research

HIGHLIGHTS
EPIDEMIOLOGY CKD-attributable CVD accounted
for 4.6% of all-cause mortality. Global

The impact of chronic kidney

all-age CKD mortality increased
by 41.5% between 1990 and 2017,
whereas age-standardized CKD

disease on global health mortality remained stable. “From

1990 to 2017, global age-standardized
mortality declined by 30.4% for
The Global Burden of Disease (GBD) “The first GBD study in 2012 CVD, 14.9% for cancer and 41.3%
study 2017 quantified the contrib­ only estimated the burden of low for chronic obstructive pulmonary
targeting ution of 354 diseases and injuries glomerular filtration rate but with disease, but a similar decline was not
and 84 risk factors to morbidity and each GBD revision cycle new kidney seen for CKD,” notes Vos.
CKD will be
mortality in 195 countries and disease indicators were introduced,” The authors also estimate that
an important territories between 1990 and 2017. adds co-corresponding author in 2017, CKD resulted in 35.8 million
consideration A new analysis based on this study Theo Vos. “Our analysis considers disability-adjusted life years (DALYs),
for reaching estimates morbidity and mortality all patients with CKD (using appro­ whereas 25.3 million CVD DALYs
owing to chronic kidney disease priate references to the KDIGO could be attributed to impaired
[the sustain­ (CKD) and impaired kidney func­ classification) and also considers kidney function. Diabetic kidney
able develop­ tion at the global, regional and the burden of cardiovascular disease disease was the leading cause of CKD
ment] goals national levels. (CVD) and gout related to impaired DALYS, accounting for 30.7% of the
“The main aim of the GBD study kidney function.” total. “The DALY rate for impaired
is to provide policy makers worldwide The new analysis suggests that kidney function was higher than
with up-to-date infor­mation on health in 2017, the global prevalence of that for drug use, unsafe sanitation,
outcomes that are comparable CKD was 9.1% (697.5 million low physical activity, second-hand
between diseases, combining infor­ cases). The age-standardized global smoke and several dietary risk
mation on deaths and non-fatal prevalence of CKD was higher factors,” says Bikbov. Differences
disease,” explains Boris Bikbov, in women and girls (9.5%) than in in CKD burden between countries
co-corresponding author on the men and boys (7.3%). Nearly one- were particularly apparent when
new analysis. “The United Nations third of all cases of CKD were in comparing age-standardized CKD
sus­tain­able development goals aim China (132.3 million) or India DALYs, which were particularly high
to reduce premature mortality from (115.1 million), 10 countries had in Oceania, sub-Saharan Africa and
non-communicable diseases by one- >10 million cases and 79 countries Latin America.
third by 2030, and our had >1 million cases. Although the “We hope that our analysis will
estimates suggest all-age global prevalence of CKD lead to greater attention to kidney
that targeting CKD increased by 29.3% between 1990 disease in the public health agenda,
will be an impor­ and 2017, the age-standardized global and inspire the development of
tant consideration prevalence did not change signifi­ National Strategic Action Plans for
for reaching cantly. “The increase in all-age prev­ kidney disease in all countries,” says
these goals.” alence is due to ageing of the world’s Bikbov. “Importantly, such action
popu­lation,” says Vos. The all-age and plans should be much wider than
age-standardized global incidence the provision of dialysis and kidney
of dialysis and kidney transplanta­ transplantation — they should also
tion also increased between 1990 include early CKD detection and
C re d i t :

and 2017 (by 43.1% and 10.7%, prevention in high-risk groups as

respectively, for dialysis and 34.4% well as the provision of essential
L ara C ro w

and 12.8%, respectively, for trans­ medicines for patients with CKD
plantation), reflecting increasing in the poorest countries and for
availability of these therapies. disadvantaged social groups.”
/Sp

In 2017, CKD resulted in

ri n

Ellen F. Carney
ge

1.2 million deaths and was the

rN

ur
12th leading cause of death world­
at

eL Original article GBD Chronic Kidney

im Disease Collaboration. Global, regional and
ite
d wide. In addition, 7.6% of all CVD national burden of chronic kidney disease,
deaths (1.4 million) could be attrib­ 1990–2017: a systematic analysis for the Global
uted to impaired kidney function. Burden of Disease Study 2017. Lancet 395,
709–733 (2020)
Together, deaths due to CKD or to

NAture Reviews | Nephrology volume 16 | MAY 2020 | 251