Global and Chinese burden of chronic kidney disease due to type 2 diabetes and associated risk factors from 1990 to 2021

doi:10.16150/j.1671-2870.2025.03.005

Abstract

Abstract:

Objective To assess the burden of chronic kidney disease (CKD) caused by type 2 diabetes (T2D) (CKD-T2D) among populations of different ages, genders, regions, and socio-demographic index (SDI) levels globally and in China from 1990 to 2021. Methods Based on data from the 2021 Global Burden of Disease Study (GBD), incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of CKD-T2D in 204 countries and regions were analyzed, with absolute numbers and their 95% uncertainty intervals (UIs) calculated. Results From 1990 to 2021, the global burden of CKD-T2D increased significantly. In 2021, there were 2 012 024 (95%UI: 1 857 800-2 154 288) new cases, marking a 167.2% (95%UI: 153.5%-182.6%) increase from 1990. The age-standardized incidence rate (ASIR) reached 23.07 per 100 000 (95%UI: 21.40-24.72), an increase of 21.0% (15.0%-27.5%) since 1990. Regional analysis showed that North Africa and the Middle East had the highest ASIR (42.802 per 100 000). Compared to 1990, China's CKD-T2D incidence rose significantly to 354,157 cases (95%UI: 321 265-382 784), with crude incidence increasing by 177.6% (95%UI: 154.8%- 205.5%) and ASIR rising slightly by 7.8% [95%UI: (-0.1%) to 17.8%]. For other indicators, crude rates increased whereas age-standardized rates declined. In 2021, CKD-T2D incidence was highest among people aged 65-74 worldwide [364 163 new cases in ages 65-69 (95%UI: 272 571-475 468) and 366 045 in ages 70-74 (95%UI: 286 728-459 891)], with males bearing a higher burden than females [65-69: males 187 097 (95%UI: 140 064-243 571), females 177 066 (95%UI: 132 338-231 769); 70-74: males 187 216 (95%UI: 146 377-234 997), females 178 830 (95%UI: 140 938-224 801)]. SDI stratification indicated that from 1990 to 2021, high-SDI regions had the highest ASIR with a continuous upward trend, while low-SDI regions had the highest mortality rates with limited improvement. Hyperglycemia, obesity, high-calorie diets, and hypertension were the main risk factors for CKD-T2D. Conclusion CKD-T2D remains a major public health issue, with a particularly high disease burden among elderly males and in low- and middle-income countries. While crude rates have risen in China, age-standardized mortality rate (ASMR) and DALYs have declined.

Key words: Chronic kidney disease, Type 2 diabetes mellitus, Global burden of disease, Age-standardized rate, Disability-adjusted life year

CLC Number:

SHI Manman, MA Yuhua, ZHENG Jinxin, KE Yanrong, WANG Yuxin, LIU Jian, WANG Weiming. Global and Chinese burden of chronic kidney disease due to type 2 diabetes and associated risk factors from 1990 to 2021[J]. Journal of Diagnostics Concepts & Practice, 2025, 24(03): 268-278.

