Abstract
Background
Glomerulonephritis (GN), one of the primary causes of chronic kidney disease (CKD), is gaining recognition as a major public health issue. This research sought to evaluate the worldwide impact of chronic kidney disease due to glomerulonephritis (GN-CKD) between 1990 and 2021 and to forecast trends up to 2036, leveraging data from the Global Burden of Disease (GBD) study.
Methods
The analysis of GN-CKD from 1990 to 2021 utilized GBD open data as a secondary dataset to examine global prevalence, deaths, disability-adjusted life years (DALYs), and age-standardized rates of GN-CKD, and the changing trends of these indicators were statistically analyzed. To assess the practical difference between each country/region and the frontier, we utilized the 2021 DALYs and Socio-Demographic Index (SDI). To assist healthcare institutions in formulating more effective public health policies, the age-standardized mortality and DALYs rate until 2036 were predicted using Bayesian age–period–cohort (BAPC) modeling techniques.
Results
The global prevalence rate of GN-CKD, as indicated by the age-standardized prevalence rate (ASPR), grew 10.81% between 1990 and 2021, with a marginal average annual change of 0.04 (AAPC0.04, 0.03–0.05). Similarly, there was an increase of 15.84% in the age-standardized death rate (ASDR) for GN-CKD during this period, with an average annual trend of 0.50 (AAPC0.50, 0.41–0.59). Moreover, the age-standardized DALYs rate (ASYR) for GN-CKD observed an upward trend of 8.60% from 1990 to 2021, with a modest average annual change of 0.27 (AAPC0.27, 0.17–0.37). Our findings indicate that the impact of GN-CKD differs across gender, geographic areas, and socioeconomic statuses. Elevated fasting plasma glucose levels, high body-mass index (BMI), and elevated systolic blood pressure were the main contributors to deaths and disability-adjusted life years (DALYs). Fortunately, the burden of GN-CKD is expected to diminish by 2036.
Conclusions
The worldwide impact of GN-CKD has risen, with variations observed between genders and across SDI regions. Encouraging trends point toward a potential reduction in GN-CKD-related burden in the future.
Supplementary Information
The online version contains supplementary material available at 10.1007/s11255-025-04440-2.
Keywords: Glomerulonephritis, Chronic kidney disease, Global burden of disease
Introduction
Chronic kidney disease (CKD) is a chronic progressive disease with abnormal kidney structure and function for more than 3 months due to various causes and has become an increasingly severe public health problem worldwide. CKD was indicated when there were persistent abnormalities in kidney structure or function for more than 3 months, accompanied by a glomerular filtration rate (GFR) below 60 mL/min and albumin levels exceeding 30 mg/g of creatinine [1]. Drawing upon the 2019 Global Burden of Disease (GBD) research, approximately 18.99 million cases of CKD were documented, with males accounting for 55% of these cases. Regarding CKD originating from glomerulonephritis, the total number of cases amounted to 6,900,802. The burden of disease varies geographically and socioeconomically [2, 3]. GBD research reveals that the majority of CKD-related mortality burden is predominantly found in regions with middle, lower-middle, and low SDI levels [4]. Conditions like aging, high blood pressure, diabetes, obesity, proteinuria, dyslipidemia, and environmental risk factors can worsen the disease burden of CKD [5]. Simultaneously, CKD can increase the risk of cardiovascular diseases and shorten the survival time [6].
Glomerulonephritis (GN), a prevalent cause of CKD, differs from diabetic nephropathy and hypertensive nephropathy; GN encompasses various pathological types and is characterized by its recurrent and refractory nature. The definitive diagnosis of GN typically relies on renal biopsy, which is considered the most reliable diagnostic method. Hemodialysis is most frequently required for glomerular diseases, particularly immunoglobulin A nephropathy (IgAN) and focal segmental glomerulosclerosis (FSGS). The crescentic form of glomerulonephritis exhibits the highest mortality rate, often attributed to cardiovascular complications [7, 8]. AlYousef et al. showed that lupus nephritis is the main cause of secondary glomerulonephritis [9]. Without timely intervention, glomerulonephritis develops into end-stage renal disease (ESRD) [10, 11]. In addition, recurrent glomerulonephritis and new glomerulonephritis occur after kidney transplantation, which increases rejection and affects the survival rate of the kidney [12, 13]. Therefore, comprehending and scrutinizing the current state of chronic kidney disease due to glomerulonephritis (GN-CKD) are imperative for a comprehensive understanding of the disease. The GN-CKD disease burden, its population and time levels changes, and the status quo of risk factors can provide adequate data support for formulating targeted health measures and policies.
