Global Trends and Projections in Chronic Kidney Disease Burden from Diabetes, Hypertension, and Glomerulonephritis: A Population-Based Study

INTRODUCTION: Chronic kidney disease (CKD) is a major global health challenge contributing to substantial morbidity, mortality, and healthcare burden. This study analyzed global, regional, and national trends in CKD due to type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), hypertension, and glomerulonephritis from 1990 to 2021, with projections to 2045. METHODS: This population-based study used data from the Global Burden of Disease (GBD) 2021 across 204 countries and territories. The CKD burden by etiology was evaluated using prevalence, incidence, deaths, disability-adjusted life years (DALYs), and corresponding age-standardized rates (ASPR, ASIR, ASMR, ASDR). Temporal trends were assessed using regression and age-period-cohort models, and health inequalities were analyzed across regions and sociodemographic levels. RESULTS: In 2021, global CKD prevalence reached 673.7 million cases, primarily driven by T2DM and hypertension. T2DM had the highest ASPR (1,259.63) and ASIR (23.07). From 1990 to 2021, ASPRs for CKD from T1DM and glomerulonephritis initially rose but recently declined (T1DM, annual percent change [APC]: -2.51% from 2019 to 2021; glomerulonephritis, APC: -0.53% from 2015 to 2019). However, ASIRs for all four etiologies continued to increase. In 2021, CKD caused 1.53 million deaths, with T2DM contributing most to deaths and DALYs, having the highest ASMR (5.72) and ASDR (131.08). While ASMR increased for all CKD types, the ASDR for T1DM-related CKD initially declined but has risen since 2012, whereas ASDRs for CKD due to T2DM, hypertension, and glomerulonephritis have continuously increased. Middle-social development index (SDI) region saw the largest increases in CKD prevalence and incidence due to T2DM, primarily driven by population growth (69.93% of prevalence rise) and aging (50.05% of deaths, 48.16% of DALYs). While epidemiological changes reduced prevalence by 11.10%, they contributed 23.13% to the incidence increase. High-SDI regions had the fastest growth in ASMR and ASDR. South Asia led in prevalence growth, while East Asia experienced the highest incidence increases, mainly due to aging, highlighting significant regional disparities in CKD drivers. Inequality analysis indicated that wealthier countries had better outcomes for T2DM- and hypertension-related CKD, whereas poorer countries appeared to fare better for T1DM- and glomerulonephritis-related CKD. Projections to 2045 suggest continued increases in CKD from T2DM and hypertension, with potential declines in T1DM- and glomerulonephritis-related CKD. CONCLUSION: The global CKD burden has markedly increased from 1990 to 2021, primarily due to T2DM and hypertension. Regional disparities highlight the necessity for targeted public health interventions.