Skip to main content
Download PDF

Global incidence and death estimates of chronic kidney disease due to hypertension from 1990 to 2019, an ecological analysis of the global burden of diseases 2019 study

BMC Nephrology volume 24, Article number: 352 (2023) Cite this article

A Correction to this article was published on 04 January 2024

This article has been updated

Abstract

Background

The intricate relationship between hypertension and chronic kidney disease (CKD) presents a global challenge for prevention of hypertension-related CKD. This study’s objective is to analyze age, gender, regional disparities, and evolving trends in the disease burden of hypertension-related CKD. We aim to estimate changing spatial and temporal trends in incidence and mortality rates, considering the socio-demographic index (SDI), to inform health strategies effectively.

Method

Age-standardized incidence rates (ASIR) and death rates (ASDR) were collected from the GBD 2019. Trend analysis was conducted by Joinpoint regression of ASRs from 1990 to 2019. Spatial autocorrelation analysis was performed to obtain spatial patterns. The association between SDI and burden of CKD due to hypertension was estimated using a Pearson correlation analysis.

Results

The global ASIR and ASDR due to hypertension-related CKD were 19.45 (95% CI, 17.85 to 21.09) and 5.88 (95% CI, 4.95 to 6.82) per 100 K population in 2019, representing increases of 17.89% and 13.29% compared to 1990, respectively. The elderly population and males were found the highest ASIR and ASDR. The high SDI region had the highest ASIRs, while low SDI regions experienced the highest ASDRs. Joinpoint regression found both global ASIR and ASDR showed increasing trends, with the highest increases observed in middle- and high-SDI regions, respectively. The SDI exhibited a positive association with ASIRs but displayed an inverse V-shaped correlation with the average annual percentage change (AAPC) of ASIRs. Spatial autocorrelation analysis revel significant positive spatial autocorrelation for the AAPC of ASDRs and ASIRs, from 1990 to 2019.

Conclusions

Results met the objectives, and demonstrated a rising global burden of hypertension-related CKD. Factors such as aging, gender, and regional variations should be considered when designing control measures and developing healthcare systems to effectively address the burden of this complex condition.

Peer Review reports

Background

Chronic kidney disease (CKD) is a prevalent non-communicable disease afflicting excess of 650 million people and resulting more than 1.2 million deaths in 2017 worldwide [1]. It has been well documented that the prevalence number of chronic kidney disease varies considerably across the world, such as, almost a third of patients living in China (132.3 million) and India (115.1 million) [1]. A significant contributor to the CKD burden is hypertension, recognized as a leading risk factor for the development and progression of kidney disease, which was reported affect up to 90% of the population with CKD and accelerating its progression [2, 3]. The intricate interplay between hypertension and kidney function has far-reaching implications for global health [4].

Hypertension, commonly known as high blood pressure, is a pervasive and modifiable risk factor, and its association with CKD has been well-established, especially in Low- and Middle-income countries [5, 6]. Uncontrolled hypertension can lead to kidney damage, ultimately culminating in CKD, which, in its advanced stages, necessitates life-long dialysis or kidney transplantation [7]. However, there is no consensus on the goal of optimal blood pressure (BP) in the relevant guidelines, which makes it difficult to prevent hypertension related CKD [8]. In addition, the uneven worldwide distribution of chronic diseases, such as CKD, complicates the allocation of global health resources [9, 10]. Global burden of disease (GBD) CKD Collaboration estimated the burden of CKD globally in 2017, and highlighted its rising incidence and deaths burden [1]. CKD with different etiologies (such as diabetes, glomerulonephritis, and hypertension, etc.) were not reported in depth, nor was the temporal trend over the past 30 years. Exploring the burden pattern of aetiology-specific CKD, and the temporal trends may promote the precise prevention of CKD via more targeted prevention strategies.

The global implications of hypertension-related kidney disease extend beyond clinical concerns, impacting healthcare systems, economies, and, most importantly, the quality of life of affected individuals. Thus, a comprehensive comparison for temporal and spatial patterns of hypertension-related kidney disease has become imperative. To achieve this, the Global Burden of Disease (GBD) framework has emerged as a robust tool for assessing the impact of diseases on a global scale, which evaluated 369 diseases and injuries in 204 countries and territories from 1990 to 2019 to illustrate the landscape of CKD caused by distinct etiologies [11].

In our study, we hypothesize that there are significant regional, age, and gender disparities in the incidence and mortality burden of global hypertensive kidney disease. This poses a significant challenge to the prevention and control of the global burden of chronic kidney disease. Therefore, our study will investigate the age and gender distribution of the incidence and death rates of hypertension-related CKD. And we will further explore the temporal trends of age standardized incidence and death rates of CKD due to hypertension, by worldwide, regional and countries. In addition, we will analyze the relationship between SDI and CKD due to hypertension burden, and finally explored the spatial characteristics in the CKD due to hypertension burden. We hope our findings can facilitate evidence-based decision-making for clinical practice, public health policy, and global health strategies to mitigate the global burden of hypertension-related kidney disease.