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References 26

[1]	JHA R, LOPEZ-TREVINO S, KANKANAMALAGE H R, et al. Diabetes and renal complications: an overview on pathophysiology, biomarkers and therapeutic interventions[J]. Biomedicines, 2024, 12(5):1098.
[2]	OOI Y G, SARVANANDAN T, HEE N K Y, et al. Risk prediction and management of chronic kidney disease in people living with type 2 diabetes mellitus[J]. Diabetes Metab J, 2024, 48(2):196-207.
[3]	VAN RAALTE D H, BJORNSTAD P, CHERNEY D Z I, et al. Combination therapy for kidney disease in people with diabetes mellitus[J]. Nat Rev Nephrol, 2024, 20(7):433-446. doi: 10.1038/s41581-024-00827-z pmid: 38570632
[4]	DING X, LI X, YE Y, et al. Epidemiological patterns of chronic kidney disease attributed to type 2 diabetes from 1990-2019[J]. Front Endocrinol (Lausanne), 2024,15:1383777.
[5]	Institute for Health Metrics and Evaluation. Global health data exchange[EB/OL]. 2021. http://ghdx.healthdata.org/gbd-results-tool.
[6]	GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021[J]. Lancet,2024, 403(10440):2133-2161.
[7]	GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021[J]. Lancet, 2024, 403(10440):2100-2132. doi: 10.1016/S0140-6736(24)00367-2 pmid: 38582094
[8]	Institute for Health Metrics and Evaluation. Global Burden of Disease Study 2021 (GBD 2021) data resources[EB/OL]. 2024. https://ghdx.healthdata.org/gbd-2021.
[9]	Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease[J]. Kidney Int, 2024, 105(4S):S117-S314.
[10]	GBD 2021 Risk Factors Collaborators. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021[J]. Lancet, 2024, 403(10440):2162-2203. doi: 10.1016/S0140-6736(24)00933-4 pmid: 38762324
[11]	SOBAMOWO H, PRABHAKAR S S. The kidney in aging: physiological changes and pathological implications[J]. Prog Mol Biol Transl Sci, 2017,146:303-340.
[12]	LYTVYN Y, BJORNSTAD P, VAN RAALTE D H, et al. The new biology of diabetic kidney disease-mechanisms and therapeutic implications[J]. Endocr Rev, 2020, 41(2):202-231.
[13]	CLOTET-FREIXAS S, ZASLAVER O, KOTLYAR M, et al. Sex differences in kidney metabolism may reflect sex-dependent outcomes in human diabetic kidney disease[J]. Sci Transl Med, 2024, 16(737):eabm2090.
[14]	PIANI F, MELENA I, TOMMERDAHL K L, et al. Sex-related differences in diabetic kidney disease: A review on the mechanisms and potential therapeutic implications[J]. J Diabetes Complications, 2021, 35(4):107841.
[15]	LOEFFLER I, ZILLER N. Sex-related aspects in diabetic kidney disease-an update[J]. J Clin Med, 2023, 12(8):2834.
[16]	BOWE B, XIE Y, LI T, et al. Changes in the US burden of chronic kidney disease from 2002 to 2016: An analysis of the Global Burden of Disease Study[J]. JAMA Netw Open, 2018, 1(7):e184412.
[17]	SARAN R, ROBINSON B, ABBOTT K C, et al. US Renal Data System 2016 annual data report: epidemiology of kidney disease in the United States[J]. Am J Kidney Dis, 2017, 69(3Suppl 1):A7-A8.
[18]	SINDHU D, SHARMA G S, KUMBALA D. Management of diabetic kidney disease: where do we stand? A narrative review[J]. Medicine (Baltimore), 2023, 102(13):e33366.
[19]	NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults[J]. Lancet, 2024, 403(10431):1027-1050. doi: 10.1016/S0140-6736(23)02750-2 pmid: 38432237
[20]	ZU C, LIU M, SU X, et al. Association of body weight time in target range with the risk of kidney outcomes in patients with overweight/obesity and type 2 diabetes mellitus[J]. Diabetes Care, 2024, 47(3):371-378.
[21]	RUZE R, LIU T, ZOU X, et al. Obesity and type 2 diabetes mellitus: connections in epidemiology, pathogenesis, and treatments[J]. Front Endocrinol (Lausanne), 2023,14:1161521.
[22]	ROSENFELD R M, KELLY J H, AGARWAL M, et al. Dietary interventions to treat type 2 diabetes in adults with a goal of remission: An expert consensus statement from the American College of Lifestyle Medicine[J]. Am J Lifestyle Med, 2022, 16(3):342-362.
[23]	GALLARDO-GÓMEZ D, SALAZAR-MARTÍNEZ E, ALFONSO-ROSA R M, et al. Optimal dose and type of physical activity to improve glycemic control in people diagnosed with type 2 diabetes: A systematic review and meta-analysis[J]. Diabetes Care, 2024, 47(2):295-303.
[24]	GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Di-sease Study 2017[J]. Lancet, 2018, 392(10159):1736-1788.
[25]	NCD Countdown 2030 collaborators. NCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4[J]. Lancet, 2018, 392(10152):1072-1088. doi: S0140-6736(18)31992-5 pmid: 30264707
[26]	NUGENT R, BERTRAM M Y, JAN S, et al. Investing in non-communicable disease prevention and management to advance the Sustainable Development Goals[J]. Lancet, 2018, 391(10134):2029-2035. doi: S0140-6736(18)30667-6 pmid: 29627167