Junjie Hu et al. studied the global burden of disease of GN-CKD from 1990 to 2019 [14] but lacked data for 2021 and had no predictive data for the future. In this study, to assist healthcare institutions in formulating more effective public health policies, we assessed the global burden of GN-CKD from 1990 to 2021 and provided a projection for 2036, leveraging data from the GBD research. Additionally, we examined the associated risk factors to explore patterns in the disease burden. This investigation aimed to furnish health management institutions with crucial epidemiological information that can serve as a valuable reference point.
Materials and methods
Data sources
This study obtained pertinent information from the GBD Results Tool on the Global Health Data Exchange website (https://vizhub.healthdata.org/gbd-results/). Diseases were categorized and coded according to the 10th Revision of the International Classification of Diseases. CKD due to glomerulonephritis was identified using the disease classification code N02-N06.9 (ICD10) (Supplemental Table 1) [15]. The condition known as GN encompasses a group of kidney disorders that involve immune-mediated injury to the basement membrane, mesangium, or capillary endothelium, leading to blood in urine and abnormal levels of protein in urine [16]. We selected “CKD due to glomerulonephritis” as the primary factor and chose “Prevalence,” “Mortality,” and “Disability-adjusted life years (DALYs)” as the key indicators. We included all age groups and both genders, with the period spanning from 1990 to 2021. The data that were obtained underwent additional collection and analysis based on various geographic regions, levels of socioeconomic development, and sex.
Table 1.
Age-standardized prevalence and AAPC of chronic kidney disease due to glomerulonephritis in people at global and regional level, 1990–2021
| Prevalence (95% UI) | AAPC (95% CI) | ||||
|---|---|---|---|---|---|
| Number in 1990 | The age-standardized rate in 1990 (per 100,000) | Number in 2021 | The age-standardized rate in 2021 (per 100,000) | ||
| Global | 6,370,882 (5,926,723, 6,848,154) | 128.55 (119.33, 137.58) | 10,735,809 (9,925,500, 11,520,171) | 129.94 (120.25, 139.51) | 0.04 (0.03–0.05) |
| Sex | |||||
| Female | 2,644,789 (2,434,847, 2,883,624) | 106.92 (98.49, 116.09) | 4,531,261 (4,169,272, 4,956,553) | 108.5 (99.78, 118.56) | 0.05 (0.04–0.06) |
| Male | 3,726,093 (3,484,081, 3,986,630) | 150.9 (141.25, 160.98) | 6,204,548 (5,774,782, 6,630,226) | 151.85 (141.58, 162.39) | 0.03 (0.01–0.04) |
| SDI level | |||||
| High | 1,027,276 (941,928, 1,106,132) | 105.81 (97.07, 113.78) | 1,458,832 (1,336,846, 1,576,394) | 107.56 (98.74, 115.96) | 0.04 (− 0.02–0.10) |
| High–middle | 1,281,307 (1,169,160, 1,397,840) | 118.43 (108.21, 129.05) | 1,707,537 (1,534,787, 1,892,474) | 110.32 (99.11, 122.15) | − 0.22 (− 0.25–− 0.19) |
| Middle | 2,144,033 (1,980,287, 2,366,684) | 138.11 (127.8, 152.3) | 3,652,603 (3,358,371, 4,009,537) | 137.65 (126.74, 150.84) | − 0.00 (− 0.04–0.03) |
| Low–middle | 1,421,772 (1,281,558, 1,572,154) | 148.35 (135.05, 163.45) | 2,768,833 (2,508,272, 3,083,438) | 150.19 (136.92, 166.25) | 0.05 (0.02–0.08) |
| Low | 490,887 (439,164, 549,253) | 129.4 (116.09, 143.14) | 1,139,977 (1,025,594, 1,263,674) | 128.79 (116.26, 142.2) | − 0.01 (− 0.04–0.01) |
AAPC average annual percentage change; CI confidence interval; SDI socio-demographic index; UI uncertainty interval
The socio-demographic indices (SDI) vary between 0.05 and 1. This study indicated that the level of education attained was at its highest, accompanied by the highest per capita income and lowest fertility rate, all by a factor of 1 [17]. The SDI was categorized into five groups: low, low–middle, middle, high–middle, and high [18]. For every risk–outcome combination, the GBD study assesses the relative risks (RRs) of a specific outcome based on exposure to the corresponding risk factor, among other factors. These evaluations are employed to calculate the population-attributable fraction (PAF). We can quantify the attributable burden by multiplying the PAFs with the DALYs and the disease burden associated with the specific outcome. This approach has been detailed in previous studies using these methodologies [19]. We identified 14 risk factors for GN-CKD and explored the main risk factors. All the information utilized in this study was directly acquired from the GBD database, which has recently been refreshed up to 2021. Ethical exemptions were granted for this research, because it utilized publicly accessible data that did not contain confidential or personally identifiable patient information.