Materials and methods

Data source

Resources included in this study were collected from the official website of the GBD 2019 Study (http://ghdx.healthdata.org). The GBD 2019 study annually provides age-sex-specific incidence, prevalence, deaths, years of life lost (YLL), years lived with disability (YLD), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries for 204 countries throughout the world. Detailed resources search, inclusion and exclusion criteria, data processing steps and modeling methods of GBD 2019 have been delineated in previous GBD study [11]. GBD complies with the Guidelines for Accurate and Transparent Health Estimates Reporting statement [12]. The data sources were estimated from mathematical models based on surveillance data rather than surveillance data itself, which allow researchers download in accordance with their study periods for secondary analysis, thereby obviating the need for ethics approval.

In our study, we downloaded the age specific and age standardized annual incidence and deaths rates, with 95% confidence intervals (CIs) based on age and sex from 1990 to 2019 of the CKD due to hypertension, which corresponded ICD9/10 codes according to the GBD Chronic Kidney Disease Collaboration [1], using the Global Health Data Exchange (GHDx) query tool (http://ghdx.healthdata.org/gbd-results-tool). The socio-demographic index (SDI) was also extracted from the Institute for Health Metrics and Evaluation (IHME) [13]. SDI was estimated based on the country development, and composite of the country’s total fertility rate for women younger than 25 years, educational attainment, and lag-distributed income per capita [14]. According to the corresponding SDI, 204 countries and territories were divided into five regions including low, low-middle, middle, high-middle, and high-SDI regions. Besides, the world was geographically categorized into 21 GBD areas, including Oceania, Central Asia, Central Europe, Australasia [15].

Statistical analysis

We employed a Joinpoint regression analysis (National Cancer Institute Joinpoint regression program software, version 4.1.0) to investigate the temporal trends of ASIR and ASDR related to CKD attributed to hypertension from 1990 to 2019. To ascertain the significance of one or more Joinpoints, the Monte Carlo permutation method was employed. The AAPC and its corresponding 95% confidence interval (CI) were computed as a weighted average of the segmented trends [16]. Furthermore, to assess the correlation between ASR/AAPCs and the SDI at both regional and country levels using a Pearson correlation analysis. Relevant analysis and data visualizations were performed using R 4.0.3 software (Lucent Technologies, Jasmine Mountain, USA).

Furthermore, we conducted a spatial autocorrelation analysis to examine the spatial patterns of ASIR, ASDR, and AAPC across 204 countries, using arcgis10.8 (Environmental Systems Research Institute, US). To evaluate global spatial autocorrelation, we employed the global Moran’s I statistic, which ranges from − 1 to + 1 [17]. A positive Moran’s I value suggests that countries with high ASRs/AAPCs tend to be located near other countries with high ASRs/AAPCs, or countries with low ASRs/AAPCs are clustered together, while a negative Moran’s I value implies that countries with high ASRs/AAPCs tend to be near countries with low ASRs/AAPCs, or vice versa. Significance in spatial autocorrelation was determined by Z-scores greater than or equal to 1.96 and p-values less than 0.05 for Moran’s I [18]. In addition, local Moran’s index, known as the local index of spatial autocorrelation (LISA), was used to identify the existence of spatial clusters of countries with high or low values [17]. There can be five different scenarios within the LISA: (1) high-high, “hot spots”; (2) low-low, “cold spots”; (3) high-low, “spatial outliers”; (4) low-high, again “spatial outliers”; and (5) no significant local spatial autocorrelation. This methodology allows the identification of regions that contribute to spatial autocorrelation.

Results

Point estimation of chronic kidney disease burden in 2019

Globally, the ASIR was 19.45 (95% CI, 17.85 to 21.09) per 100k population for both sexes, while ASDR was 5.88 (95% CI, 4.95 to 6.82). The ASIR of global female population was 17.84 (95% CI, 16.42 to 19.30) per 100k population, which was slightly lower than males (ASIR, 21.43; 95% CI, 19.67 to 23.28) (Table 1). Similar sex variations were observed in males with a higher ASDR than it in males (Table 1). In terms of age distribution, the highest incidence and deaths rates were all observed in the old population, and higher in males than females of all the age groups (Fig. 1). Similar results were observed in the five SDI regions (Supplementary Figs. 1–2).

