CKD Burden Increasing, With Global Distribution Uneven from 1990-2021

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The age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life year (DALYs) rate of chronic kidney disease (CKD) increased from 1990 to 2021, according to findings from a recent study.¹

The research leveraged data from the Global Burden of Disease (GBD) 2021 to highlight an uneven global distribution of CKD and its attributable causes, including diabetes, hypertension, and glomerulonephritis, as well as to delineate differences in trends based on age and sex.¹

According to the National Kidney Foundation, 10% of the global population is affected by CKD. Over 2 million people worldwide currently receive treatment with dialysis or a kidney transplant, yet this number may only represent 10% of people who actually need treatment to live.²

“Despite the availability of interventions, the burden of CKD and its associated risk factors remain understudied in many parts of the world,” Ping Shuai, of the department of health management at Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, and colleagues wrote.¹ “Even in countries where data are available, awareness of the disease among the general public and health authorities is relatively low, partly leading to its progression to ESRD.”

To investigate the global, regional, and national burden of CKD and its underlying etiologies, investigators assessed data from GBD 2021, focusing specifically on 4 types of epidemiological data: incidence, prevalence, mortality, and DALYs.¹

In 2021, the worldwide number of CKD cases was 673,722,703 (95% UI, 629,095,119 to 722,364,096), with an age-standardized prevalence rate (ASPR) of 8006.00 per 100,000 persons (95% UI, 7482.12 to 8575.62). The global incidence of CKD involved 19,935,038 cases (95% UI, 18,702,793 to 21,170,794), with an ASIR of 233.56 per 100,000 persons (95% UI, 220.02 to 247.24).¹

There were 1,527,639 deaths (95% UI, 1,389,377 to 1,638,914), with an age-standardized mortality rate (ASMR) of 18.50 per 100,000 persons (95% UI, 16.72 to 19.85). The global DALYs for CKD was 44,453,684 (95% UI, 40,840,762 to 48,508,462), with an age-standardized DALYs rate of 529.62 per 100,000 persons (95% UI, 486.25 to 577.42).¹

Investigators noted the ASMR of CKD was highest in regions with a low sociodemographic index (SDI), recorded at 29.43 per 100,000 persons (95% UI, 26.13 to 33.79), and lowest in high-middle SDI regions at 12.02 per 100,000 (95% UI, 10.68 to 13.38). Similarly, the age-standardized DALYs rate for CKD was highest in regions with a low SDI, at 791.80 per 100,000 persons (95% UI, 704.14 to 909.10), and lowest in regions with a high-middle SDI, at 324.64 per 100,000 (95% UI, 293.58 to 360.92).¹

Globally, the leading cause of death for CKD was type 2 diabetes, with the highest absolute number of deaths due to type 2 diabetes in 2021 at 454,359 (95% UI, 381,290 to 524,688). In addition to “other” and “unspecified” causes, the most common cause of prevalence, incidence, and DALYs for CKD was type 2 diabetes.¹

Of note, the main causes of death and DALYs from CKD varied globally. The leading cause of death in Andean Latin America, Caribbean, Tropical Latin America, South Asia, East Asia, and Oceania was type 2 diabetes, while in high-income North America, Southeast Asia, Southern Sub-Saharan Africa, and Western Sub-Saharan Africa, it was hypertension. Additionally, investigators pointed out glomerulonephritis was the main cause of death and DALYs from CKD in Eastern Europe, Central Latin America, Central Sub-Saharan Africa, and Eastern Sub-Saharan Africa.¹

Results showed the disease burden of CKD increased with age. In most age groups, investigators noted the global prevalence and incidence of CKD were higher in females than males. However, at all ages, the global mortality rate and DALYs rate of CKD were higher in males than females.¹

Joint point regression analysis found that from 1990 to 2021, the global ASPR exhibited a downward trend (AAPC, − 0.021%; 95% CI, − 0.025% to − 0.016%; P <.001) while global ASIR exhibited a steady upward trend (AAPC, 0.634%; 95% CI, 0.629% to 0.639%; P <.001).¹

Similarly, investigators observed an upward trend for ASMR (AAPC, 0.745%; 95% CI, 0.723% to 0.765%; P <.001), with the most notable increase occurring during the 1997–2000 period (APC, 2.269%; 95% CI, 1.837% to 2.479%; P <.001). The trend for age-standardized DALYs mirrored ASMR, with an overall increase (AAPC, 0.322%; 95% CI, 0.299% to 0.342%; P <.001). The most notable increase in age-standardized DALYs rate was observed from 1996 to 2003 (APC, 0.982%; 95% CI, 0.870% to 1.126%; P <.001).¹

“The findings indicated a continued increase in the disease burden. Healthcare providers should recognize that population growth and social aging will result in an increasing number of people at risk for CKD,” investigators concluded.¹ “Targeted primary prevention, secondary prevention, and care strategies should be optimized according to age, sex, region, and type of disease.”

References

1. Deng L, Guo S, Liu Y, et al. 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. doi:10.1186/s12889-025-21851-z

2. National Kidney Foundation. Global Facts: About Kidney Disease. Accessed February 21, 2025. https://www.kidney.org/global-facts-about-kidney-disease