The burden of chronic kidney disease attributed to metabolic risk factors: Insights from the 2021 global burden of disease study

Abstract

Objective: To assess the burden and trends of chronic kidney disease(CKD) attributable to metabolic risk factors from 1990 to 2021 and to project its burden to 2040 using Global Burden of Disease Study 2021 data.

Methodology: This retrospective descriptive epidemiological study used publicly available GBD 2021 data for 204 countries and territories, downloaded on June 30, 2025. Deaths, disability-adjusted life years(DALYs), age-standardized mortality rate(ASMR), and age-standardized DALY rate (ASDR) were analyzed by sex, age, Socio-demographic Index(SDI), region, and country. Trends were assessed using estimated annual percentage change, and projections for 2022–2040 were generated using a Bayesian age-period-cohort model.

Results: In 2021, the global ASMR and ASDR were 18.49 and 529.43 per 100,000 population, respectively. From 1990 to 2021, deaths increased from 552,433.01 to 1,527,039.62, and DALYs rose from 20,731,495.66 to 44,438,400.64. The burden was higher in males, increased with age, and varied markedly across SDI regions. Low-SDI regions had the highest ASMR and ASDR, whereas high-SDI regions showed the fastest increase over time. High fasting plasma glucose was the leading contributor, followed by high systolic blood pressure and high body mass index. ASMR is projected to continue rising slowly to 2040, while ASDR may decline slightly.

Conclusion: The CKD attributable to metabolic risk factors remains a growing and unevenly distributed global burden. Prevention should be SDI-stratified, emphasizing obesity control in high-SDI regions, early screening and basic management of diabetes and hypertension in low-SDI regions, and guideline-based kidney-protective therapies, including sodium-glucose cotransporter-2 inhibitors for eligible patients.