Mortality Trends in CKD: Rising Death Toll Despite Slowing Rates

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From 1990 to 2019, the global number of deaths from chronic kidney disease (CKD) rose from 591,800 to 1.43 million. The age-adjusted mortality rate also increased, but it is expected to slightly decrease by 2030. Despite this, CKD-related deaths are forecasted to reach 1.81 million by 2030. Certain subgroups, particularly those with glomerulonephritis, people over 40, and those in middle- to high-income countries, are expected to experience rising mortality rates.

CKD is defined as the irreversible failure of kidney function and can lead to complications including cardiovascular disease, hypertension, diabetes, anemia, bone and mineral disorders, dyslipidemia and a general weakening of the immune system.

“Despite the sharp and transparent information about risk factors, complications, incidence and mortality rates from this health outcome, there is no research predicting the mortality rate of CKD in the future,” wrote a group of investigators from Hamadan University of Medical Sciences in Iran. “Therefore, predicting the extent of this disorder in the future will help health system planners and policymakers deal with its complications and provide a general outline of what resources and to what extent are needed for better control of this disease.”

To determine trends in CKD mortality on a global scale between 1990 and 2019, as well as predict mortality rates and numbers until 2030, investigators collected data from the Global Burden of Disease 2019 study. The average annual percentage change in mortality was estimated using a joinpoint regression model and a generalized additive model predicted mortality through 2030.

The number of CKD-related deaths increased from 591,800 to 1.43 million between 1990 and 2019 and the age-adjusted mortality rate increased from 15.95 per 100,000 people to 18.35 per 100,000 people. The number of CKD deaths is predicted to continue to increase to 1.81 million by 2030. However, the age-adjusted mortality rate is expected to slightly decrease to 17.76 per 100,000 people during this time.

The CKD mortality rate is predicted to decrease in women, men, people younger than 40 years old, all subgroups of disease etiology with the exception of glomerulonephritis, and all countries based on the sociodemographic index (SDI) with the exception of high-middle-SDI countries. These countries include the United States, Central America, Mexico, Venezuela, Ecuador, Kazakhstan, Sweden, Finland, Norway, Belarus, Ukraine and Germany. The number of CKD deaths will increase from 935,600 in men and 874,120 in women by 2030, although the CKD age-adjusted mortality rate will decrease to 20.60 per 100,000 in men and 15.56 per 100,000 in women for the next 6 years.

Limitations of the study included its ecological nature, which hinders causal inference. Essentially, the level of data coverage and/or reporting of each region can impact the results of the trends and forecasts. Additionally, investigators are unable to forecast unexpected changes or fluctuations. Findings should be interpreted with caution as they were derived from data from the global burden of disease website and were estimated from mathematical models instead of surveillance data.

“The most pronounced decrease is expected among people with hypertension, people with diabetes mellitus, and younger people, suggesting that current prevention strategies should focus on subgroups that still have an increasing trend until 2030,” investigators concluded. “Effective preventive measures are still needed to reduce death from CKD in people with glomerulonephritis and people older than 40 years.”