Statistical analysis
A thorough examination was carried out to assess the worldwide impact of GN-CKD. We compared the age-standardized prevalence rate (ASPR per 100,000 population), the age-standardized death rate (ASDR per 100,000 population), and the age-standardized DALYs rate (ASYR per 100,000 population) across different sexes, regions, and countries. The findings were presented as estimated values accompanied by uncertainty intervals at a confidence level of 95% [20]. Based on GN-CKD data obtained from the GBD study, we estimated the average annual percentage changes (AAPC) using Join-point regression to measure the temporal trend [21]. Join-point regression is a statistical methodology employed to analyze trend changes in time-series data. This approach identifies specific points, known as “joinpoints,” which divide the time-series into distinct phases. It then calculates each segment’s Annual Percent Change (APC) and AAPC [22]. The AAPC signifies the average yearly percentage change or the rate of fluctuation in a specific variable over a specified period. This study indicates the modified variation in annual percentage derived from the weighted average of slope coefficients obtained through Join-point regression analysis from 1990 to 2021 [23]. We utilized the Join-point Regression program to derive AAPC values and 95% confidence intervals (CI) for global SDI regions and 204 countries. To evaluate the correlation between the prevalence of GN-CKD and socio-demographic progress, we employed data spanning 1990–2021 to construct a frontier analysis, aiming to gain insights into the potential enhancements in DALYs rate that could be attained within nations [24]. The BAPC model predicted the future prevalence, mortality, and DALYs trends [25]. All statistical analyses were conducted utilizing Join-point Regression software (version 5.1.0) and the R programming language (version 4.3.2).
Results
Global trends
The global prevalence of GN-CKD has seen a 68.51% surge between 1990 and 2021, with the number of cases escalating from 6 to 11 million. Moreover, the ASPR of GN-CKD has witnessed an increase of 10.81%, rising from 128.55 per 100, 000 population in 1990 to 129.94 per 100,000 population in our study year. The trend of change on average is 0.04 (AAPC 0.04, 0.03–0.05) (Table 1, Fig. 1). The number of deaths due to GN-CKD has increased over more than 3 decades. The deaths of GN-CKD increased by 133.25% between 1990 and 2021, from eighty thousand to 2 hundred thousand. The ASDR experienced a 15.84% increase, rising from 2.02 per 100,000 individuals in 1990 to 2.34 per 100,000 individuals in 2021, exhibiting an average growth rate of 0.50 (AAPC 0.50, 0.41–0.59) (Table 2, Fig. 1). The burden of GN-CKD measured by DALYs witnessed a substantial increase of 85.53% between 1990 and 2021, escalating from 4 million to a staggering figure of 7 million. The ASYR demonstrated an upward trend with an increment of 8.60%, progressing from77.78 per100,000 population in1990 to 84.47 per100,000 population in 2021, with an average trend of 0.27 (AAPC 0.27, 0.17–0.37) (Table 3, Fig. 1).
Fig. 1.
The number and age-standardized rate of prevalence (a), deaths (b), and Dalys (c) for GN-CKD from 1990 to 2021. DALYs, disability-adjusted life years; GN-CKD, chronic kidney disease due to glomerulonephritis
Table 2.
Age-standardized deaths and AAPC of chronic kidney disease due to glomerulonephritis in people at global and regional level, 1990–2021
| Deaths (95% UI) | AAPC (95% CI) | ||||
|---|---|---|---|---|---|
| Number in 1990 | The age-standardized rate in 1990 (per 100,000) | Number in 2021 | The age-standardized rate in 2021 (per 100,000) | ||
| Global | 83,170 (69,625, 97,738) | 2.02 (1.68, 2.38) | 193,997 (162,332, 226,569) | 2.34 (1.96, 2.74) | 0.50 (0.41–0.59) |
| Sex | |||||
| Female | 37,141 (31,114, 43,462) | 1.67 (1.38, 1.96) | 89,022 (73,524, 105,883) | 1.99 (1.66, 2.36) | 0.58 (0.49–0.68) |
| Male | 46,028 (37,748, 54,972) | 2.5 (2.05, 3.01) | 104,975 (87,280, 123,438) | 2.78 (2.3, 3.26) | 0.36 (0.28–0.45) |
| SDI level | |||||
| High | 13,033 (10,498, 15,953) | 1.22 (0.99, 1.47) | 34,137 (27,565, 40,865) | 1.56 (1.32, 1.8) | 0.84 (0.63–1.06) |
| High–middle | 13,110 (10,969, 15,202) | 1.4 (1.17, 1.64) | 22,410 (17,985, 26,810) | 1.21 (0.98, 1.44) | − 0.43 (− 0.73 to − 0.14) |
| Middle | 20,582 (17,429, 24,172) | 1.8 (1.48, 2.13) | 52,958 (43,083, 63,342) | 2.08 (1.69, 2.47) | 0.46 (0.28–0.63) |
| Low–middle | 18,754 (15,428, 22,478) | 2.67 (2.12, 3.28) | 48,737 (39,768, 59,073) | 3.35 (2.7, 4.08) | 0.79 (0.58–1.00) |
| Low | 17,585 (14,558, 21,150) | 6.75 (5.42, 8.33) | 35,584 (29,009, 43,231) | 6.38 (5.1, 7.79) | − 0.19 (− 0.30 to − 0.07) |
AAPC average annual percentage change; CI confidence interval; SDI socio-demographic index; UI uncertainty interval
Table 3.
