Global CKD Burden Nearly Doubles Since 1990, Reaching 788 Million Adults Worldwide – The American Journal of Managed Care® (AJMC®)

Global Burden of Chronic Kidney Disease: A Report on Progress Towards Sustainable Development Goals

Introduction and Alignment with SDG 3 (Good Health and Well-being)

A 2023 report from the Global Burden of Disease Study, published in The Lancet, indicates that Chronic Kidney Disease (CKD) has become one of the world’s fastest-growing noncommunicable diseases (NCDs). This trend presents a significant challenge to the achievement of Sustainable Development Goal 3, particularly Target 3.4, which aims to reduce premature mortality from NCDs. The comprehensive analysis, covering 204 countries, underscores the urgent need for global health strategies to address the escalating burden of CKD.

Key Epidemiological Findings

The study reveals a substantial increase in the global prevalence and impact of CKD, directly affecting health and well-being targets.

• Prevalence: In 2023, 788 million adults aged 20 and older were living with CKD, more than double the 378 million recorded in 1990. The global age-standardized prevalence reached 14.2%.
• Mortality: CKD was identified as the ninth leading cause of death worldwide, accounting for 1.48 million deaths in 2023.
• Disability Burden: The disease ranked twelfth globally in Disability-Adjusted Life-Years (DALYs), with age-standardized rates of 769 per 100,000 adults, undermining progress towards ensuring healthy lives.
• Cardiovascular Link: Impaired kidney function was responsible for 11.5% of global cardiovascular deaths, highlighting the interconnected nature of NCDs and the need for integrated health solutions as envisioned by SDG 3.

Attributable Risk Factors and the Challenge to SDG 3.4

The report identifies several modifiable risk factors that are central to NCD prevention strategies under SDG 3.4. The primary contributors to the CKD burden worldwide reinforce the need for integrated public health policies targeting metabolic diseases.

• High fasting plasma glucose
• Elevated body-mass index
• High systolic blood pressure

Global Inequities and the Imperative of SDG 10 (Reduced Inequalities)

The findings highlight significant global disparities in both the burden of CKD and access to care, directly contradicting the aims of SDG 10 to reduce inequality within and among countries.

• Regional Disparities: The highest disease burden was recorded in North Africa and the Middle East, where 18% of adults live with CKD.
• Access to Care: There is wide variation in access to kidney replacement therapy, including dialysis and transplantation. Many individuals with kidney failure in low- and middle-income regions remain untreated, compounding health and economic inequalities.
• Diagnostic Gaps: Persistent gaps in screening and early detection, particularly the underutilization of albuminuria and estimated glomerular filtration rate tests, lead to late-stage diagnoses and worsen outcomes, disproportionately affecting vulnerable populations.

Strategic Recommendations for Achieving Global Health Targets

To counteract the rising burden of CKD and advance progress on the SDGs, the study calls for coordinated international action, aligning with the principles of SDG 17 (Partnerships for the Goals). The following strategic priorities are recommended:

1. Enhance Prevention and Risk-Factor Modification: Implement robust public health strategies focused on preventing and managing diabetes, hypertension, and obesity.
2. Promote Early Diagnosis: Strengthen health systems to improve screening and early detection, particularly within primary care settings.
3. Ensure Equitable Access to Care: Address global disparities by increasing access to effective therapies and kidney replacement treatments, especially in low- and middle-income countries, to fulfill the promise of SDG 10.
4. Adopt Integrated Care Models: Develop and scale integrated care models that address the link between CKD and cardiovascular disease to reduce overall NCD mortality and achieve the targets of SDG 3.4.

Analysis of Sustainable Development Goals (SDGs) in the Article

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

The article on the rising burden of Chronic Kidney Disease (CKD) primarily addresses the following Sustainable Development Goals:

• SDG 3: Good Health and Well-being: This is the most central SDG, as the article focuses entirely on a major noncommunicable disease (NCD), its prevalence, mortality, risk factors, and the need for better healthcare systems to manage it.
• SDG 10: Reduced Inequalities: The article explicitly points out significant disparities in both the burden of CKD and access to care between different regions and income levels, directly connecting to the goal of reducing inequality within and among countries.
• SDG 17: Partnerships for the Goals: The article concludes by emphasizing the need for global cooperation and coordinated action to tackle the CKD epidemic, which aligns with the goal of strengthening global partnerships for sustainable development.

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

Based on the article’s discussion, several specific SDG targets can be identified:

1. Under SDG 3 (Good Health and Well-being):
   • 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.” The article directly relates to this by identifying CKD as “one of the fastest-growing noncommunicable diseases worldwide” and the “ninth leading cause of death worldwide.” It calls for prevention, early diagnosis, and risk-factor modification to reduce its burden.
   • Target 3.8: “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services…” The article highlights major gaps in achieving this target by noting “persistent gaps in screening and early detection” and “significant global inequities in kidney care.” It mentions that access to essential treatments like “dialysis and transplantation, varied widely between countries,” especially affecting “low- and middle-income regions.”
2. Under SDG 10 (Reduced Inequalities):
   • Target 10.4: “Adopt policies, especially fiscal, wage and social protection policies, and progressively achieve greater equality.” While not mentioning specific policies, the article underscores the health dimension of inequality. It states that disparities in CKD burden “reflect the parallel rise in metabolic, lifestyle, and environmental risk factors that disproportionately affect some regions” and that these inequities “compound the long-term health and economic effects of CKD.”
3. Under SDG 17 (Partnerships for the Goals):
   • Target 17.16: “Enhance the global partnership for sustainable development… to support the achievement of the sustainable development goals in all countries.” The article’s conclusion is a direct call to action for this target, stating the study “called for coordinated international action to address the rising burden of CKD.” The Global Burden of Disease Study itself is an example of such a partnership in action.

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

Yes, the article provides several quantitative and qualitative indicators that can be used to measure progress:

1. For Target 3.4 (Reduce NCD mortality):
   • Mortality Rate from NCDs (Indicator 3.4.1): The article provides a direct measure, stating CKD was “responsible for 1.48 million deaths in 2023.” It also notes that “impaired kidney function accounted for 11.5% of global cardiovascular deaths,” providing a specific metric for CKD’s contribution to overall NCD mortality.
   • Disease Prevalence and Burden: The article reports a “global age-standardized CKD prevalence” of 14.2% in 2023, up from 1990. It also measures disease burden using “disability-adjusted life-years (DALYs),” with CKD ranking twelfth globally. Tracking these figures over time would indicate progress.
   • Prevalence of Risk Factors: The article identifies “high fasting plasma glucose, elevated body-mass index, and high systolic blood pressure” as leading contributors. Monitoring the prevalence of these risk factors in the population serves as an indicator for prevention efforts.
2. For Target 3.8 (Universal Health Coverage):
   • Coverage of Essential Health Services (Indicator 3.8.1): The article implies a lack of coverage by highlighting that screening tests like “albuminuria and estimated glomerular filtration rate… remain underutilized in many health systems.” An increase in the utilization of these diagnostic tests would be a key progress indicator.
   • Access to Treatment: The article points to a clear indicator of inequality in coverage by stating, “Access to kidney replacement therapy, including dialysis and transplantation, varied widely between countries.” Measuring and reducing this variation is a direct way to track progress.

4. Summary Table of SDGs, Targets, and Indicators

Source: ajmc.com