Table 1 The ASIR, ASDR, and trends of CKD due to hypertension from 1990 to 2019, by global and regions
Full size table
Fig. 1
figure 1

The age-specific incidence (A) and deaths (B) rates of CKD due to hypertension in different age groups, globally in 2019

Full size image

For SDI regions, the high-SDI region had the highest ASIR (24.96 per 100k population; 95% CI, 23.02 to 27.05), while the low-SDI regions had a top ASDR with 8.16 per 100k population (95% CI, 6.85 to 9.66) (Table 1). The incidence and death burden of CKD due to hypertension burden in the 21 geographical regions were presented in Table 1, with the highest incidence burden were observed in the North Africa and Middle East with ASIRs were 36.55 (95% CI, 33.59 to 39.58) per 100k population, and the Central Latin America were observed the highest ASDRs (12.51; 95% CI, 9.9 to 15.32).

Regarding the 204 countries, the highest ASIR was observed in the Saudi Arabia (45.66 per 100k population; 95% CI, 41.39 to 50.22), followed by the Qatar and the United Arab Emirates (Fig. 2A, Supplementary Table 1). The lowest ASIR was observed in the Madagascar, followed by the Central African Republic, and Moldova (Fig. 2A, Supplementary Table 1). By ASDR, countries Mauritius was observed the highest rate by 28.10 per 100k population (95% CI, 21.91 to 35.16), and followed by, Micronesia and Palau (Fig. 2B, Supplementary Table 2). On the contrary, the top three lowest ASDRs were the Belarus, Ukraine and Moldova (Fig. 2, Supplementary Table 2).

Fig. 2
figure 2

The age-standardized incidence rate (ASIR, A) and the age-standardized deaths rate (ASDR, B) of CKD due to hypertension for both sexes in 204 countries and territories in 2019

Full size image

Incidence trends estimates of CKD due to hypertension from 1990 to 2019

Globally, the ASIR of CKD due to hypertension increased, with an AAPC (%) of 0.69 (95%CI, 0.66 to 0.71), from 15.97 (95%CI, 14.6 to 17.4) in 1990 to 19.45 (95%CI, 17.85, 21.09) per 100 K population in 2019 (Table 1). The most pronounced increase country was observed in the Morocco (AAPC, 2.55%), and followed by Ecuador (AAPC, 2.42%) and Oman (AAPC, 2.40%) (Fig. 3A, Supplementary Table 1). All the countries were observed significant increased ASIRs (AAPC > 0) except for the Ireland, Greece and UK (Supplementary Table 1).

Fig. 3
figure 3

The annual variation of CKD due to hypertension burden from 1990 to 2019, by regions and countries. AAPCs of age-standardized incidence (ASIR, A) and deaths rates (ASDR, B) in 204 countries/territories. AAPCs of age-standardized incidence (C) and deaths rates (D) in SDI quintiles and 21 GBD geographic regions, by sex. AAPC, average annual percentage changes; SDI, social-demographic index

Full size image

For regions, the ASIRs of the five SDI regions kept increasing from 1990 to 2019 (Fig. 4). The Middle SDI region was observed the lowest ASIR but highest percentage change (28.04%) and AAPC (1.15%; 95% CI, 1.13 to 1.16) (Table 1; Fig. 4). However, the high-SDI region was observed the highest ASIR by years and gender (Fig. 4), and the lowest percentage change (11.56%) and AAPC (0.42%; 95% CI, 0.41 to 0.44) (Table 1; Fig. 4). Similarly, the 21 geographical regions were all observed increased trends, with the highest region was the Andean Latin America (change percentage, 47.29%; AAPC 2.24, 95% CI, 2.20–2.28%) (Table 1). The gender differences of ASIRs change and AAPCs were shown in Fig. 3C and Supplementary Fig. 3.

Fig. 4
figure 4

The age-standardized incidence rate (ASIR) and deaths rate (ASDR) of CKD due to hypertension, by SDI regions and gender from 1990 to 2019. SDI, social-demographic index

Full size image

Deaths trends estimates of CKD due to hypertension from 1990 to 2019

The trends of ASDRs showed more heterogeneity than ASIRs around the world. Generally, the global ASDR increased from 1990 to 2019 by 13.29%, with an AAPC (%) of 0.49 (95%CI: 0.42, 0.56) (Table 1). According to our statistical analysis, compared with 1990, ASDRs in 2019 were observed significant increase among 127 countries (AAPC > 0), while 74 countries decreased (AAPC < 0), with the top 3 increased countries were the Estonia (AAPC, 5.34%), and followed by Tajikistan (AAPC, 4.54%) and EI Salvador (AAPC, 4.58%) (Fig. 3, Supplementary Table 2).

