Supplementary Material for: Disease burden and epidemiological trends of chronic kidney disease at the global, regional, national levels from 1990 to 2019

Background: Chronic kidney disease (CKD) is a serious public health issue worldwide, but the disease burden of CKD caused by different etiologies and changing trends have not been fully examined. Methods: We collected data from Global Burden of Disease Study 2019 (GBD 2019), including incident cases, age-standardized incidence rate (ASIR), disability-adjusted life years (DALYs), and age-standardized DALY rate between 1990 and 2019 by region, etiology, age, and sex, and calculated the estimated annual percentage change (EAPC) of the rate to evaluate the epidemiological trends. Results: Globally, incident cases of CKD increased from 7.80 million in 1990 to 18.99 million in 2019, and DALYs increased from 21.50 million to 41.54 million. ASIR increased with an EAPC of 0.69 (95% UI 0.49-0.89) and reached 233.65 per 100,000 in 2019, while the age-standardized DALY rate increased with an EAPC of 0.30 (95% UI 0.17-0.43) and reached 514.86 per 100,000. North Africa and Middle East, central Latin America and North America had the highest ASIR in 2019. Central Latin America had the highest age-standardized DALY rate meanwhile. Almost all countries experienced an increase in ASIR, and over 50% of countries had an increasing trend in age-standardized DALY rate from 1990 to 2019. CKD due to diabetes mellitus type 2 and hypertension accounted for the largest disease burden with 85% incident cases and 66% DALYs in 2019 of known causes, with the highest growth in age-standardized DALY rate and a similar geographic pattern to that of total CKD. Besides, the highest incidence rate of total and four specific CKDs were identified in people aged 70-plus years, who also had the highest DALY rate with a stable trend after 2010. Females had a higher ASIR, while males had a higher age-standardized DALY rate, the gap of which was most distinctive in CKD due to hypertension. Conclusion: The disease burden of CKD remains substantial and continues to grow globally. From 1990 to 2019, global incident cases of CKD have more than doubled and DALYs have almost doubled and surpassed 40 million years. CKD due to diabetes mellitus type 2 and hypertension contribute nearly 2/3 DALYs in 2019 of known causes, and had witnessed the highest growth in age-standardized DALY rate. Etiology-specific prevention strategies should be placed a high priority on the goal of precise control of CKD.

背景：慢性肾脏病（Chronic kidney disease, CKD）是全球范围内严重的公共卫生问题，但不同病因所致CKD的疾病负担及其变化趋势尚未得到充分阐明。
方法：本研究从2019年全球疾病负担研究（Global Burden of Disease Study 2019, GBD 2019）中获取数据，涵盖1990至2019年按地区、病因、年龄及性别划分的新发病例数、年龄标化发病率（age-standardized incidence rate, ASIR）、伤残调整寿命年（disability-adjusted life years, DALYs）及年龄标化DALY率，并计算率的估计年度百分比变化（estimated annual percentage change, EAPC）以评估流行病学趋势。
结果：全球范围内，CKD新发病例数从1990年的780万增至2019年的1899万，伤残调整寿命年从2150万增至4154万。年龄标化发病率以0.69（95% UI 0.49~0.89）的估计年度百分比变化逐年上升，2019年达每10万人233.65例；而年龄标化DALY率以0.30（95% UI 0.17~0.43）的估计年度百分比变化上升，2019年达每10万人514.86。2019年，北非与中东、拉丁美洲中部及北美洲的年龄标化发病率位居全球前列；同期拉丁美洲中部的年龄标化DALY率也为全球最高。1990至2019年间，几乎所有国家的年龄标化发病率均呈上升趋势，超过50%的国家年龄标化DALY率也呈现升高态势。在已知病因中，2型糖尿病与高血压所致CKD占新发病例的85%、伤残调整寿命年的66%，是疾病负担最重的两类病因，其年龄标化DALY率增幅最高，地理分布模式与总体CKD相似。此外，70岁及以上人群的总体CKD及4种特定亚型CKD的发病率均为最高，该人群的伤残调整寿命年率也居于首位，且2010年后趋于稳定。女性的年龄标化发病率更高，而男性的年龄标化DALY率更高，这一差异在高血压所致CKD中最为显著。
结论：全球CKD的疾病负担依然沉重且持续增长。1990至2019年，全球CKD新发病例数翻倍有余，伤残调整寿命年近乎翻倍并突破4000万人年。2019年已知病因中，2型糖尿病与高血压所致CKD贡献了近2/3的伤残调整寿命年，且其年龄标化DALY率增幅最高。针对不同病因制定精准预防策略，应作为实现CKD精准防控的优先工作重点。