Temporal trends in prevalence and mortality for chronic kidney disease in China from 1990 to 2019: an analysis of the Global Burden of Disease Study 2019

BACKGROUND: This study aimed to characterize the temporal trends of chronic kidney disease (CKD) burden in China during 1990–2019, evaluate their age, period and cohort effects, and predict the disease burden for the next 10 years. METHODS: Data were obtained from the Global Burden of Disease (GBD) 2019 study. Join-point regression model was used to estimate the average annual percentage change (AAPC) of CKD prevalence and mortality, and the age-period-cohort analysis was used to estimate the age, period and cohort effects. We extended the autoregressive integrated moving average (ARIMA) model to predict the disease burden of CKD in 2020–2029. RESULTS: In 2019, there were 150.5 million cases of (10.6%) and 196 726 deaths from (13.8 per 100 000 general population) CKD in China. Between 1990 and 2019, the prevalence and mortality rate of CKD increased significantly from 6.7% to 10.6%, and from 8.3/100 000 to 13.8/100 000. The AAPC was estimated as 1.6% and 1.8%, respectively. Females had a higher CKD prevalence of CKD but a lower mortality rate. Setting the mean level of age, period and cohort as reference groups, the risk of developing CKD increased with age [RR(age(15–19)) = 0.18 to RR(age(85–89)) = 2.45]. The cohort risk was significantly higher in the early birth cohort [RR(cohort(1905–1909)) = 1.56]. In contrast, the increase in age-specific CKD mortality rate after 60–64 years was exponential [RR(age(60–64)) = 1.24]. The cohort-based mortality risk remained high prior to the 1945–1949 birth cohorts (RR(cohort) ranging from 1.69 to 1.89) and then declined in the 2000–2004 birth cohort [RR(cohort(2000–2004)) = 0.22]. The CKD prevalence and mortality are projected to rise to 11.7% and 17.1 per 100 000, respectively, by 2029. CONCLUSIONS: To reduce the disease burden of CKD, a comprehensive strategy that includes risk factors prevention at the primary care level, CKD screening among the elderly and high-risk population, and access to high-quality medical services is required.