Global CKD Burden Projected to Rise in Young Adults and Decline in Children by 2050

A systematic review of the global disease burden in chronic kidney disease (CKD) suggests a rapid rise among young adults but a gradual decline among children by 2050.1

The data also suggest countries with a lower sociodemographic index (SDI) carry a disproportionately higher CKD burden. Investigators reported broader society should provide greater attention, support, and resources to low SDI regions.1

“Notably, despite persistent disparities in regional burden distribution, the global trend indicates a progressive reduction in the CKD burden among children,” wrote study investigator Nina Zhang, from the Department of Nursing at Shanghai Sixth People’s Hospital. “This optimistic projection holds particular significance for economically disadvantaged regions currently experiencing a disproportionate disease impact.”1

The clinical and public health implications of CKD remain substantial. In 2017, CKD affected approximately 850 million people worldwide and accounted for 1.2 million deaths. Investigators cited projections suggesting CKD may become the fifth leading cause of death globally by 2040.1,2

To evaluate long-term trends, investigators conducted a systematic analysis using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) from 1990 to 2021. The analysis assessed incidence, mortality, and disability-adjusted life years (DALYs) at global, regional, and SDI levels.1

Investigators also evaluated attributable risk factors, annual percent change (APC), and average annual percent change (AAPC), and projected CKD incidence from 2022 through 2050. Risk factors were categorized into environmental or occupational, behavioral, and metabolic domains, including exposures such as low temperature, elevated systolic blood pressure, and high-sodium diets. Countries were grouped into 21 geographic regions and stratified into SDI quintiles using 2021 values.1

The study population included children aged 0–14 years and young adults aged 15–39 years.1

Among children, investigators observed a modest decline in global CKD incidence, decreasing from 31.6 (27.0–37.4) per 100,000 population in 1990 to 30.6 (26.4–35.9) in 2021, although this change was not statistically significant. Over the same period, investigators reported a 45.1% reduction in mortality, from 1.5 (1.0–1.7) to 0.8 (0.6–0.9), and a 43.2% decline in DALYs, from 132.6 (96.1–151.1) to 75.3 (60.8–87.2).1

Trend analyses showed a significant overall reduction in pediatric CKD burden from 1990 to 2021. Investigators reported an AAPC of −0.095 (−0.139 to −0.051) for incidence, with notable declines during 1990–1995 and 2016–2021. Mortality declined with an AAPC of −1.925 (−2.129 to −1.720), while DALYs decreased with an AAPC of −1.820 (−2.002 to −1.638).1

In contrast, investigators observed a substantial increase in CKD incidence among young adults. From 1990 to 2021, incidence rose by 33.6%, increasing from 27.0 (20.4–34.6) to 36.1 (28.3–45.2). Mortality increased from 2.6 (2.3–2.9) to 2.8 (2.5–3.1), while DALYs rose from 198.3 (176.8–223.9) to 211.1 (188.7–236.7). Investigators noted these changes were not statistically significant.1

Across the study period, investigators reported an AAPC of 0.941 (0.927–0.955) for CKD incidence in young adults, with the most rapid growth occurring during 2019–2021. Smaller but significant increases were also observed for mortality (AAPC, 0.256 [0.035–0.477]) and DALYs (AAPC, 0.187 [0.005–0.368]).1

Regionally, investigators reported the highest CKD incidence among children in 2021 in Central Latin America [49.9 (43.1–58.5)], Central Asia [48.6 (40.6–57.8)], and North Africa and the Middle East [40.5 (34.8–47.9)]. Among young adults, the highest incidence rates were observed in Central Latin America [70.2 (58.8–83.9)], Central Asia [67.8 (53.6–82.7)], and Eastern Europe [64.6 (47.6–83.6)].1

Across SDI strata, investigators observed CKD burden in high-middle and high SDI regions remained lower than the global average. In 2021, age-standardized incidence showed a moderate positive correlation with SDI (r = 0.482; P = 0.028). In contrast, age-standardized mortality (r = −0.719; P <.001) and DALYs (r = −0.835; P <.001) were strongly negatively correlated with SDI.

Investigators reported the proportion of deaths attributable to all CKD risk factors increased from 39.2% in 1990 to 53.9% in 2021. This increase was driven primarily by metabolic risks, which rose from 23.7% to 35.4%, representing a 49.4% increase. Investigators also reported diets high in processed and red meat accounted for a higher proportion of CKD-related deaths in high SDI regions.1

Looking ahead, investigators projected pediatric CKD incidence will decline to 25.20 per 100,000 population by 2050, corresponding to 552,469.7 incident cases and a 17.65% reduction compared with 2021. By age group, projected incidence rates include 62.19 in children younger than 5 years, 12.48 in those aged 5–9 years, and 17.80 in those aged 10–14 years.1

In contrast, investigators projected CKD incidence among young adults will increase from 36.06 per 100,000 population in 2021 to 47.92 in 2050, with total incident cases reaching 1,768,601. Age-stratified incidence rates were projected at 37.10 (15–19 years), 36.15 (20–24 years), 40.12 (25–29 years), 59.23 (30–34 years), and 99.58 (35–39 years), representing increases of 37.76% to 68.69% compared with 2021.1

References

1. He Y, Qian Y, Xu Q, Lu Q, Zhang N. Global trends and risk factors of chronic kidney disease in children and young adults from 1990 to 2021: a systematic analysis of the global burden of disease study 2021. Frontiers in Public Health. 2025;13:1696021-1696021. doi:https://doi.org/10.3389/fpubh.2025.1696021

2. Kovesdy CP. Epidemiology of chronic kidney disease: An update 2022. Kidney International Supplements. 2022;12(1):7-11. doi:https://doi.org/10.1016/j.kisu.2021.11.003