Items	Incidence	Prevalence	Mortality	DALYs
2021
Number(×1 000)	2 012.024 (1 857.800-2 154.288)	107 559.955 (99 170.797-115 994.732)	477.273 (401.541-565.951)	11 278.935 (9 682.785-13 103.871)
ASRs(/100 000)	23.074 (21.403-24.724)	1 259.627 (1 161.985-1 359.917)	5.723 (4.826-6.792)	131.082 (112.752-152.492)
2019
Number(×1 000)	1 898.285 (1 756.086-2 033.895)	103 692.703 (95 804.213-111 877.535)	452.842 (384.289-535.796)	10 649.449 (9 179.491-12 417.895)
ASRs(/100 000)	22.903 (21.208-24.569)	1 261.314 (1 164.900-1 360.483)	5.731 (4.833-6.798)	130.187 (112.440-151.504)
1990
Number(×1 000)	753.106 (680.930-826.928)	58 105.268 (53 056.992-63 286.818)	147.970 (124.179-176.413)	4 122.919 (3 498.980-4 818.958)
ASRs(/100 000)	19.073 (17.285-20.835)	1 327.225 (1 223.256-1 439.418)	4.154 (3.504-4.936)	105.710 (90.677-122.672)
Percent change (2021 vs 2019)
Number	6.0% (5.4%-6.6%)	3.7% (3.4%-4.1%)	5.4% (0.2%-10.9%)	5.9% (1.3%-10.9%)
ASRs	0.7% (0.2%-1.3%)	-0.1% (-0.5%-0.2%)	-0.1 (-4.9%-5.0%)	0.7% (-3.7%-5.4%)
Percent change (2021 vs 1990)
Number	167.2% (153.5%-182.6%)	85.1% (78.1%-91.4%)	222.5% (177.4%-253.8%)	173.6% (140.5%-194.3%)
ASRs	21.0% (15.0%-27.5%)	-5.1% (-7.5%-3.0%)	37.8% (19.2%-49.6%)	24.0% (9.3%-33.0%)

Items	Incidence	Prevalence	Mortality	DALYs
2021
Number(×1 000)	354.157 (321.265-382.784)	20 911.520 (19 184.463-2 2605.470)	107.652 (84.626-134.047)	2 537.070 (2 044.338-3 072.897)
ASRs(/100 000)	16.287 (14.921-17.529)	1 053.915 (971.106-1 139.636)	5.637 (4.462-6.998)	122.149 (99.621-146.989)
2019
Number(×1 000)	324.557 (293.012-350.843)	20 100.997 (18 473.868-21 752.987)	100.313 (81.544-119.984)	2 376.638 (1 935.101-2 779.215)
ASRs(/100 000)	15.939 (14.489-17.164)	1 051.714 (969.074-1 137.546)	5.692 (4.573-6.835)	122.509 (100.078-143.707)
1990
Number(×1 000)	127.561 (112.718-142.654)	11 890.522 (10 790.476-1 3078.708)	43.537 (35.988-53.065)	1 231.518 (1 022.061-1 492.725)
ASRs(/100 000)	15.109 (13.452-16.795)	1 214.763 (1 109.345-1 320.704)	6.825 (5.739-8.340)	155.940 (131.157-188.264)
Percent change(2021 vs 2019)
Number	9.1% (6.9%-1.0%)	4.0% (3.3%-4.8%)	7.3% (-11.4%-31.0%)	6.8% (-10.0%-26.2%)
ASRs	2.2% (0.5%-3.9%)	0.2% (-0.4%-0.7%)	-1.0% (-17.5%-19.6%)	-0.3% (-15.8%-17.7%)
Percent change(2021 vs 1990)
Number	177.6% (154.8%-205.5%)	75.9% (66.4%-85.1%)	147.3% (89.3%-209.3%)	106.0% (65.6%-148.7%)
ASRs	7.8% (-0.1%-17.8%)	-13.2%(-15.9%-10.9%)	-17.4%(-37.4%-1.9%)	-21.7% (-37.0%-5.7%)