Background and objectives Chronic kidney disease (CKD) is a major non-communicable cause of premature mortality and disability in India, yet no study has systematically evaluated the State-level trajectories and inequalities underpinning its burden. Methods We extracted age-standardised incidence, prevalence, mortality, and disability-adjusted life-years (DALY) estimates for CKD (ICD-10: N18–N19) from the global burden of disease (GBD) 2023 database for the period 1990-2023. Estimated annual percentage change (EAPC) was calculated using log-linear regression. States were classified into clusters based on burden relative to the national age-standardised rate and trend direction. Socioeconomic gradients were assessed using the socio-demographic index (SDI), concentration curves, and concentration indices. Uncertainty intervals (UIs) were incorporated. Results In 2023, across Indian States the incidence ranged from 226.4 to 316.4 per 100,000, prevalence from 10,452 to 12,539 per 100,000, mortality from 6.71 to 19.84 per 100,000, and DALYs from 312.2 to 666.4 per 100,000. National EAPCs showed declining trends for incidence (-0.45%), prevalence (-0.22%), mortality (-0.90%), and DALYs (-1.10%). However, high-burden States such as Telangana and Punjab had sustained elevated mortality and DALYs despite declining trends. Concentration indices demonstrated significant pro-poor inequality for mortality confidence interval (CI) -0.12 and DALYs (CI -0.24). Locally estimated scatterplot smoothing (LOESS) models revealed non-linear SDI relationships, with high-SDI States achieving lower mortality but persistent high prevalence. Interpretations and conclusions CKD poses a substantial and unequal burden across India, with widening disparities in mortality and disability. Targeted State-level interventions, early detection programmes, and equitable renal care infrastructure are urgently needed to reduce geographic inequity and achieve national NCD targets.
Meshram et al. (Wed,) studied this question.