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

GBD Chronic Kidney Disease Collaboration, Boris Bikbov, Caroline A Purcell, Andrew S Levey, Mari Smith, Amir Abdoli, Molla Abebe, Oladimeji M Adebayo, Mohsen Afarideh, Sanjay Kumar Agarwal, Marcela Agudelo-Botero, Elham Ahmadian, Ziyad Al-Aly, Vahid Alipour, Amir Almasi-Hashiani, Rajaa M Al-Raddadi, Nelson Alvis-Guzman, Saeed Amini, Tudorel Andrei, Catalina Liliana Andrei, Zewudu Andualem, Mina Anjomshoa, Jalal Arabloo, Alebachew Fasil Ashagre, Daniel Asmelash, Zerihun Ataro, Maha Moh'd Wahbi Atout, Martin Amogre Ayanore, Alaa Badawi, Ahad Bakhtiari, Shoshana H Ballew, Abbas Balouchi, Maciej Banach, Simon Barquera, Sanjay Basu, Mulat Tirfie Bayih, Neeraj Bedi, Aminu K Bello, Isabela M Bensenor, Ali Bijani, Archith Boloor, Antonio M Borzì, Luis Alberto Cámera, Juan J Carrero, Félix Carvalho, Franz Castro, Ferrán Catalá-López, Alex R Chang, Ken Lee Chin, Sheng-Chia Chung, Massimo Cirillo, Ewerton Cousin, Lalit Dandona, Rakhi Dandona, Ahmad Daryani, Rajat Das Gupta, Feleke Mekonnen Demeke, Gebre Teklemariam Demoz, Desilu Mahari Desta, Huyen Phuc Do, Bruce B Duncan, Aziz Eftekhari, Alireza Esteghamati, Syeda Sadia Fatima, João C 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 Singh Gill, Ibrahim Abdelmageed 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 Herteliu, 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, Ali Kabir, Amaha Kahsay, Amir Kasaeian, Tesfaye Dessale Kassa, Hagazi Gebremedhin Kassaye, Yousef Saleh Khader, Rovshan Khalilov, Ejaz Ahmad Khan, Mohammad Saud Khan, Young-Ho Khang, Adnan Kisa, Csaba P Kovesdy, Barthelemy Kuate Defo, G Anil Kumar, Anders O Larsson, Lee-Ling Lim, Alan D Lopez, Paulo A Lotufo, Azeem Majeed, Reza Malekzadeh, Winfried März, Anthony Masaka, Hailemariam Abiy Alemu Meheretu, Tomasz Miazgowski, Andreea Mirica, Erkin M Mirrakhimov, Prasanna Mithra, Babak Moazen, Dara K Mohammad, Reza Mohammadpourhodki, Shafiu Mohammed, Ali H Mokdad, Linda Morales, Ilais Moreno Velasquez, Seyyed Meysam Mousavi, Satinath Mukhopadhyay, Jean B Nachega, Girish N Nadkarni, Jobert Richie Nansseu, Gopalakrishnan Natarajan, Javad Nazari, Bruce Neal, Ruxandra Irina Negoi, Cuong Tat Nguyen, Rajan Nikbakhsh, Jean Jacques Noubiap, Christoph Nowak, Andrew T Olagunju, Alberto Ortiz, Mayowa Ojo Owolabi, Raffaele Palladino, Mona Pathak, Hossein Poustchi, Swayam Prakash, Narayan Prasad, Alireza Rafiei, Sree Bhushan Raju, Kiana Ramezanzadeh, Salman Rawaf, David Laith Rawaf, Lal Rawal, Robert C Reiner Jr, Aziz Rezapour, Daniel Cury Ribeiro, Leonardo Roever, Dietrich Rothenbacher, Godfrey M Rwegerera, Seyedmohammad Saadatagah, Saeed Safari, Berhe Weldearegawi Sahle, Hosni Salem, Juan Sanabria, Itamar S Santos, Arash Sarveazad, Monika Sawhney, Elke Schaeffner, Maria Inês Schmidt, Aletta Elisabeth Schutte, Sadaf G Sepanlou, Masood Ali Shaikh, Zeinab Sharafi, Mehdi Sharif, Amrollah Sharifi, Diego Augusto Santos Silva, Jasvinder A Singh, Narinder Pal Singh, Malede Mequanent M Sisay, Amin Soheili, Ipsita Sutradhar, Berhane Fseha Teklehaimanot, Berhe Etsay Tesfay, Getnet Fetene Teshome, Jarnail Singh Thakur, Marcello Tonelli, Khanh Bao Tran, Bach Xuan Tran, Candide Tran Ngoc, Irfan Ullah, Pascual R Valdez, Santosh Varughese, Theo Vos, Linh Gia Vu, Yasir Waheed, Andrea Werdecker, Haileab Fekadu Wolde, Adam Belay Wondmieneh, Sarah Wulf Hanson, Tomohide Yamada, Yigizie Yeshaw, Naohiro Yonemoto, Hasan Yusefzadeh, Zoubida Zaidi, Leila Zaki, Sojib Bin Zaman, Nelson Zamora, Afshin Zarghi, Kaleab Alemayehu Zewdie, Johan Ärnlöv, Josef Coresh, Norberto Perico, Giuseppe Remuzzi, Chris