Regarding SDI regions, the low-SDI region was observed the highest but decreased ASDR from 1990 to 2019, with AAPC was − 0.42% (95% CI, -0.52% to -0.32%) (Table 1; Fig. 3D). The ASDRs slightly increased in the high-SDI, high-middle SDI, middle SDI, low-middle SDI regions with the AAPC range from 0.17 to 0.99% (Table 1; Fig. 4). Among the 21 geographical regions, ASDRs increased in 15 regions, including the greatest increase of the Central Latin America (change percentage = 44.22%; AAPC, 2.04%; 95% CI, 1.84–2.24%), followed by the high-income North America (AAPC, 1.71%; 95% CI, 1.50–1.91%) (Table 1). The global AAPC of ASDR in females was slightly higher than which in males (Table 1; Fig. 3D). Differently, lower AAPCs in females were observed in two SDI regions (middle SDI and low-middle SDI) and five geographical regions, including the Central Asia, Oceania, Andean Latin America, Central Latin America, and Tropical Latin America (Fig. 3D, Supplementary Fig. 5).

Correlation between Burden of CKD due to hypertension and SDI

Supplementary Fig. 5 demonstrates the trend in ASIR and ASDR across SDI by geographical regions, from 1990 to 2019. ASIRs of regions generally followed the increasing incidence along with SDI (in 2019). However, decrease trend of ASDR corelated to SDI were observed in our results. Further correlations were analyzed between AAPCs of 204 countries and SDI (in 2019) (Fig. 5A). A significant positive association was found between AAPCs of ASIR and SDI (ρ = 0.22; P = 0.002) when the SDI was limited to below 0.63. For an SDI above 0.63, the association was observed as significant negative (ρ = -0.536; P < 0.001). Besides, a significant negative association (ρ = 0.503; P < 0.001) was observed between AAPCs of ASDRs and SDI (in 2019) (Fig. 5B). These results reveal that countries with middle SDI have experienced a heaviest increasing incidence burden, and lower SDI countries have experienced a more rapid increase in deaths burden of hypertension related CKD from 1990 to 2019.

Fig. 5
figure 5

The correlation between SDI and ASR of CKD due to hypertension in 2019. (A) Correlation between SDI (in 2019) and age-standardized incidence rate (ASIR). (B) Correlation between SDI (in 2019) and age-standardized deaths rate (ASDR). SDI, social-demographic index

Full size image

Spatial autocorrelation of CKD due to hypertension

Spatially, the global autocorrelation analysis showed no significant spatial clustering pattern for the ASIR (Moran’s I, -0.007; Z, -0.07; p = 0.94) and ASDR (Moran’s I, 0.128; Z, 1.47; p = 0.14) of CKD due to hypertension (Supplementary Fig. 7A, 8A). However, the Moran’s diagram implies a positive spatial autocorrelation for the AAPC of ASIRs (Moran’s I, 0.191; Z, 8.66; p < 0.001) from 1990 to 2019, with 19 countries (Kazakhstan, Uzbekistan, Afghanistan, Iraq, Saudi Arabia, United Arab Emirates, et al.) were found in the high-high quadrant (Fig. 6A). Meanwhile, positive spatial autocorrelation for the AAPC of ASDRs (Moran’s I, 0.254; Z, -0.07; p < 0.001) were observed, and 21 countries (including US, Mexico, Argentina, Chile, Bolivia, Norway, Sweden, Finland, et al.) were clustered into high-high quadrant (Fig. 6B).

Fig. 6
figure 6

Regionalization of 204 countries based on the local index of spatial autocorrelation (LISA) analysis of CKD due to hypertension for age-standardized incidence (ASIR, A), and age-standardized death rate (ASDR, C) in 2019, and their average annual percentage changes (AAPCs) from 1990 to 2019 (B, D)

Full size image

Discussion

In response to our research objectives and hypothesis, this study conducted a comprehensive analysis of the global, regional, and national burden and trends of hypertension-related CKD from 1990 to 2019, yielding several key findings. First, we confirmed a persistent increase in both ASIR and ASDR of CKD attributed to hypertension on a global scale. Second, Middle-developed regions, such as Andean Latin America, North Africa and the Middle East, and Central Asia, exhibited the highest increasing ASIR trends, while High-developed regions, including High-income North America and Central Latin America, showed the highest increasing ASDR trends. These results underscore the regional disparities in CKD burden. Third, our analysis revealed greater complexity in ASDR trends across global regions and countries compared to ASIR trends. Fourth, our study highlighted that hypertension-related CKD disproportionately affects males and the elderly population, emphasizing the need for targeted interventions in these demographic groups. Fifth, spatial autocorrelation analysis demonstrated significant positive spatial autocorrelation for the AAPC of both ASDRs and ASIRs from 1990 to 2019. These findings provide insights into the spatial distribution and clustering of hypertension-related CKD trends, further informing effective prevention and control strategies.