Age-standardized DALYs and AAPC of chronic kidney disease due to glomerulonephritis in people at global and regional level, 1990–2021
| DALYs (95% UI) | AAPC (95% CI) | ||||
|---|---|---|---|---|---|
| Number in 1990 | The age-standardized rate in 1990 (per 100,000) | Number in 2021 | The age-standardized rate in 2021 (per 100,000) | ||
| Global | 3,751,088 (3,252,292, 4,269,460) | 77.78 (67.62, 88.41) | 6,959,758 (6,018,414, 7,961,673) | 84.47 (73.2, 96.13) | 0.27 (0.17–0.37) |
| Sex | |||||
| Female | 1,655,577 (1,429,752, 1,885,529) | 67.19 (57.78, 76.73) | 3,068,936 (2,640,502, 3,521,006) | 72.47 (62.8, 82.98) | 0.25 (0.12–0.38) |
| Male | 2,095,512 (1,783,982, 2,409,288) | 90.23 (77.22, 104.71) | 3,890,822 (3,322,946, 4,499,291) | 97.57 (83.48, 112.8) | 0.25 (0.18–0.31) |
| SDI level | |||||
| High | 416,680 (358,745, 479,000) | 42.1 (36.5, 47.98) | 831,401 (730,529, 929,639) | 49.13 (44, 54.57) | 0.52 (0.38–0.66) |
| High–middle | 533,161 (463,605, 607,669) | 51.84 (45.27, 58.59) | 658,153 (564,020, 754,426) | 38.43 (33.24, 43.48) | − 0.94 (− 1.23 to − 0.65) |
| Middle | 1,085,659 (931,108, 1,233,921) | 73.21 (63.29, 84) | 2,038,278 (1,741,190, 2,368,814) | 77.74 (66.73, 89.79) | 0.21 (0.03–0.39) |
| Low–middle | 920,674 (775,271, 1,068,108) | 99.1 (83.81, 116.58) | 1,925,519 (1,646,084, 2,232,277) | 113.95 (97.03, 132.32) | 0.46 (0.39–0.53) |
| Low | 790,539 (662,784, 938,657) | 215.38 (179.72, 258.83) | 1,500,348 (1,227,707, 1,830,514) | 192.55 (159.05, 232.19) | − 0.36 (− 0.45 to − 0.27) |
AAPC average annual percentage change; CI confidence interval; SDI socio-demographic index; UI uncertainty interval
Global trends by sex
In the join-point analysis, from 1990 to 2021, the mortality, prevalence, and DALYs of GN-CKD were higher in men than in women. Between 1990 and 2021, there was a global rise in the prevalence for both sexes (males experienced an increase from 4 to 6 million, while females saw a rise from 3 to 5 million). Notably, the growth rate of ASPR was comparatively higher among females than males (AAPC values of 0.05 versus 0.03) (Table 1, Supplementary Fig. 1). Between 1990 and 2021, there was a slight increase in ASDR for both genders, with men experiencing a smaller rise (AAPC of 0.36 compared to women’s AAPC of 0.58) (Table 2, Supplementary Fig. 1). Over the same period, ASYR increased at an average annual rate of 0.25 for both men and women (Table 3, Supplementary Fig. 1).
