Comparative analysis of the trends in the global and Chinese burden of chronic kidney disease from 1990 to 2021 and prediction of the incidence and mortality rates in China over the next 30 years

Background This study examines the current status and temporal trends in the disease burden of chronic kidney disease (CKD) in China and worldwide from 1990 to 2021, aiming to inform evidence-based strategies for the prevention and control of CKD.Methods The data were sourced from the GBD 2021 public database, covering the incidence, prevalence, mortality and disability-adjusted life years (DALYs) of chronic kidney disease (CKD) among different genders and age groups in China and globally from 1990 to 2021. The average annual percentage change (AAPC) of CKD prevalence and mortality was estimated using the joinpoint regression model. The temporal trends of CKD burden in China and globally were analyzed using R software, and the future 30-year prevalence and mortality of CKD in China were projected using the ARIMA model in the GlobalBurdenR package.Results In 2021, China reported 118.4 million cases of chronic kidney disease (CKD) and 204,230 CKD-related deaths, while globally there were 673.72 million cases and 1,527,638 deaths. From 1990 to 2021, the age-standardized mortality rate of CKD in China declined significantly from 14.16 to 10.84 per 100,000 population, whereas the global rate increased from 14.85 to 18.50 per 100,000. Over the same period, the estimated average annual percentage change (EAPC) in age-standardized prevalence and mortality rates in China was -0.40% and -0.91%, respectively, compared with -0.02% and 0.73% worldwide. Both global and Chinese CKD burdens exhibit notable disparities by gender and age: women have a higher prevalence than men, but lower mortality. The elderly are the primary high-risk group, particularly individuals aged 50 years and older. After adjusting for changes in population age structure, the age-standardized prevalence and mortality rates of CKD in China have exhibited a gradual downward trend and are increasingly stabilizing.Conclusions The disease burden of chronic kidney disease (CKD) in China and globally remains substantial, with notable disparities across regions, age groups, and genders. Projections indicate that China will continue to experience high CKD prevalence and mortality rates through 2050. To effectively mitigate the CKD burden, the implementation of comprehensive prevention and control strategies is still required.

背景 本研究旨在解析1990年至2021年中国及全球范围内慢性肾脏病（chronic kidney disease, CKD）的疾病负担现状与时间趋势，以期为CKD的循证预防控制策略提供参考依据。

方法 本研究数据来源于全球疾病负担研究2021（Global Burden of Disease 2021, GBD 2021）公开数据库，涵盖1990年至2021年中国及全球不同性别、年龄组人群慢性肾脏病（CKD）的发病率、患病率、死亡率与伤残调整寿命年（disability-adjusted life years, DALYs）。采用连接点回归模型估算CKD患病率与死亡率的平均年度变化百分比（average annual percentage change, AAPC）；借助R软件分析中国及全球CKD负担的时间趋势，并通过GlobalBurdenR包中的自回归积分滑动平均（AutoRegressive Integrated Moving Average, ARIMA）模型预测中国未来30年的CKD患病率与死亡率。

结果 2021年，中国慢性肾脏病（CKD）患病人数达1.184亿，CKD相关死亡204230例；全球范围内CKD患病人数为6.7372亿，死亡1527638例。1990年至2021年，中国CKD年龄标化死亡率从每10万人14.16显著降至10.84，而全球该指标则从14.85升至18.50。同期，中国CKD年龄标化患病率与死亡率的估算平均年度变化百分比（estimated average annual percentage change, EAPC）分别为-0.40%与-0.91%，全球对应值则为-0.02%与0.73%。全球及中国的CKD负担均存在显著的性别与年龄差异：女性患病率高于男性，但死亡率更低；老年人群是主要高危群体，尤以50岁及以上人群为甚。在调整人口年龄结构变化后，中国CKD的年龄标化患病率与死亡率已呈现逐步下降的趋势，并愈发趋于稳定。

结论 中国及全球的慢性肾脏病（CKD）疾病负担仍较为沉重，且在地区、年龄组与性别间存在显著差异。预测结果显示，截至2050年，中国仍将维持较高的CKD患病率与死亡率水平。为有效减轻CKD疾病负担，仍需落实综合预防控制策略。