Impact of Adverse Metabolic Factors on the Burden of Chronic Kidney Disease in the Chinese Population ≥ 20 Years Old, 1990-2019.

AIMS: To quantify temporal trends in chronic kidney disease (CKD) burden attributable to adverse metabolic risk factors among Chinese adults aged ≥ 20 years during 1990-2019. MATERIALS AND METHODS: We used Global Burden of Disease Study 2019 (GBD 2019) estimates for China to assess five CKD causes (CKD due to type 1 diabetes, type 2 diabetes, hypertension, glomerulonephritis, and other/unspecified causes) and three metabolic risks (high systolic blood pressure (SBP), high body mass index (BMI), and high fasting plasma glucose (HFPG)). Outcomes were deaths and disability-adjusted life years (DALYs) (numbers and rates per 100,000), stratified by sex and 13 age groups. Joinpoint regression was used to estimate annual percent change (APC) and average annual percent change (AAPC) in rates from 1990 to 2019. RESULTS: In 2019, the mortality rate for CKD attributable to these metabolic risks was 6.87 per 100,000, and total attributable DALYs were 4201 (thousand). Hypertensive nephropathy had the largest attributable burden (mortality 2.5/100,000; DALY rate 59.2/100,000), followed by CKD due to type 2 diabetes. From 1990 to 2019, the overall attributable CKD mortality rate increased (AAPC = 0.55%) while the DALY rate decreased slightly (AAPC = -0.27%). High SBP remained the leading contributor to attributable burden in 2019, whereas high BMI showed the fastest increase in attributable mortality burden over time. Attributable burden increased steeply with age and was higher in males than in females. CONCLUSIONS: High SBP remains a major driver of CKD burden in China, but the rapidly rising high-BMI-attributable burden highlights the need for integrated prevention focused on blood pressure control and obesity prevention, particularly among older adults and men.