Global trends by SDI
The ASPR of GN-CKD increased in regions with High and Low–middle SDI from 1990 to 2021, especially in the Low–middle SDI region (AAPC 0.05, 0.02–0.08). The ASPR of GN-CKD decreased in the other three subgroups of SDI from 1990 to 2021, especially with the High–middle SDI region (AAPC − 0.22, − 0.25 to − 0.19). In 2021, the highest prevalence of GN-CKD was observed in the Low–middle SDI region (150.19 per 100,000 population) (Table 1, Supplementary Fig. 2). In contrast, mortality related to GN-CKD increased in the High, Low–middle, and Middle SDI regions from 1990 to 2021, particularly in the High SDI region (AAPC 0.84, 0.63–1.06). However, GN-CKD-related mortality decreased in the remaining two subgroups of SDI during this period, especially with the High–middle SDI region (AAPC − 0.43, − 0.73–0.14). In terms of absolute numbers for the year 2021, the highest mortality due to GN-CKD was recorded in regions classified as having a Low SDI at a rate of 6.38 per100 000 population (Table 2, Supplementary Fig. 3). Additionally, there was a notable increase in ASYR within regions classified as High, Low–middle, and Middle SDI from 1990 to 2021. This increase was particularly noteworthy with the High SDI region (AAPC 0.52, 0.38–0.66). Conversely, GN-CKD-related DALYs decreased in the other SDI subgroups over the same timeframe, especially with the High–middle SDI region (AAPC − 0.94, − 1.23 to − 0.65). In 2021, the Low SDI region exhibited the highest burden of DALYs attributed to GN-CKD at a rate of 192.55 per 100,000 population (Table 3, Supplementary Fig. 3). There was a statistically significant difference in the AAPC between low and low–middle SDI regions, with the AAPC being notably higher in the low–middle SDI region (Fig. 2).
Fig. 2.
The comparison of disease burden of GN-CKD in low–middle and low SDI regions. a ASRP, b ASDR, and c ASYR. ASYR, age-standardized DALYs rate; ASDR, age-standardized deaths rate; ASPR, age-standardized prevalence rate; DALYs, disability-adjusted life years; SDI, socio-demographic index; GN-CKD, chronic kidney disease due to glomerulonephritis
Fig. 3.
Global GN-CKD burden in 204 countries and territories. The ASPR (a), ASDR (b), and ASYR (c) in 2021; AAPC in the ASPR (d), ASDR (e), and ASYR (f) from 1990 to 2021. ASYR, age-standardized DALYs rate; ASDR, age-standardized deaths rate; ASPR, age-standardized prevalence rate; DALYs, disability-adjusted life years; AAPC, average annual percentage change; GN-CKD, chronic kidney disease due to glomerulonephritis
National trends
In terms of national statistics, Ukraine (SDI 0.76) (AAPC 9.70, 7.05–12.42) witnessed the most significant rise in ASDR related to GN-CKD between 1990 and 2021, followed by Armenia (SDI 0.70) (AAPC 7.42, 5.03–9.87) and Georgia (SDI 0.73) (AAPC 3.88, 1.86–5.93). Over the same period, El Salvador (SDI 0.56) exhibited the most substantial rise in ASPR with GN-CKD (AAPC 0.63, 0.57–0.69), followed by the United States of Guam (SDI 0.80) (AAPC 0.55, 0.53–0.57). In 2021, Ukraine had the highest increase in the ASYR of GN-CKD (AAPC 5.17, 3.88–6.48), followed by Armenia (SDI 0.70) (AAPC 3.22, 1.74–4.72). In 2021, Mauritius (SDI 0.70) had the highest ASPR for GN-CKD (214.56 per 100,000 population), El Salvador (SDI 0.56) had the highest ASYR (570.21 per 100,000 population), and the United Republic of Tanzania (SDI 0.44) had the highest ASDR (17.94 per 100,000 population) (Fig. 3).
Frontier analysis of GN-CKD burden
The frontier represents the forefront countries or regions pushing boundaries and having the lowest disease burden as reflected by their SDI (Fig. 4). Sufficient disparity refers to the discrepancy between the observed burden of a country or region, as determined by its SDI, and the potential disease burden that can be actualized. A distinction from the forefront signifies unexplored advantages or prospects for enhancement (DALYs) based on a country or region’s position within the development continuum. We employed 2021 DALYs and SDI to assess the disparity in effectiveness between each country/region and the frontier. Among countries with low SDI, Somalia, Niger, the Solomon Islands, Vanuatu, and Papua New Guinea showed minimal distance disparities. While among high SDI countries, the United States of America, Lithuania, Singapore, Germany, and Austria exhibited substantial differences in distance. The frontier is depicted by a continuous black line, with countries/regions represented by dots. The blue dots indicate an upward trend, whereas the red dots signify the opposite.
