High temperature-attributable chronic kidney disease burden in China, 1990-2023: temporal trends, population aging as the dominant driver, and projections to 2036

Background Ambient temperatures have risen in China over recent decades, but the long-term disease burden of chronic kidney disease (CKD) estimated to be attributable to high temperature has not been systematically quantified. We aimed to estimate this burden from 1990 to 2023 and project trends to 2036. Methods Using Global Burden of Disease Study 2023 data, we extracted deaths, DALYs, age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) for high temperature-attributable CKD in China. Joinpoint regression and estimated annual percentage change (EAPC) analyses assessed temporal trends. Decomposition analysis identified drivers of DALY changes. Bayesian age-period-cohort models projected the burden to 2036. Results From 1990 to 2023, ASMR increased from 0.04 to 0.08 per 100,000, and ASDR rose from 1.42 to 1.57 per 100,000. Joinpoint regression revealed an accelerating trend (APC: 0.17% for ASDR, 1.63% for ASMR). EAPC analysis showed divergent sex-specific trends. Population aging was the primary driver of DALY increases, with other factors having offsetting effects. By 2036, total deaths are projected to reach 1,261 (95% CrI: 800–1,986), a 17.1% increase from 2023. Conclusion The burden of high temperature-attributable CKD in China has increased over three decades and is projected to continue rising. Elderly males are the most vulnerable group, and targeted interventions are urgently needed.