Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Abstract

Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. MethodsThe main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function.Findings Globally, in 2017, 1•2 million (95% uncertainty interval [UI] 1•2 to 1•3) people died from CKD. The global all-age mortality rate from CKD increased 41•5% (95% UI 35•2 to 46•5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2•8%, -1•5 to 6•3). In 2017, 697•5 million (95% UI 649•2 to 752•0) cases of all-stage CKD were recorded, for a global prevalence of 9•1% (8•5 to 9•8). The global all-age prevalence of CKD increased 29•3% (95% UI 26•4 to 32•6) since 1990, whereas the age-standardised prevalence remained stable (1•2%, -1•1 to 3•5). CKD resulted in 35•8 million (95% UI 33•7 to 38•0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1•4 million (95% UI 1•2 to 1•6) cardiovascular diseaserelated deaths and 25•3 million (22•2 to 28•9) cardiovascular disease DALYs were attributable to impaired kidney function.Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI.Funding Bill & Melinda Gates Foundation.

Inflammation and Premature Ageing in Chronic Kidney Disease

“…Because the kidneys are involved in the regulation of many systemic processes, patients with CKD are at a high risk to develop multiple systemic complications, including rheologic, metabolic, immunologic, CV, and other disturbances [42]. Importantly, several of these complications show similarities with the ageing process, such as CV diseases (CVD), sarcopenia, bone disease, as well as frailty [43,44], cognitive dysfunction [44], immune deficiency [12], and finally mortality [1]. Thus, patients with CKD appear to have a highly accelerated ageing process as compared to healthy subjects or non-CKD patients.…”

“…Chronic kidney disease (CKD) is a major global health burden that contributes to increased morbidity and mortality in affected patients [1]. Inflammation is a key risk factor for CKD progression [2], and recent data from the CANTOS trial suggest that anti-inflammatory treatment in patients with CKD reduces major adverse cardiovascular events [3].…”

The Growing Importance of Tuberculosis Preventive Therapy and How Research and Innovation Can Enhance Its Implementation on the Ground

“…However, a well-conducted cohort study in Taiwan showed that there is an increased risk of TB in early stage chronic kidney disease (CKD) [52], and it has been suggested that TB prevention efforts be targeted to all people with this condition. This recommendation needs further study because over the last 25 years, the global all-age prevalence of CKD has increased by 29% with nearly 700 million patients of all-stage CKD recorded in 2017 [53].…”

SGLT2 inhibitors and kidney outcomes in the real world

“…Chronic kidney disease affects 700 million individuals worldwide and contributes to one in 20 deaths annually 1. Globally, the age standardised mortality rate attributable to CKD has remained virtually unchanged over the past decade, in contrast to most other non-communicable chronic diseases for which these rates have fallen 12. This seemingly intractable problem is driven largely by diabetes 1.…”

“…Globally, the age standardised mortality rate attributable to CKD has remained virtually unchanged over the past decade, in contrast to most other non-communicable chronic diseases for which these rates have fallen 12. This seemingly intractable problem is driven largely by diabetes 1. It is thus not surprising that sodium glucose cotransporter 2 (SGLT2) inhibitors have garnered considerable attention following recent clinical trials showing consistent benefits of these glucose lowering drugs on major adverse kidney outcomes 3456…”