Fig. 4.
a Frontier analysis based on SDI and GN-CKD DALYs rate from 1990 to 2021. b Frontier analysis based on SDI and GN-CKD DALYs rate in 2021. ASYR, age-standardized DALYs rate; SDI, socio-demographic index; GN-CKD, chronic kidney disease due to glomerulonephritis
Risk factors
We investigated 14 potential factors that may contribute to the development of GN-CKD. On a global scale, high fasting plasma glucose, high body-mass index, and high systolic blood pressure were the main contributors to GN-CKD deaths and DALYs (Fig. 5, Supplemental Table 5). Specifically, high fasting plasma glucose was responsible for 14.70% of global deaths, followed by high body-mass index (11.80%) and high systolic blood pressure (11.70%). The impact of these risk factors on mortality differed across SDI regions. Notably, high–middle SDI regions experienced higher proportions of deaths attributed to high fasting plasma glucose (18.80%), high body-mass index (18.00%), and high systolic blood pressure (16.40%) compared to other SDI regions. Globally, high fasting plasma glucose was responsible for 9.90% of all DALYs, followed by high body-mass index (9.30%) and high systolic blood pressure (8.40%). The impact of these risk factors on DALYs differed across SDI regions. High SDI regions experienced more DALYs, which is attributed to high fasting plasma glucose (16.3%). In contrast, high–middle SDI regions saw higher proportions of DALYs linked to high body-mass index (14.70%) and high systolic blood pressure (13.70%) compared to other SDI regions.
Fig. 5.
Trends in GN-CKD mortality and DALYs associated with the risk factors across global and SDI regions from 1990 to 2021. Risk factors include high fasting plasma glucose, body-mass index, and systolic blood pressure; GN-CKD, chronic kidney disease due to glomerulonephritis; SDI, socio-demographic index
Bayesian age–period–cohort model
According to the GBD data spanning from 1990 to 2021, we utilized the BAPC model to forecast a notable decline in ASDR and ASYR for GN-CKD for both males and females within the timeframe of 2021–2036. The summarized outcomes suggest that the ASDR is estimated to decrease annually post-2021, going from 128.78 per 100,000 population in 2021 to 123.19 per 100,000 population by 2036. Meanwhile, the predictive findings demonstrated a yearly reduction in ASYR from its initial value of 82.65 per 100,000 population in 2021 to 73.25 per 100,000 population by 2036 (Fig. 6).
Fig. 6.
The disease burden of GN-CKD is predicted until 2036. a ASDR, b ASYR. ASYR, age-standardized DALYs rate; ASDR, age-standardized deaths rate; DALYs, disability-adjusted life years; GN-CKD, chronic kidney disease due to glomerulonephritis
Discussion
Drawing on the most recent data from the GBD report spanning from 1990 to 2021, this study examined various indicators, including prevalence, deaths, and DALYs, to assess the impact of chronic kidney disease due to glomerulonephritis in different regions and populations over time. The findings revealed a notable increase in the age-standardized prevalence rate (ASPR), the age-standardized death rate (ASDR), and the age-standardized DALYs rate (ASYR). Earlier GBD research indicated that in 2019, the incidence of DALYs attributed to GN-CKD was 86.2 per 100,000 individuals, and the mortality rate increased to 2.3 per 100,000 individuals. This observation aligns with the outcomes of our investigation [14]. Our findings indicate that the impact of GN-CKD differs across gender, geographic areas, and socioeconomic statuses. This variation could be associated with disparities in economic conditions, educational attainment, distribution of healthcare resources, availability of medical professionals, standards of care, lifestyle practices, and management of risk factors.
The burden of GN-CKD showed a notable gender difference, with men facing a greater disease burden than women. Men show a greater prevalence of albuminuria and, consequently, CKD stages 1–2. Additionally, males demonstrate an accelerated deterioration in renal function, experience more frequent advancements in kidney failure, and face elevated mortality rates, as well as an increased susceptibility to cardiovascular disease when compared to females [26, 27]. This phenomenon could be ascribed to inherent biological variations. Sex disparities may arise from distinct physiological compositions, alterations during pregnancy, immune system reactions, and fluctuations in hormone levels throughout the day. Additionally, sex-specific discrepancies can be observed in various subtypes of glomerular diseases [28, 29]. Monitoring of creatinine or albuminuria, including women with diabetes or hypertension, was infrequent [30]. Enhancing early screening measures for patients are essential to address these disparities. Routine physical examinations for men should include urine microalbumin-to-creatinine ratio testing and the frequency of outpatient follow-ups for male patients with glomerulonephritis should be increased. These steps aim to facilitate early diagnosis and timely treatment, helping mitigate these differences.
