Globally, Chronic Kidney Disease is on the rise!
Introduction
The significant global impact of chronic kidney disease (CKD) should be highlighted. This disease affects over 10-13% of the population worldwide, surpassing 800 million individuals. CKD is more prevalent in older individuals, women, racial minorities, and those with diabetes mellitus and hypertension (Kovesdy C. P., 2022).
CKD is a non-communicable disease primarily caused by diabetes and hypertension. Cardiovascular disease is a significant contributor to early morbidity and mortality in CKD patients. The severity of CKD is quantified by a low serum creatinine-based estimated glomerular filtration rate and raised urinary albumin, which are indicators of excretory kidney function and kidney damage, respectively (Cockwell and Fisher, 2020).
Particularly burdening low- and middle-income countries, CKD has become a leading cause of mortality globally, contrasting with a decline in associated deaths for many other non-communicable diseases (NCDs) over the past two decades.
The challenges in defining CKD in epidemiological studies are due to variations in diagnostic criteria and their impact on prevalence estimates. There is an increasing prevalence of CKD globally, affecting both men and women and varying by geographic region and income level. Notably, CKD is highlighted as a leading cause of mortality worldwide, with a disproportionate burden across different regions, necessitating enhanced efforts in prevention and treatment.
Figure 1 (Source: IHME) and Table 1: The rate of DALYs (per 100,000) caused by CKD globally and in WHO regions between 2010 and 2019 for all ages and sexes.
CKD Disability Adjusted Life Years (DALYS)
Looking at the global burden of disease (GBD) data from IHME, we analysed the burden of CKD in terms of DALYs per 100,000 individuals across different regions and years (Figure 1 and Table 1)(IHME, 2020). In 2010 and 2019, the African Region experienced relatively stable rates, with values around 413 to 426 per 100,000 individuals. The Eastern Mediterranean Region showed an increase in rates from approximately 567 to 613 per 100,000 individuals during the same period. Similarly, the European Region witnessed a rise in rates from about 358 to 393 per 100,000 individuals. Notably, the Region of the Americas significantly increased rates, climbing from approximately 687 to 810 per 100,000 individuals. The Southeast Asia Region also experienced increased CKD DALY rates, rising from around 531 to 561 per 100,000 individuals. In the Western Pacific Region, CKD DALY rates increased from about 437 to 479 per 100,000 individuals.
Globally, CKD DALY rates rose from approximately 495 to 537 per 100,000 individuals between 2010 and 2019.
These trends underscore the increasing burden of CKD in terms of disability-adjusted life years across various regions, highlighting the pressing need for comprehensive strategies to address this public health challenge.
Figure 2 (Source: IHME) and Table 2: The rate of deaths (per 100,000) caused by chronic kidney disease globally and in WHO regions between 2010 and 2019 for all ages and sexes.
CKD Mortality Rates
In 2010 and 2019, the African Region had relatively stable CKD mortality rates, with approximately 11-12 deaths per 100,000 individuals. The Eastern Mediterranean Region saw a slight increase in CKD mortality rates from around 16 to 18 per 100,000 individuals during the same period. In the European Region, CKD mortality rates rose from about 16 to 19 deaths per 100,000 individuals. The Region of the Americas experienced a notable increase in CKD mortality rates, rising from approximately 26 to 32 per 100,000 individuals. Similarly, the Southeast Asia Region witnessed an increase in CKD mortality rates from around 14 to 16 per 100,000 individuals. In the Western Pacific Region, CKD mortality rates also rose from about 14 to 17 per 100,000 individuals.
Globally, CKD mortality rates increased from around 16 to 18 deaths per 100,000 individuals between 2010 and 2019.
These trends indicate a concerning rise in CKD-related mortality across various regions, underscoring the urgent need for global efforts to address this public health issue.
Conclusion
Early identification and management of CKD are crucial, particularly in countries with limited resources. Interventions that target diabetes, hypertension, and CKD will improve clinical and societal outcomes. Moreover, developing sustainable and affordable healthcare infrastructure for CKD and other NCDs must be a global priority.
In conclusion, global initiatives are urgently required to address CKD, given its widespread prevalence, increasing impact on mortality, and disparities in affected populations. Efforts aimed at preventing, detecting, and managing CKD are crucial to mitigate its devastating effects on public health.
Acknowledgement and Collaboration
One of our fellows, Fakhriya Al Rashdi, a family physician from Oman, has examined figures in previous publications and experienced the CKD burden in her practice. During her fellowship programme at our Centre, she will systematically review CKD management strategies that she can implement in her community.
Join our fellowship programme here: Postgraduate Fellowship Programme – Imperial WHO College Collaborating Centre (imperialwhocc.org)
References
- Kovesdy C. P. (2022). Epidemiology of chronic kidney disease: an update 2022. Kidney International Supplements, 12(1), 7–11. https:/doi.org/10.1016/j.kisu.2021.11.003
- Institute for Health Metrics and Evaluation (IHME). GBD Compare Data Visualisation. Global Burden of Disease (GBD) Study 2019. Seattle, WA: IHME, University of Washington, 2020. Available from http://vizhub.healthdata.org/gbd-compare. (Accessed 3/14/2024).
- Cockwell, P. and Fisher, L.-A. (2020) ‘The global burden of chronic kidney disease’, The Lancet, 395(10225), pp. 662–664. doi:10.1016/s0140-6736(19)32977-0.
