Global CKD Burden Attributable to Obesity on the Rise

New research is shedding light on increases in the global burden of chronic kidney disease (CKD). From 1990 to 2021, while the overall CKD burden increased slowly, CKD-related deaths, disability-adjusted life-years (DALYs), and corresponding age-standardized rate (ASR)s attributable to high BMI exhibited a more pronounced and sustained growth.1

In addition to this historical upward trend, study findings project further increases in the burden of CKD attributable to high BMI by 2050, underscoring the need for comprehensive strategies for the prevention, assessment, and management of CKD to effectively mitigate this growing burden.1

According to the American Kidney Fund (AKF), an estimated 35.5 million people in the US have kidney disease, which is the fastest-growing noncommunicable disease in the country. The AKF recommends maintaining a healthy weight, following a kidney-friendly food and fluid plan, getting tested for kidney disease, and being physically active for preventing kidney disease.2

“Epidemiologically, quantifying the disease burden associated with modifiable risk factors such as obesity is essential for understanding its relationship with CKD,” Weihong Zhao, of the division of nephrology at Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital in China, and colleagues wrote.1 “However, CKD burden attributable to obesity, especially in epidemiological patterns and dynamic changes, remains unclear.”

To address this gap in research, investigators extracted annual data from 1990 to 2021 from the Global Burden of Disease (GBD) Study 2021 on CKD deaths, DALYs, age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR) attributable to high BMI, stratified by sex and age, for 204 countries and territories. In addition to the estimated annual percentage changes (EAPCs) from 1990 to 2021, investigators calculated projected attributable CKD burden through 2050.1

Investigators defined CKD as renal dysfunction based on glomerular filtration rate (GFR) and proteinuria criteria in the GBD 2021 Study, including an estimated GFR < 60 mL/min/1.73m2, calculated using serum creatinine, and/or an albumin-to-creatinine ratio > 30 mg/g. High BMI was defined as a BMI ≥25 kg/m2.1

The global number of CKD-related deaths was 1,527,639 (95% UI, 1,389,377-1,638,914) in 2021, with corresponding DALYs reaching 44,453,684 (95% UI, 40,840,762-48,508,462). The ASMR and ASDR were 18.50 (95% UI, 16.72-19.85) and 529.62 (95% UI, 486.25-577.42) per 100,000 population, respectively.1

Globally, investigators noted high BMI was responsible an estimated 418,402 (95% UI, 224,309-621,353) CKD deaths, accounting for 27.4% of CKD-related deaths, with an ASMR of 5.06 (95% UI, 2.70-7.51). Corresponding DALYs were 10,422,561 (95% UI, 5,658,159-15,387,254), representing 23.4% of CKD-related DALYs, and the ASDR was 123.86 (95% UI, 67.23-182.96).1

Further analysis revealed global CKD burden attributable to high BMI showed a sustained upward trend over the study period. Compared to 1990, deaths and DALYs cases increased approximately 3.5-fold and 2.9-fold in 2021, respectively. EAPC for ASMR was 2.25 (95% CI, 2.13-2.36), and EAPC for ASDR was 1.98 (95% CI, 1.89-2.07), indicating a faster growth rate compared to the overall CKD burden. Of note, trends were similar across the sexes, with slightly greater EAPCs for males.1

Projections indicated that from 2022 to 2050, the number of deaths and DALYs, along with their ASRs, will continue to increase. Although ASRs for males and females were expected to remain comparable, females will account for more cases.1

Further decomposition analysis assessed the relative contributions of aging, population growth, and epidemiological changes to the rising disease burden from 1990 to 2021, with results revealing that all 3 factors contributed to the increasing burden. Of note, aging played a prominent role in the middle, high-middle, and high SDI regions.1

“Our findings provide valuable insights for policymakers in formulating evidence-based strategies to address this pressing public health challenge,” investigators concluded.1

References

1. Ma Y, Chen S, Shen Y, et al. Independent and joint impacts of high body mass index and aging on global burden of chronic kidney disease: insights from the Global Burden of Disease Study 2021. Front. Nutr. doi:10.3389/fnut.2025.1582534

2. American Kidney Fund. Quick kidney disease facts and stats. February 11, 2025. Accessed August 12, 2025. https://www.kidneyfund.org/all-about-kidneys/quick-kidney-disease-facts-and-stats