There is an inverse relationship between the SDI and the burden of GN-CKD, as measured by DALYs [31]. Our research results show that with the increase of SDI, DALYs present a downward trend and become stable at around 0.6 value of SDI. A study shows that in low and low–middle income countries, the epidemiological characteristics of glomerulonephritis are insufficient, mainly due to the poor feasibility of renal biopsy. Focal segmental glomerulosclerosis is common in large populations in Latin America, Africa, the Middle East, and Southeast Asia, while IgA nephropathy is common in the Chinese population. Membranoproliferative glomerulonephritis is also common in adults and children in some African countries, and in these regions, glucocorticoids and cyclophosphamide are often used in treatment, with high risks of drug complications, renal failure, and death [32]. Our results show that the prevalence is predominantly focused in low–middle regions. The higher ASPR in high SDI regions may also be related to the high prevalence of disease screening and the high detection rate. The patterns of mortality and DALYs across different SDI regions exhibit similarities, with the highest disease burden observed in low and low–middle SDI regions. Although the age-standardized rate peaked in low SDI regions, the AAPC was more pronounced in low–middle SDI areas, indicating a faster upward trend with statistically significant differences between these groups. Low–middle SDI encounters diverse obstacles such as restricted availability and affordability of diagnostic tests and medications, inadequate kidney replacement therapy and transplantation resources, inadequate healthcare system infrastructure, limited availability of skilled personnel, and inadequate funding mechanisms to facilitate holistic and integrated management of kidney conditions [33–35]. The stabilization of the disease burden in low SDI regions may be attributed to relatively slower economic growth and limited dissemination of kidney disease awareness. The low rate of disease detection is also a contributing factor, leading to the difference in disease burden compared with the low–middle SDI regions and further widens the gap with the high SDI regions. At the national level, Mauritius, Africa’s most affluent country, falls within the high–middle SDI category. According to our research findings, Mauritius ranks first out of 204 countries in ASPR, which could be attributed to the comparatively high incidence of diabetes and hypertension in the country [36]. Ukraine holds the highest rank among 204 countries concerning fatalities due to GN-CKD. This situation could be attributed to inadequate medical funding, a deficiency in healthcare professionals, and insufficient dialysis equipment and medications [37]. El Salvador, with an SDI of 0.56, exhibited the highest ASYR, while the United Republic of Tanzania, having an SDI of 0.44, reported the highest ASDR. This aligns with the observed disease patterns in regions categorized by their SDI levels. To sum up, the country (For example, Ukraine) can reduce the disparity in disease burden among nations by increasing capital investment, enhancing educational attainment, prioritizing early disease screening and chronic disease management, and optimizing the allocation of medical resources in key underprivileged areas.
Among the 14 risk factors, metabolic factors were the main contributors to GN-CKD deaths and DALYs. Metabolic syndrome (MetS) encompasses central obesity, elevated blood glucose, lipid abnormalities, and raised blood pressure. A study by Eris Ozkan et al. showed that the risk of FSGS decreased by 0.12 times with the decrease of HbA1c [38]. Another study showed that compared with primary glomerulonephritis in diabetic patients, diabetic nephropathy had a higher HbA1c (8.98 ± 2.3 vs. 6.9 ± 1.05, p: 0.001), and HbA1c variability was identified as an important determinant for differentiating diabetic nephropathy and non-diabetic glomerulonephritis [39]. The presence of chronic hypertension over an extended period can result in thickening of the inner lining and narrowing of the renal arteries and arterioles, as well as glomerular sclerosis, interstitial fibrosis, and tubular atrophy, thereby exacerbating the burden of GN-CKD [40]. Obesity can contribute to the occurrence of hyperinsulinemia, insulin resistance, disrupted lipid metabolism, activation of the renin–angiotensin–aldosterone system, chronic inflammation, and oxidative stress, and these factors collectively facilitate the progression of glomerulopathy associated with obesity [41]. Dietary factors are also risk factors for GN-CKD; therefore, a reasonable diet improves the prognosis and progression of GN-CKD disease [42]. To sum up, managing blood sugar, blood pressure and BMI, as well as a reasonably controlling diet, is helpful for better-controlling diseases and reducing the burden they bring.
