Global, regional and national burden of CKD in children and adolescents

BACKGROUND: Chronic kidney disease (CKD) in children and adolescents elevates lifelong cardiovascular and kidney failure risk, yet global epidemiological studies remain limited. METHODS: Data from the Global Burden of Disease (GBD) Study 2021 were extracted to analyse the incidence, prevalence, mortality and disability-adjusted life years (DALYs) of CKD in children and adolescents ages 0-19 years. Age-standardized rates (ASRs) and estimated annual percentage change (EAPC) were calculated. The study further examines differences across regions, age groups, sex, risk factors and aetiologies. Health inequality analysis was performed not only to investigate the distribution of CKD, but also to assess the impact of kidney replacement therapy (KRT, including dialysis and transplantation) accessibility on CKD-related DALYs. The Bayesian Age-Period-Cohort model was applied to predict trends in disease burden from 2022 to 2050. RESULTS: In 2021, the global incidence of CKD among individuals ages 0-19 years was estimated at ≈7.54 million, with an age-standardized incidence rate (ASIR) of 28.62 (95% uncertainty interval 20.88-38.08). Central Asia had the highest ASIR. The low-middle Socio-Demographic Index (SDI) region experienced the fastest increase in ASIR, with an EAPC of 0.403 (95% confidence interval 0.332-0.475). Incidence rates in adolescents ages 14-19 years increased by 44.29%. A strong negative correlation was observed between the SDI and age-standardized mortality rate (ρ = -0.822, P < .001). The concentration index for DALYs shifted from -0.240 in 1990 to -0.293 in 2021. Areas with higher accessibility to KRT consistently bore a lower burden of CKD. By 2050, the ASIR is projected to decrease to 25.54. CONCLUSIONS: The increase in the health inequality concentration index underscores the importance of enhancing early CKD screening in low SDI areas. Targeted policies, including health education and early CKD screening, should be prioritized.