Global trends from 1990 to 2019 show increasing ASIR and ASDR of CKD due to hypertension, which is similar to the trend of CKD due to type 2 diabetes [19]. The increase trend of ASDR of CKD due to hypertension was consist with the ASDR of CKD and resulted in the number of deaths caused by CKD to rise from 17th to 12th in the globally [1]. However, in the past 30 years, the global ASDR for cardiovascular disease, cancer, and COPD decreased by 30.4%, 14.9%, and 41.4%, respectively [20]. These findings underscore the need for greater attention to be given to global healthcare resources and policies in the treatment of highly prevalent chronic conditions, including CKD, and hypertension-related kidney disease.

Hypertension and related chronic conditions such as cardiovascular diseases were widely observed on a global scale, but regional variations were pronounced [20, 21]. Hypertension-related CKD burden also discrepancies at SDI, regional, and national. High-SDI quintile regions the lowest ASDR and increasing trend of ASIR. These results suggest that, from 1990 to 2019, high-SDI regions effectively controlled hypertension-related CKD. This may be associated with the ongoing improvement of diagnosis, medical care, blood pressure management and treatment in these regions [22,23,24]. The most pronounced increase of ASIR was observed in middle-SDI quintile. From 1990 to 2019, a number of locations, notably Morocco, Ecuador, Oman, Peru, Turkey, and Armenia, experienced significant increases in both proportion and AAPCs. These can be explained by many driven factors, including organizational policy and awareness lacking, degree of population aging changing, lifestyle and diet adjustment according to the economic development, which had gone through by the high-SDI region [25]. Low-SDI region had the highest ASDR, which may be due to the lack of access to renal replacement therapy [26].

The ASIR and ASDR were in reverse correlation to SDI in 2019, that means low-developed countries in the low-SDI quintile was bearing the heaviest burden of fatality, and the highly developed quintile was bearing the heaviest incidence burden. This association may also be explained by dietary structure, physical health, well-established medical systems, and popularization of low-cost treatment for both hypertension and CKD [27,28,29]. This phenomenon suggests that early layout prevention measures are needed in high-SDI quintile countries and the allocation of medical resources could be tilted to low-SDI countries. A notable situation is, from 1990 to 2019, all regions observed an increasing trend of ASIR following the increasing SDI, however, an asymmetrically inverted V-shaped correlation between AAPCs and SDI. This finding reveals that nations in the middle quintile of SDI bore the heaviest weight of increasing incidence, revealing the history of high-SDI countries and the future of low-SDI countries.

In 2019, elderly individuals vastly surpassed young people in absolute incidence and fatal load, and the situation was comparable for both sexes. Our data supported the concept that women were more resistant to hypertension-related CKD than men. The incidence rate and deaths rate in males were higher than which in females by all age-periods. Similar sex broken distribution in age-periods were observed in the SDI regions. Sex preponderance was unquestionably present in hypertension-related CKD, as it was in other hypertension-related conditions, such as cardiovascular diseases (CVDs) [30]. It was discovered that women have higher proportions of hypertension awareness, treatment and control than men [27]. In fact, differences in behavioral and metabolic risk variables substantially account for the gender disparity in hypertension among men [31]. There were evidences of substantial gender disparities in access to CKD treatment [32]. Studies also shown that inherent sex heterogeneity in CKD, end-stage kidney disease and CVDs in younger women compared to men, and omitting this gender protection after menopause, which was demonstrated as the outcome of estrogen exhausted [33]. However, our data shows some special performances that attract attention. First, elderly theoretically postmenopausal females, without protection with estrogen, were still lower in ASIR and ASDR which need more studies to clarify the complex risk factors. Second, the estimated annual percentage changes of ASDR reveal a global upward tendency, particularly in those locations with a median SDI. This clinically significant difference between the sexes necessitates heightened awareness and the adoption of sex-specific measures to ensure equal access to kidney health care for the purpose of enhancing prevention and treatment.

In order to investigate, analyze, and explain spatial patterns of CKD due to hypertension, we have applied the techniques of spatial autocorrelation, both global and local methods. We assessed the spatial autocorrelation of CKD due to hypertension, and identified significant spatial clusters of AAPCs of ASIR and ASDR, with relatively large geographical difference. The results of the local indices show the existence of significant high to high clusters countries of AAPC of ASIR were located in Middle or Low-middle SDI regions, while the significant high to high clusters countries of AAPC of ASDR were located in High SDI regions. These results are likely to indicate the presence of common predisposing factors in these regions, such as economy, education, lifestyle habits, dietary habits. Although our study does not further elucidate the specific causes of spatial clustering, the findings of this research may have potential applications in assisting relevant authorities in making decisions regarding policies and regulations for the control and prevention of CKD due to hypertension.

