Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017
Boris Bikbov, Caroline Purcell, Andrew S. Levey, Mari Smith, Amir Abdoli, Molla Abebe, Oladimeji Adebayo, Mohsen Afarideh, Sanjay Kumar Agarwal, Marcela Agudelo‐Botero, Elham Ahmadian, Ziyad Al‐Aly, Vahid Alipour, Amir Almasi‐Hashiani, Rajaa Al‐Raddadi, Nelson Alvis‐Guzmán, Saeed Amini, Tudorel Andrei, Cătălina Liliana Andrei, Zewudu Andualem, Mina Anjomshoa, Jalal Arabloo, Alebachew Fasil Ashagre, Daniel Asmelash, Zerihun Ataro, Maha Atout, Martin Amogre Ayanore, Alaa Badawi, Ahad Bakhtiari, Shoshana H. Ballew, Abbas Balouchi, Maciej Banach, Sı́món Barquera, Sanjay Basu, Mulat Tirfie Bayih, Neeraj Bedi, Aminu K. Bello, Isabela M. Benseñor, Ali Bijani, Archith Boloor, Antonio Maria Borzì, Luis Alberto Cámera, Juan Jesús Carrero, Félix Carvalho, Franz Castro, Ferrán Catalá-López, Alex R. Chang, Ken Lee Chin, Sheng‐Chia Chung, Massimo Círillo, Ewerton Cousin, Lalit Dandona, Rakhi Dandona, Ahmad Daryani, Rajat Das Gupta, Feleke Mekonnen Demeke, Gebre Teklemariam Demoz, Desilu Mahari Desta, Huyen Phuc, Bruce Bartholow Duncan, Aziz Eftekhari, Alireza Esteghamati, Syeda Sadia Fatima, João Carlos Fernandes, Eduarda Fernandes, Florian Fischer, Marisa Freitas, Mohamed M. Gad, Gebreamlak Gebremedhn Gebremeskel, Begashaw Melaku Gebresillassie, Birhanu Geta, Mansour Ghafourifard, Alireza Ghajar, Nermin Ghith, Paramjit Gill, Ibrahim Ginawi, Rajeev Gupta, Nima Hafezi‐Nejad, Arvin Haj‐Mirzaian, Arya Haj‐Mirzaian, Ninuk Hariyani, Mehedi Hasan, Milad Hasankhani, Amir Hasanzadeh, Hamid Yimam Hassen, Simon I Hay, Behnam Heidari, Claudiu Herţeliu, Chi Linh Hoang, Mostafa Hosseini, Mihaela Hostiuc, Seyed Sina Naghibi Irvani, Sheikh Mohammed Shariful Islam, Nader Jafari Balalami, Spencer L James, Simerjot K Jassal, Vivekanand Jha, Jost B Jonas, Farahnaz Joukar, Jacek Jerzy Jozwiak
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. METHODS: The 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 disease-related 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.