Chronic Kidney Disease Now in the Top 10 Causes of Death Worldwide – MedPage Today

Global Chronic Kidney Disease Burden and its Implications for Sustainable Development Goals

Executive Summary

A 2023 report from the Global Burden of Disease Study highlights a significant increase in the global prevalence and mortality of Chronic Kidney Disease (CKD). Now ranked as the ninth leading cause of death worldwide, CKD presents a formidable challenge to achieving several Sustainable Development Goals (SDGs), most notably SDG 3 (Good Health and Well-being). The disease’s rising burden, coupled with profound inequities in treatment access, underscores the urgent need for integrated global health strategies that address non-communicable diseases (NCDs), reduce inequalities (SDG 10), and consider environmental determinants of health (SDG 13).

Global Prevalence and Mortality of CKD

Key Statistics from the 2023 Global Burden of Disease Study

• Global Prevalence: An estimated 788 million individuals aged 20 and older were living with CKD in 2023, a substantial increase from 378 million in 1990.
• Prevalence Rate: The global age-standardized prevalence of CKD has risen from 3.5% to 14.2% since 1990.
• Mortality: CKD accounted for 1.48 million deaths in 2023, elevating it to the ninth leading cause of death globally.
• Disability-Adjusted Life-Years (DALYs): The disease is the 12th leading cause of DALYs, with an age-standardized rate of 769.2 per 100,000.

CKD as a Barrier to SDG 3: Good Health and Well-being

Rising Mortality and Non-Communicable Disease Targets

The escalating mortality rate from CKD directly threatens the achievement of SDG Target 3.4, which aims to reduce premature mortality from NCDs by one-third. The report notes this increase is occurring despite the availability of evidence-based therapies to slow disease progression and mitigate associated cardiovascular mortality. This points to a critical gap in the implementation of effective prevention and treatment strategies on a global scale.

Major Risk Factors and Prevention

The leading risk factors for CKD-related DALYs are intrinsically linked to the global NCD epidemic. Addressing these is crucial for prevention and aligns with SDG 3 objectives.

1. High fasting plasma glucose
2. High Body Mass Index (BMI)
3. High systolic blood pressure

Furthermore, CKD itself is a significant risk factor for cardiovascular disease, another leading cause of global mortality. Impaired kidney function was responsible for an estimated 11.5% of cardiovascular deaths worldwide, ranking it as the seventh most significant risk factor for cardiovascular mortality.

Socioeconomic and Geographic Disparities: A Challenge to SDG 10

Regional Burden and Contributing Factors

The burden of CKD is not distributed equally, revealing significant global inequalities that contravene the principles of SDG 10 (Reduced Inequalities). The highest numbers of individuals with CKD were found in China (152 million) and India (138 million). Regions with the highest age-standardized prevalence include:

• North Africa and the Middle East
• South Asia
• Sub-Saharan Africa
• Latin America and the Caribbean

Factors contributing to these regional disparities include a combination of vascular risk factors, genetic predispositions such as APOL1 variants in West Africa, and environmental stressors.

Inequities in Access to Treatment and Universal Health Coverage (SDG 3.8)

The report highlights stark disparities in access to kidney replacement therapies, a critical failure in the pursuit of Universal Health Coverage (UHC) as outlined in SDG Target 3.8. High-income regions exhibit the highest prevalence of patients receiving dialysis and transplants. In contrast, sub-Saharan Africa demonstrates an “extremely low” relative prevalence of both treatments. This gap between disease burden and access to care underscores the deep-seated inequalities within global health systems.

Broader Implications for Sustainable Development

Climate Change and Health (SDG 13)

The study posits a potential link between the rise of CKD in certain regions and environmental factors, directly connecting the health crisis to SDG 13 (Climate Action). Climate change, excess heat stress, and extreme weather events are suggested as contributing factors, highlighting the need for health policies to consider environmental determinants.

Recommendations and Path Forward

Enhancing Data Collection for Policy (SDG 17)

The report’s findings were limited by data gaps, particularly the lack of albuminuria data in several global regions. To address these inequities and inform effective policy, a concerted effort is needed to improve data collection, especially in lower sociodemographic index settings. This aligns with SDG 17 (Partnerships for the Goals), as it requires collaboration between governments, researchers, and national and regional health societies.