The worldwide prevalence of CKD is on a steep incline and is projected to rank as the fifth leading cause of global mortality by 2040 [34]. As hypertension stands out as a primary risk factor for CKD development, underscoring the significance of mitigating the CKD burden attributable to hypertension in the broader effort to diminish CKD’s overall impact. Thus, our results could provide a clear understanding the distribution of the global burden of CKD due to hypertension, and contributed for public health prioritization, guiding preventative strategies, addressing health disparities, fostering research and innovation, and assessing the impact of interventions, as well as enables effective resource allocation, reduces health inequalities, and informs the development of better diagnostics and treatments.

However, this study has several limitations. First, A 2021 article reported on the global burden of hypertensive kidney disease from 1990 to 2019 using DALYs, which somewhat reduced the novelty of our study [35]. However, in contrast to previous work, we focused on using incidence and death rates as indicators, which may better reflect the immediate control and treatment benefits for hypertensive kidney disease. Additionally, in our study, we employed spatial autocorrelation analysis to identify regional clustering of changes in incidence and mortality rates, which could potentially provide richer information for policy-making and the development of prevention and treatment strategies. Second, the major limitation is the integrity and accuracy of data from the GBD database, which were estimated from mathematical models based on surveillance data rather than surveillance data itself [1, 11, 36]. Third, there are results bias risks as GBD 2019 adjusted its data sources, collation, and analytical strategies to decrease missing data and improve its data quality and comparability. Fourth, despite the GBD study followed the standardized definition of CKD presented by the KDIGO guidelines, sources of information on non-fatal CKD were influenced by many factors (such as sampling, laboratory methods, and the equation used to calculate eGFR) [37]. Meanwhile, Different global hypertension diagnostic methods and CKD standards can impact condition estimates. GBD study algorithm changes during evaluation increase uncertainty due to limited data sources and potential bias in demographic subgroups. Fifth, global, regional and country levels were analyzed in our study, however, further analyzing discrepancies in domestic areas were absence. Last but not least, the risk factors and clinical information of hypertension-related CKD cannot be available in GBD database, therefore the causes for the shifting patterns in burden should be further examined.

Conclusion

This study conducted comprehensive analyses of the incidence and mortality burden of hypertension-related CKD. Our findings indicate high-SDI, and low SDI regions and countries require more efficient strategies and increased investment in the prevention and control of the escalating mortality burden associated with CKD due to hypertension. Additionally, our research highlights the importance of prioritizing the elderly population and males in healthcare interventions, and emphasizing the importance of focusing on preventive measures for the younger population. Overall, these results underscore the need for targeted efforts and resource allocation based on regional variations and population demographics to effectively mitigate the burden of CKD due to hypertension.

Data Availability

The datasets generated and analysed during the current study are available in the official website of the GBD 2019 Study (http://ghdx.healthdata.org), and download according to the Global Health Data Exchange (GHDx) query tool (http://ghdx.healthdata.org/gbd-results-tool).

Change history

References

  1. Collaboration GBDCKD. Global, regional, and national burden of chronic Kidney Disease, 1990–2017: a systematic analysis for the global burden of Disease Study 2017. Lancet. 2020;395(10225):709–33.

    Article  Google Scholar 

  2. Habas E, Sr., Habas E, Khan FY, Rayani A, Habas A, Errayes M, Farfar KL, Elzouki AY. Blood pressure and chronic Kidney Disease Progression: an updated review. Cureus. 2022;14(4):e24244.

    PubMed  PubMed Central  Google Scholar 

  3. Ndumele CE, Rangaswami J, Chow SL, Neeland IJ, Tuttle KR, Khan SS, Coresh J, Mathew RO, Baker-Smith CM, Carnethon MR et al. Cardiovascular-Kidney-Metabolic Health: A Presidential Advisory From the American Heart Association. Circulation 2023.

  4. Yu Z, Rebholz CM, Wong E, Chen Y, Matsushita K, Coresh J, Grams ME. Association between Hypertension and kidney function decline: the Atherosclerosis risk in communities (ARIC) Study. Am J Kidney Dis. 2019;74(3):310–9.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ke C, Liang J, Liu M, Liu S, Wang C. Burden of chronic Kidney Disease and its risk-attributable burden in 137 low-and middle-income countries, 1990–2019: results from the global burden of Disease study 2019. BMC Nephrol. 2022;23(1):17.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Collaborators GBDRF et al. Global, regional, and national comparative risk assessment of 84 behaviournvironmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. LANCET 2018, 392(10159):1923–1994.

  7. Olsen MH, Angell SY, Asma S, Boutouyrie P, Burger D, Chirinos JA, Damasceno A, Delles C, Gimenez-Roqueplo AP, Hering D, et al. A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on Hypertension. Lancet. 2016;388(10060):2665–712.

    Article  PubMed  Google Scholar 

  8. Filippone EJ, Foy AJ, Naccarelli GV. Controversies in Hypertension II: the optimal target blood pressure. Am J Med. 2022;135(10):1168–77. e1163.