J L Murray, Theo Vos, GBD Chronic Kidney Disease Collaboration, Boris Bikbov, Caroline A Purcell, Andrew S Levey, Mari Smith, Amir Abdoli, Molla Abebe, Oladimeji M Adebayo, Mohsen Afarideh, Sanjay Kumar Agarwal, Marcela Agudelo-Botero, Elham Ahmadian, Ziyad Al-Aly, Vahid Alipour, Amir Almasi-Hashiani, Rajaa M Al-Raddadi, Nelson Alvis-Guzman, Saeed Amini, Tudorel Andrei, Catalina Liliana Andrei, Zewudu Andualem, Mina Anjomshoa, Jalal Arabloo, Alebachew Fasil Ashagre, Daniel Asmelash, Zerihun Ataro, Maha Moh'd Wahbi Atout, Martin Amogre Ayanore, Alaa Badawi, Ahad Bakhtiari, Shoshana H Ballew, Abbas Balouchi, Maciej Banach, Simon Barquera, Sanjay Basu, Mulat Tirfie Bayih, Neeraj Bedi, Aminu K Bello, Isabela M Bensenor, Ali Bijani, Archith Boloor, Antonio M Borzì, Luis Alberto Cámera, Juan J Carrero, Félix Carvalho, Franz Castro, Ferrán Catalá-López, Alex R Chang, Ken Lee Chin, Sheng-Chia Chung, Massimo Cirillo, Ewerton Cousin, Lalit Dandona, Rakhi Dandona, Ahmad Daryani, Rajat Das Gupta, Feleke Mekonnen Demeke, Gebre Teklemariam Demoz, Desilu Mahari Desta, Huyen Phuc Do, Bruce B Duncan, Aziz Eftekhari, Alireza Esteghamati, Syeda Sadia Fatima, João C 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 Singh Gill, Ibrahim Abdelmageed 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 Herteliu, 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, Ali Kabir, Amaha Kahsay, Amir Kasaeian, Tesfaye Dessale Kassa, Hagazi Gebremedhin Kassaye, Yousef Saleh Khader, Rovshan Khalilov, Ejaz Ahmad Khan, Mohammad Saud Khan, Young-Ho Khang, Adnan Kisa, Csaba P Kovesdy, Barthelemy Kuate Defo, G Anil Kumar, Anders O Larsson, Lee-Ling Lim, Alan D Lopez, Paulo A Lotufo, Azeem Majeed, Reza Malekzadeh, Winfried März, Anthony Masaka, Hailemariam Abiy Alemu Meheretu, Tomasz Miazgowski, Andreea Mirica, Erkin M Mirrakhimov, Prasanna Mithra, Babak Moazen, Dara K Mohammad, Reza Mohammadpourhodki, Shafiu Mohammed, Ali H Mokdad, Linda Morales, Ilais Moreno Velasquez, Seyyed Meysam Mousavi, Satinath Mukhopadhyay, Jean B Nachega, Girish N Nadkarni, Jobert Richie Nansseu, Gopalakrishnan Natarajan, Javad Nazari, Bruce Neal, Ruxandra Irina Negoi, Cuong Tat Nguyen, Rajan Nikbakhsh, Jean Jacques Noubiap, Christoph Nowak, Andrew T Olagunju, Alberto Ortiz, Mayowa Ojo Owolabi, Raffaele Palladino, Mona Pathak, Hossein Poustchi, Swayam Prakash, Narayan Prasad, Alireza Rafiei, Sree Bhushan Raju, Kiana Ramezanzadeh, Salman Rawaf, David Laith Rawaf, Lal Rawal, Robert C Reiner Jr, Aziz Rezapour, Daniel Cury Ribeiro, Leonardo Roever, Dietrich Rothenbacher, Godfrey M Rwegerera, Seyedmohammad Saadatagah, Saeed Safari, Berhe Weldearegawi Sahle, Hosni Salem, Juan Sanabria, Itamar S Santos, Arash Sarveazad, Monika Sawhney, Elke Schaeffner, Maria Inês Schmidt, Aletta Elisabeth Schutte, Sadaf G Sepanlou, Masood Ali Shaikh, Zeinab Sharafi, Mehdi Sharif, Amrollah Sharifi, Diego Augusto Santos Silva, Jasvinder A Singh, Narinder Pal Singh, Malede Mequanent M Sisay, Amin Soheili, Ipsita Sutradhar, Berhane Fseha Teklehaimanot, Berhe Etsay Tesfay, Getnet Fetene Teshome, Jarnail Singh Thakur, Marcello Tonelli, Khanh Bao Tran, Bach Xuan Tran, Candide Tran Ngoc, Irfan Ullah, Pascual R Valdez, Santosh Varughese, Theo Vos, Linh Gia Vu, Yasir Waheed, Andrea Werdecker, Haileab Fekadu Wolde, Adam Belay Wondmieneh, Sarah Wulf Hanson, Tomohide Yamada, Yigizie Yeshaw, Naohiro Yonemoto, Hasan Yusefzadeh, Zoubida Zaidi, Leila Zaki, Sojib Bin Zaman, Nelson Zamora, Afshin Zarghi, Kaleab Alemayehu Zewdie, Johan Ärnlöv, Josef Coresh, Norberto Perico, Giuseppe Remuzzi, Chris J L Murray, Theo Vos

