ASMR, with an overall increase (AAPC = 0.322%; 0.299% to 0.342%; P < 0.001). The most notable increase in age-standardized DALYs rate was observed from 1996 to 2003 (APC = 0.982%; 0.870% to 1.126%; P < 0.001) (Fig. 5D and Supplementary Table S29).

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