Epidemiology of chronic kidney disease: an update 2022 Csaba P. Kovesdy 1 1 Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA Chronic kidney disease is a progressive condition that affects >10% of the general population worldwide, amounting to >800 million individuals. Chronic kidney disease is more prevalent in older individuals, women, racial minorities, and in people experiencing diabetes mellitus and hypertension. Chronic kidney disease represents an especially large burden in low- and middle- income countries, which are least equipped to deal with its consequences. Chronic kidney disease has emerged as one of the leading causes of mortality worldwide, and it is one of a small number of non-communicable diseases that have shown an increase in associated deaths over the past 2 decades. The high number of affected individuals and the significant adverse impact of chronic kidney disease should prompt enhanced efforts for better prevention and treatment. Kidney International Supplements (2022) 12, 7–11; https://doi.org/10.1016/ j.kisu.2021.11.003 KEYWORDS: chronic kidney disease; mortality; prevalence; risk factors Copyright ª 2022, International Society of Nephrology. Published by Elsevier Inc. All rights reserved. C hronic kidney disease (CKD) has emerged as one of the most prominent causes of death and suffering in the 21 st century. Due in part to the rise in risk factors, such as obesity and diabetes mellitus, the number of patients affected by CKD has also been increasing, affecting an esti- mated 843.6 million individuals worldwide in 2017. 1 Although mortality has declined in patients with end-stage kidney disease (ESKD), 2 the Global Burden of Disease (GBD) studies have shown that CKD has emerged as a leading cause of worldwide mortality. 3,4 It is, therefore, paramount that CKD is identified, monitored, and treated, and that preventative and therapeutic measures addressing CKD are systematically implemented worldwide. This narrative review summarizes information about global CKD prevalence, its trends over time, its various determinants, and its associated mortality. Other aspects of kidney disease epidemiology, such as CKD in pediatric patients, CKD incidence, progression to ESKD, or various clinical (e.g., cardiovascular disease) and patient-reported outcomes caused by CKD, are mentioned briefly or not discussed. Definitions of CKD and its pitfalls in epidemiologic studies The diagnosis of CKD is made by laboratory testing, most often by estimating glomerular filtration rate (GFR) from a filtration marker, such as serum creatinine or cystatin C, using various formulas, or by testing urine for the presence of albumin or protein (or a combination of these). 5 The clas- sification schemas advocated by various professional organi- zations in the past 2 decades 5 have laid the groundwork for the systematic detection and monitoring of CKD worldwide, resulting in an improved understanding of its prevalence and the resulting impact on outcomes, such as mortality. Most studies have used estimated GFR (eGFR) to determine the presence of CKD (and, therefore, report on the prevalence of CKD stages 3–5), whereas other studies have combined albuminuria (typically defined as an albumin-to-creatinine ratio of >30 mg/g) and decreased eGFR to report on CKD stages 1–5. Finally, to differentiate CKD (which is considered to be a chronic progressive disease) from conditions such as acute kidney injury or from transient fluctuations in kidney function unrelated to kidney damage, the standard definition of CKD includes a so-called “chronicity criterion” (i.e., that the low eGFR or elevated urine albumin should be detectable for at least 90 days, requiring the presence of repeated mea- surements over time). 5 There is currently no consensus on the length of time used in the assessment of CKD when applying the chronicity criterion, with epidemiologic studies applying Correspondence: Csaba P. Kovesdy, Division of Nephrology, University of Tennessee Health Science Center, 956 Court Ave, Memphis, Tennessee 38163, USA. E-mail: [email protected] Received 6 July 2021; revised 1 October 2021; accepted 8 November 2021 www.kisupplements.org review Kidney International Supplements (2022) 12, 7–11 7
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