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.

Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access Article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1
Figure 1
Age-standardised rate of DALYs for chronic kidney disease in 2017 DALY=disability-adjusted life-year. ATG=Antigua and Barbuda. FSM=Federated States of Micronesia. LCA=Saint Lucia. TLS=Timor-Leste. TTO=Trinidad and Tobago. VCT=Saint Vincent and the Grenadines.
Figure 2
Figure 2
Age-standardised rate of DALYs by SDI quintiles for chronic kidney disease, 1990–2017 Shaded areas represent 95% uncertainty intervals. DALY=disability-adjusted life-year. SDI=Socio-demographic Index.
Figure 3
Figure 3
Age-standardised rate of DALYs for chronic kidney disease for 21 world regions, 1990–2017 Solid black line shows expected values across the spectrum of the SDI. DALY=disability-adjusted life-year. SDI=Socio-demographic Index.
Figure 4
Figure 4
Number (A) and rate (B) of global DALYs for CKD by underlying cause in 1990 and 2017 DALY=disability-adjusted life-year. CKD=chronic kidney disease.
Figure 5
Figure 5
Age-standardised rate of DALYs for chronic kidney disease, cardiovascular diseases, and gout, attributable to impaired kidney function, for 21 world regions in 2017 DALY=disability-adjusted life-year.

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Source: PubMed

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