Call to Action for the Global Health Community

Experts urge the global nephrology community to intensify efforts to achieve key SDG-related health targets by:

1. Raising awareness about the need for testing at-risk individuals for kidney disease.
2. Supporting the integration of CKD management into primary care pathways to improve early detection and care.
3. Empowering clinicians at all levels to implement guideline-directed, evidence-based therapies.

SDGs, Targets, and Indicators related to Chronic Kidney Disease

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being: The entire article focuses on Chronic Kidney Disease (CKD) as a major global health issue, detailing its prevalence, mortality, and risk factors, which directly aligns with promoting health and well-being.
• SDG 10: Reduced Inequalities: The article highlights significant disparities in the burden of CKD and access to treatment between different countries and income levels. For example, it notes that “High-income areas tended to have the highest prevalence of patients receiving dialysis and transplant,” while Sub-Saharan Africa had an “extremely low” prevalence of such treatments, pointing to vast inequalities in healthcare access.
• SDG 13: Climate Action: A direct link is made between environmental factors and the disease, as the article suggests that “Climate change, excess heat stress, and extreme weather events may be two other factors contributing to the rise in CKD in certain areas of the world.”
• SDG 17: Partnerships for the Goals: The article calls for improved data collection to inform policy, stating, “To address substantial inequities, efforts must be intensified to collect comprehensive data from lower sociodemographic index settings.” This emphasizes the need for capacity-building and better data systems, which is a core component of SDG 17.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
   • Explanation: The article identifies CKD as a non-communicable disease that has become the “ninth spot on the leading causes of death globally.” It also discusses its primary risk factors (“High fasting plasma glucose, BMI, and systolic blood pressure”), which are central to NCD prevention and treatment strategies. The call to implement “evidence-based therapies to slow progression of CKD” directly supports this target.
2. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
   • Explanation: The article reveals major gaps in universal health coverage by highlighting the disparity in access to “expensive kidney replacement therapies” like dialysis and transplantation. The observation that Sub-Saharan Africa has an “extremely low” relative prevalence of these treatments indicates a lack of access to essential health services for CKD patients in that region.
3. Target 13.1: Strengthen resilience and adaptive capacity to climate-related hazards and natural disasters in all countries.
   • Explanation: The article connects the rise in CKD to climate-related hazards by suggesting “Climate change, excess heat stress, and extreme weather events” as contributing factors. This positions CKD as a health outcome of climate change, making resilience and adaptation in health systems relevant to this target.
4. Target 17.18: By 2020, enhance capacity-building support to developing countries… to increase significantly the availability of high-quality, timely and reliable data disaggregated by… income, geographic location and other characteristics relevant in national contexts.
   • Explanation: The article explicitly calls for better data, noting that “albuminuria was largely missing in certain global regions” and that “efforts must be intensified to collect comprehensive data from lower sociodemographic index settings.” This directly aligns with the goal of improving data availability in developing countries to inform policy and address health inequities.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Mortality rate attributed to CKD: The article explicitly states that CKD accounted for “1.48 million deaths” and is the ninth leading cause of death. Tracking this number measures progress towards Target 3.4.
2. Prevalence and burden of CKD: The article provides detailed statistics on the disease burden, including the “global age-standardized prevalence of CKD” (14.2%) and the “age-standardized DALY [disability-adjusted life-years] rate of 769.2 per 100,000.” These are direct indicators of the scale of the NCD problem.
3. Prevalence of risk factors for NCDs: The article identifies “High fasting plasma glucose, BMI, and systolic blood pressure” as leading risk factors for CKD. Monitoring the prevalence of these conditions in the population is an implied indicator for prevention efforts under Target 3.4.
4. Coverage of essential health services for CKD: The article discusses the “prevalence of patients treated with dialysis and transplant.” This serves as a direct indicator for access to essential, life-saving treatment for severe CKD, which is relevant to measuring universal health coverage (Target 3.8). The disparity between regions highlights gaps in this coverage.
5. Availability of disaggregated data on CKD: The article implies a key indicator by highlighting its absence. The call to “collect comprehensive data from lower sociodemographic index settings” and use “household surveys” suggests that the availability and quality of such data is a measurable indicator of progress towards Target 17.18.

4. Summary Table of SDGs, Targets, and Indicators

Source: medpagetoday.com