    Article  PubMed  Google Scholar 

  9. Tinajero MG, Malik VS. An update on the epidemiology of type 2 Diabetes: A Global Perspective. Endocrinol Metab Clin North Am. 2021;50(3):337–55.

    Article  PubMed  Google Scholar 

  10. Sun J, Qiao Y, Zhao M, Magnussen CG, Xi B. Global, regional, and national burden of Cardiovascular Diseases in youths and young adults aged 15–39 years in 204 countries/territories, 1990–2019: a systematic analysis of global burden of Disease Study 2019. BMC Med. 2023;21(1):222.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Diseases GBD, Injuries C. Global burden of 369 Diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of Disease Study 2019. Lancet. 2020;396(10258):1204–22.

    Article  Google Scholar 

  12. Stevens GA, Alkema L, Black RE, Boerma JT, Collins GS, Ezzati M, Grove JT, Hogan DR, Hogan MC, Horton R, et al. Guidelines for Accurate and Transparent Health estimates reporting: the GATHER statement. Lancet. 2016;388(10062):e19–e23.

    Article  PubMed  Google Scholar 

  13. Population GBD, Fertility C. Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017. LANCET 2018, 392(10159):1995–2051.

  14. Collaborators GBDCD. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the global burden of Disease Study 2016. Lancet. 2017;390(10100):1151–210.

    Article  Google Scholar 

  15. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.

    Article  PubMed  Google Scholar 

  16. Akhtar S, Al-Abkal J, Alroughani R. Joinpoint Regression Analysis of trends in multiple sclerosis incidence in Kuwait: 1980–2019. Neuroepidemiology. 2020;54(6):472–81.

    Article  PubMed  Google Scholar 

  17. Vilinova K. Spatial autocorrelation of breast and Prostate Cancer in Slovakia. Int J Environ Res Public Health 2020, 17(12).

  18. Luo LS, Jiang JF, Luan HH, Zi H, Zhu C, Li BH, Zeng XT. Spatial and temporal patterns of Prostate cancer burden and their association with Socio-Demographic Index in Asia, 1990–2019. Prostate. 2022;82(2):193–202.

    Article  PubMed  Google Scholar 

  19. Deng Y, Li N, Wu Y, Wang M, Yang S, Zheng Y, Deng X, Xiang D, Zhu Y, Xu P, et al. Global, Regional, and National Burden of Diabetes-related chronic Kidney Disease from 1990 to 2019. Front Endocrinol (Lausanne). 2021;12:672350.

    Article  PubMed  Google Scholar 

  20. Collaborators GBDCoD. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the global burden of Disease Study 2017. Lancet. 2018;392(10159):1736–88.

    Article  Google Scholar 

  21. Lu Y, Lan T. Global, regional, and national burden of Hypertensive Heart Disease during 1990–2019: an analysis of the global burden of Disease study 2019. BMC Public Health. 2022;22(1):841.

    Article  PubMed  PubMed Central  Google Scholar 

  22. American Diabetes A. Standards of Care in Diabetes-2023 abridged for primary care providers. Clin Diabetes. 2022;41(1):4–31.

    Article  Google Scholar 

  23. Park CH, Kim HW, Park JT, Chang TI, Yoo TH, Park SK, Kim Y, Jung JY, Jeong JC, Oh KH, et al. The 2021 KDIGO blood pressure target and the progression of chronic Kidney Disease: findings from KNOW-CKD. J Intern Med. 2023;294(5):653–64.

    Article  CAS  PubMed  Google Scholar 

  24. Martinez JD, Thomas IC, Montez-Rath ME, Pao AC, Fung E, Charu V, Sim JJ, An J, Odden MC, Kurella Tamura M. Treatment and Control of Hypertension Among Adults With Chronic Kidney Disease, 2011 to 2019. Hypertension 2023.

  25. Couser WG, Remuzzi G, Mendis S, Tonelli M. The contribution of chronic Kidney Disease to the global burden of major noncommunicable Diseases. Kidney Int. 2011;80(12):1258–70.

    Article  PubMed  Google Scholar 

  26. Ashuntantang G, Osafo C, Olowu WA, Arogundade F, Niang A, Porter J, Naicker S, Luyckx VA. Outcomes in adults and children with end-stage Kidney Disease requiring dialysis in sub-saharan Africa: a systematic review. Lancet Glob Health. 2017;5(4):e408–17.

    Article  PubMed  Google Scholar 

  27. Mills KT, Stefanescu A, He J. The global epidemiology of Hypertension. Nat Rev Nephrol. 2020;16(4):223–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Swift SL, Drexler Y, Sotres-Alvarez D, Raij L, Llabre MM, Schneiderman N, Horn LV, Lash JP, Mossavar-Rahmani Y, Elfassy T. Associations of sodium and potassium intake with chronic Kidney Disease in a prospective cohort study: findings from the Hispanic Community Health Study/Study of Latinos, 2008–2017. BMC Nephrol. 2022;23(1):133.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Chou R, Selph S, Blazina I, Bougatsos C, Jungbauer R, Fu R, Grusing S, Jonas DE, Tehrani S. Screening for Glaucoma in adults: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2022;327(20):1998–2012.