Among the risk factors, the three main factors vary across different SDI regions. The high–middle and high SDI regions account for the most significant proportion of GN-CKD-related DALYs and deaths associated with these three major risk factors. This might be another reason for the increasing trend of disease burden in high SDI regions compared to low and low–middle SDI regions. However, metabolic diseases in low–middle SDI regions should not be overlooked. Previous research has indicated that low–middle SDI regions face a relatively high risk of mortality from diabetes and hypertension [43]. This phenomenon could be attributed to lacking a comprehensive diagnostic and therapeutic framework for metabolic diseases in medium and low SDI regions. The elevated prevalence of metabolic disorders in high SDI areas might stem from unhealthy lifestyle choices, poor dietary patterns, and an aging population. In regions with low–middle and low SDI, the impact and rise in mortality and DALYs due to high BMI are more pronounced. This may be linked to a diet predominantly composed of carbohydrate-rich foods like rice and other processed items and a deficiency in high-quality protein intake [44]. Driven by population growth and epidemiological changes, the burden of diabetes in low and low–middle SDI regions has increased most rapidly. In contrast, the trend in high SDI regions has tended to stabilize. In the future, it will be mainly affected by population aging to a large extent [18]. In middle–low and low SDI regions, the healthcare system may lag behind the progression rate of metabolic diseases. This may be related to the increase in the disease burden in the middle and low SDI regions. In summary, rapid economic development and advanced medical facilities have been observed in regions with high SDI. However, the increasing disease burden in these regions can be attributed to various factors such as unhealthy lifestyles, an aging population, elevated blood glucose and pressure levels, and higher BMI. In contrast, low and low–middle SDI regions face challenges including a shortage of medical resources, limited economic capacity, and inadequate allocation of healthcare personnel. Additionally, the rising burden of metabolic diseases and uncontrolled risk factors further exacerbate the overall disease burden in these regions. Therefore, attach importance to the screening of glomerulonephritis medical, focusing on improving the economic level, resource allocation, and economic education level in low and low–middle SDI regions, improving the dietary habits in high SDI regions, controlling global metabolic diseases, and controlling the attainment of standard blood sugar, blood pressure, and BMI, will help improve the global disease burden of GN-CKD and shorten the differences between regions.
A declining trend in prevalence, deaths, and DALYs associated with chronic GN-CKD is expected in the future. In the future, as glomerular diseases become more widely recognized in terms of promoting health, early screening, risk stratification, and timely treatment within the healthcare system will contribute to decreasing the burden associated with GN-CKD. With the progress in science and technology, scientists and medical circles have extensively explored and researched the etiology and therapeutic targets of glomerulonephritis. Currently, targeted therapy using biological agents such as B-cell targeted therapy for IgA nephropathy and complement-targeted therapy are potentially being utilized to improve remission rates of the disease. The advent of glucocorticoid replacement drugs has also reduced the side effects of glucocorticoids and the disease burden [45–48]. In the future, a reduction in the disease burden of GN-CKD is expected to have several positive impacts on the healthcare system. This includes decreased demand for dialysis services, reduced medical expenses, accelerated research and development of novel therapies, and improved patient outcomes and quality of life.
A few limitations still need to be discussed in this study. First, disparities in data quality across multiple sources led to discrepancies between the GBD estimates of GN-CKD burden and real-world data. Second, although the association between DALYs and the SDI offers explanatory insights, it should not be interpreted as a causal relationship. Perhaps, the reliability can be enhanced in the future by increasing the correlation analysis. In areas where renal puncture biopsy cannot be performed due to the lack of medical resources, the ASPR may be even lower than the actual level, further affecting other indicators and prediction results. The BAPC model has unique advantages in analyzing age, period, and cohort effects and is suitable for trend prediction of long-term data. However, it relies on historical data trends. If new changes occur in the future, the model may not be able to predict accurately. Despite these constraints, health system officials can significantly benefit from the valuable information the GBD 2021 database provides when formulating interventions, addressing modifiable risk factors, and effectively preventing GN-CKD. However, since the database was updated in 2021, there is an urgent requirement for obtaining the latest epidemiological data from 2024.
Conclusions
The global burden of GN-CKD is increasing, constituting a considerable hindrance. The growing burden of GN-CKD varies across gender, region, and SDI. It is essential to acknowledge these disparities. It may be possible to reduce this upward trend by increasing the accessibility of medical resources and controlling risk factors such as metabolic diseases. Promising indications suggest a future decrease in the burden associated with GN-CKD.
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements
The authors would like to thank all doctors, epidemiologists, statisticians, and related individuals who devoted their time and energy to establishing and accomplishing the GBD study rounds.
Author contribution
Xiaotong Wang and ZL contributed equally to this study. ZL conceived of and designed the study. LY and Xuejiao Wang supervised this study. Xiaotong Wang、LL and LM performed statistical analysis. Xiaotong Wang and ZL drafted the manuscript. NY reviewed and edited this manuscript.
Funding
This study was not funded.
Data availability
The data used in this study were obtained online (http://ghdx.healthdata.org/gbd-results-tool).
Declarations
Conflict of interest
The authors declare no conflict of interest.
Clinical trial number
Not applicable.
Consent for publication
Not applicable.
Ethical approval
Not applicable.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Xiaotong Wang and Zhaoyi Liu have contributed equally to this work and should be considered co-first authors.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The data used in this study were obtained online (http://ghdx.healthdata.org/gbd-results-tool).