Global, regional, and national burden of Chronic kidney disease due to type 2 diabetes mellitus, 1990-2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021

Importance Chronic kidney disease (CKD) attributable to type 2 diabetes mellitus (T2DM) represents a growing global health concern. However, comprehensive long-term epidemiological trends and projections, stratified by sociodemographic and geographic variables, remain inadequately delineated. Objective To evaluate the global, regional, and national burden of CKD due to T2DM from 1990 to 2021, and to forecast its trends through 2050 using Bayesian age-period-cohort (BAPC) modeling. Design, Setting, and Participants This population-based observational study used data from the Global Burden of Disease Study 2021 (GBD 2021), which includes 204 countries and territories across five sociodemographic index (SDI) quintiles and 21 GBD regions. The study covers the period 1990–2021 with projections to 2050. Exposure Diagnosis of T2DM mellitus as an underlying cause for CKD. Main Outcome Measures Incident and prevalent cases, mortality, and disability-adjusted life-years (DALYs) attributable to T2DM-related CKD. Age-standardized incidence (ASIR), prevalence (ASPR), mortality (ASDR), and DALY (ASR) rates were computed, alongside estimated annual percentage changes (EAPC). Results From 1990 to 2021, the global number of incident CKD cases due to T2DM increased by 167.2%, while the ASIR rose by 21.0% (EAPC: 0.61). Prevalent cases nearly doubled (+85.1%), although ASPR declined slightly (−5.1%, EAPC: −0.17). Deaths surged by 222.6%, and ASDR increased by 37.8% (EAPC: 1.17). DALYs rose by 173.6%, with a 24.0% increase in ASR (EAPC: 0.81). Males and older adults consistently exhibited higher burden across all indicators. Low- and middle-SDI nations experienced the most pronounced burden growth, yet high-SDI regions also registered substantial increases in mortality and DALYs. Geographically, Latin America, Central Asia, and select Sub-Saharan African regions exhibited the most rapid ascents. Marked national disparities were evident, with Pacific Island nations bearing the highest age-standardized rates. Conclusions and Relevance T2DM-related CKD has emerged as a major global health challenge, with sustained increases in incidence, mortality, and DALYs over the past three decades. Despite modest declines in age-standardized prevalence, the absolute burden continues to rise, particularly in lower-resource settings. Projections to 2050 suggest a continued escalation, with incident cases exceeding 2.6 million and deaths surpassing 700,000 annually by mid-century. These findings highlight the urgent need for targeted prevention, early detection, and improved management strategies, particularly in high-growth regions and vulnerable populations.