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

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GBD Chronic Kidney Disease Collaboration (Including:

Bikbov, Boris, Purcell, Caroline A., Levey, Andrew S., Smith, Mari, Abdoli, Amir, Abebe, Molla, Adebayo, Oladimeji M., Afarideh, Mohsen, Agarwal, Sanjay Kumar, Agudelo-Botero, Marcela et al.
). (2020) Global, regional, and national burden of chronic kidney disease, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 395 (10225). pp. 709-733. doi:10.1016/S0140-6736(20)30045-3

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Official URL: http://dx.doi.org/10.1016/S0140-6736(20)30045-3

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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.

Item Type: Journal Article
Subjects: Q Science > QM Human anatomy
R Medicine > RC Internal medicine
Divisions: Faculty of Medicine > Warwick Medical School > Health Sciences
Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Kidneys -- Diseases, Chronic diseases -- Diagnosis
Journal or Publication Title: The Lancet
Publisher: Lancet Publishing Group
ISSN: 0140-6736
Official Date: 29 February 2020
Dates:
DateEvent
29 February 2020Published
13 February 2020Available
13 February 2020Accepted
Date of first compliant deposit: 3 March 2020
Volume: 395
Number: 10225
Page Range: pp. 709-733
DOI: 10.1016/S0140-6736(20)30045-3
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
UNSPECIFIEDBill and Melinda Gates Foundationhttp://dx.doi.org/10.13039/100000865
Marie Sklodowska-Curie grant (agreement no 703226)Horizon 2020 Framework Programmehttp://dx.doi.org/10.13039/100010661
UNSPECIFIEDPublic Health Agency of Canadahttp://dx.doi.org/10.13039/100011094
2019-0105VetenskapsrådetUNSPECIFIED
UID/MULTI/04378/2019Fundação para a Ciência e a Tecnologia UNSPECIFIED
UID/QUI/50006/2019Ministério da Ciência, Tecnologia e Ensino Superior UNSPECIFIED
R01DK100446National Institute of Diabetes and Digestive and Kidney Diseaseshttp://dx.doi.org/10.13039/100000062
K23DK10651National Institute of Diabetes and Digestive and Kidney Diseaseshttp://dx.doi.org/10.13039/100000062
UID/Multi/50016/2019Fundação para a Ciência e a Tecnologia UNSPECIFIED
COMPETE POCI-01-0145-FEDER-02924European Regional Development Fundhttp://dx.doi.org/10.13039/501100008530
TDC/NAN-MAT/29248/2017Fundação para a Ciência e a Tecnologia UNSPECIFIED
UNSPECIFIEDNational Heart Foundation of Australiahttp://dx.doi.org/10.13039/501100001030
UNSPECIFIEDDeakin Universityhttp://dx.doi.org/10.13039/501100001778
UNSPECIFIEDSistema Nacional de Investigadoreshttp://dx.doi.org/10.13039/501100013395
25TW011217National Institutes of Healthhttp://dx.doi.org/10.13039/100000002
1D43TW010937-01ANational Institutes of Healthhttp://dx.doi.org/10.13039/100000002
Lilly Young Investigator Research AwardEuropean Association for the Study of Diabeteshttp://dx.doi.org/10.13039/501100007885
PI16/02057European Regional Development Fundhttp://dx.doi.org/10.13039/501100008530
PI19/00588European Regional Development Fundhttp://dx.doi.org/10.13039/501100008530
PI19/00815European Regional Development Fundhttp://dx.doi.org/10.13039/501100008530
DTS18/00032European Regional Development Fundhttp://dx.doi.org/10.13039/501100008530
ERA-PerMed-JTC2018European Regional Development Fundhttp://dx.doi.org/10.13039/501100008530
IDNEY ATTACK AC18/00064European Regional Development Fundhttp://dx.doi.org/10.13039/501100008530
PERSTIGAN AC18/00071European Regional Development Fundhttp://dx.doi.org/10.13039/501100008530
ISCIII-RETIC REDinREN RD016/0009European Regional Development Fundhttp://dx.doi.org/10.13039/501100008530
UNSPECIFIEDFundación Renal "Íñigo Álvarez de Toledo" (Madrid, España)http://viaf.org/viaf/158881340
IFRA2 B2017/BMD-3686Comunidad de Madridhttp://dx.doi.org/10.13039/100012818
SARChI GUN 86895National Research Foundationhttp://dx.doi.org/10.13039/501100001321
UNSPECIFIEDSouth African Medical Research Councilhttp://dx.doi.org/10.13039/501100001322
UID/MULTI/04378/2019Fundação para a Ciência e a Tecnologia UNSPECIFIED
UID/QUI/50006/2019Ministério da Ciência, Tecnologia e Ensino Superior UNSPECIFIED

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