    Article  PubMed  Google Scholar 

  30. Boggia J, Thijs L, Hansen TW, Li Y, Kikuya M, Bjorklund-Bodegard K, Richart T, Ohkubo T, Jeppesen J, Torp-Pedersen C, et al. Ambulatory blood pressure monitoring in 9357 subjects from 11 populations highlights missed opportunities for cardiovascular prevention in women. Hypertension. 2011;57(3):397–405.

    Article  CAS  PubMed  Google Scholar 

  31. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, Chen J, He J. Global disparities of Hypertension prevalence and control: a systematic analysis of Population-Based studies from 90 countries. Circulation. 2016;134(6):441–50.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Carrero JJ, Hecking M, Chesnaye NC, Jager KJ. Sex and gender disparities in the epidemiology and outcomes of chronic Kidney Disease. Nat Rev Nephrol. 2018;14(3):151–64.

    Article  PubMed  Google Scholar 

  33. Sciarra F, Campolo F, Franceschini E, Carlomagno F, Venneri MA. Gender-specific impact of sex hormones on the Immune System. Int J Mol Sci 2023, 24(7).

  34. Foreman KJ, Marquez N, Dolgert A, Fukutaki K, Fullman N, McGaughey M, Pletcher MA, Smith AE, Tang K, Yuan CW, et al. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016-40 for 195 countries and territories. Lancet. 2018;392(10159):2052–90.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Chen A, Zou M, Young CA, Zhu W, Chiu HC, Jin G, Tian L. Disease Burden of chronic Kidney Disease due to Hypertension from 1990 to 2019: A global analysis. Front Med (Lausanne). 2021;8:690487.

    Article  PubMed  Google Scholar 

  36. Dai H, Alsalhe TA, Chalghaf N, Ricco M, Bragazzi NL, Wu J. The global burden of Disease attributable to high body mass index in 195 countries and territories, 1990–2017: an analysis of the global burden of Disease Study. PLoS Med. 2020;17(7):e1003198.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Matsushita K, Mahmoodi BK, Woodward M, Emberson JR, Jafar TH, Jee SH, Polkinghorne KR, Shankar A, Smith DH, Tonelli M, et al. Comparison of risk prediction using the CKD-EPI equation and the MDRD study equation for estimated glomerular filtration rate. JAMA. 2012;307(18):1941–51.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank all the staffs of the Institute for Health Metrics and Evaluation (IHME), and all collaborators in GBD 2019 study.

Funding

This study was funded by (1) The Scientific Research Project of Sichuan Provincial Health Commission (No. 19PJ160), and (2) The Scientific research project of Sichuan Medical Association (No. S21051).

Author information

Authors and Affiliations

  1. Department of Nephrology, Chengdu Second People’s Hospital, No. 2 Huatai Road, Chenghua District, 610000, Chengdu, Sichuan Province, China

    Yan Liu, Qin He, Min Tian & Dongmei He

  2. Department of Endocrine, The fourth people’s hospital of Zi Gong, No. 400, North Dangui Street, Ziliujing District, 643000, Zigong, Sichuan Province, China

    Qiying Li, Xiaojiao Li & Chunying Deng

  3. Department of Stomatology, Traditional Chinese Medicine Hospital, No. 800 Zhongshan Street, 610000, Lishui City, Zhejiang Province, China

    Xufeng Yao

Authors
  1. Yan Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qin He
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Qiying Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Min Tian
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xiaojiao Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xufeng Yao
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dongmei He
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chunying Deng
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Chunying Deng, Dongmei He, and Xufei Yao designed this study. Yan Liu, Qiying Li, Qin He, Min Tian and Xiaojiao Li were involved in acquisition of the data. Yan Liu performed analysis and interpretation of the data. Yan Liu drafted of the paper. Xufei Yao optimized the manuscript in the revise process. All authors read and approved the final manuscript and all authors agree to be accountable for all aspects of the work.

Corresponding authors

Correspondence to Xufeng Yao, Dongmei He or Chunying Deng.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liu, Y., He, Q., Li, Q. et al. Global incidence and death estimates of chronic kidney disease due to hypertension from 1990 to 2019, an ecological analysis of the global burden of diseases 2019 study. BMC Nephrol 24, 352 (2023). https://doi.org/10.1186/s12882-023-03391-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12882-023-03391-z

Keywords

BMC Nephrology

ISSN: 1471-2369

Contact us