#6798 BURDEN OF NONCOMMUNICABLE DISEASES ATTRIBUTABLE TO KIDNEY DYSFUNCTION: RESULTS FROM THE GLOBAL BURDEN OF DISEASE STUDY 2019
Authors: Jing Chen 
Published: June 2023

Abstract

Background and Aims
Non-communicable diseases (NCD) represent a major public health and disability burden worldwide. The UN Sustainable Development Goal (SDG) target 3.4 called for reducing premature mortality from NCD by one third through prevention and treatment by 2030. To lessen the impact of the burden of NCD, evidence-based and precise data are needed for making policy and allocating resources. However, the burden of NCD attributable to kidney dysfunction has not been systematically estimated. We aimed to estimate the global latest trend of kidney dysfunction-related NCD quantified by death and disability-adjusted life-years (DALY) at global, regional, and national levels using data extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.

Method
In GBD study 2019, kidney dysfunction is classified as level 2 risk factor for disease in metabolic risk factors hierarchy, which refers to glomerular filtration rate (GFR) &lt;60 mL/min/1·73 m² or albumin-to-creatine ratio (ACR) &gt;30 mg/g. The GBD study 2019 provides a systematic assessment of published, publicly available, and contributed data on mortality and disability-adjusted life-years (DALY), which were estimated with Bayesian geospatial regression using data at global, regional and country level. Further analyses were performed by year, age, sex, and regions in 204 countries. To assess the change trend, we calculated the estimated annual percentage change (EAPC) of age-standardized rate with the linear regression model. The Socio-demographic Index (SDI) was used as an comprehensive indicator of national socioeconomic status. we explored the relationship between age-standardized mortality or DALY rate and SDI using Pearson's correlation analysis. Additionally, burdens in main types of NCD (including cardiovascular disease and chronic kidney disease) attributable to impaired kidney function were analyzed.

Results
From 1990 to 2019, the absolute numbers of death and DALYs increased, while the age-standardized rates of deaths and DALYs of NCD attributable to kidney dysfunction deceased worldwide. The age-standardized mortality decreased by an average of −0.35% (95% UI −0.41 to −0.29) per year, from 45.17(95% UI 37.62 to 52.33) per 100,000 population in 1990 to 40.64(95% UI 34.81 to 46.71) per 100,000 population in 2019. Over the same interval, the age-standardized DALYs rate declined from 1024.13 (95% UI 898.38 to 1154.8) per 100,000 population to 945.31 (95% UI 836.33 to 1066.77) per 100,000 population, with an EAPC of −0.25% (95% UI −0.31 to −0.19). Globally, gender imbalance existed over the past 29 years, the burden in males were higher than those in females. Besides, the burden of NCDs as a result of kidney dysfunction increased with age growth, and the elder had higher rate of death and DALYs. Geographically, the age-standardized DALYs rate attributable to kidney dysfunction increased in Central Latin America, Southern Sub-Saharan Africa, Caribbean, Central Asia, Andean Latin America, Oceania, Southeast Asia. Age-standardized death and DALY rates demonstrated a higher burden in low, low-middle and middle SDI countries than those in high-middle and high SDI countries.

Conclusion
The result of the present work implied that the NCD as a result of kidney dysfunction has been an important contribution to the increasing burden of NCD over the past several decades, particularly in developing countries. Therefore, greater efforts are needed to carry out early screening and detection, primary care, and reasonable resource allocation to reduce mortality and the long-term burden, especially in low-to-middle Sociodemographic Index regions. Our data would provide the necessary information for priority setting and precision planning of health services to prevent and control NCD.