Global burden of chronic kidney disease

Overview

GBD Chronic Kidney Disease Collaboration. Lancet 2020 · PMID 32061315 · DOI 10.1016/S0140-6736(20)30045-3

About 9% of the world's population (698 million people) had CKD in 2017, about 7.1 million of them in Egypt; diabetes caused almost a third of the burden.

Does the study support the specific claim? No · Methodological quality: moderate

Original publication

Plain-language summary

Scientific in-depth review

1. Full reference

Authors

GBD Chronic Kidney Disease Collaboration

Journal

Lancet

Year

2020

Identifier

PMID 32061315 DOI 10.1016/S0140-6736(20)30045-3

Verification

verified – PubMed efetch 2026-10-25

Retracted

no

Corrections

none

Extent checked

full text

Conflicts of interest and funding

Bill & Melinda Gates Foundation (GBD); individual collaborators acknowledge various public grants. Declaration of interests lists numerous industry fees/grants (e.g. Amgen, AstraZeneca, Bayer, Fresenius, Baxter) for several co-authors, all stated as outside the submitted work.

2. Research question

What is the global, regional and national burden of CKD?

3. Study design and population

Study design

Risk assessment – Systematic analysis / modelling (Global Burden of Disease 2017)

Population

Populations of 195 countries and territories (GBD 2017), all ages, both sexes

Country

Global (195 countries) incl. Egypt and the North Africa and Middle East region

Period

1990-2017 (cause-of-death data 1980-2017; literature from 1980 onwards; registry data to 2017)

Sample size

not applicable (modelled population estimates); global 697.5 million prevalent CKD cases in 2017

Inclusion and exclusion criteria

Population-based prevalence studies (clinic- or laboratory-based samples excluded), vital registration, verbal autopsy, surveillance, renal replacement therapy registries, household surveys; systematic reviews in PubMed and Embase.

4. Methods and endpoints

Exposure / intervention

Chronic kidney disease (all stages, defined by single eGFR and/or ACR measurement, dialysis, transplant) and impaired kidney function as risk factor for cardiovascular disease and gout

Comparator

not applicable

Endpoints

Incidence, prevalence, mortality, DALYs

Statistical methods

Cause of Death Ensemble model (CODEm) for mortality; DisMod-MR 2.1 Bayesian meta-regression for non-fatal outcomes; eGFR equation adjustment to CKD-EPI; cause attribution using Geisinger Health System data; comparative risk assessment for attributable burden; 95% uncertainty intervals.

5. Actual results

Results

Global 2017: 1.2 million CKD deaths (UI 1.2-1.3); all-age CKD mortality rate +41.5% (35.2-46.5) since 1990, age-standardised mortality unchanged (+2.8%, -1.5 to 6.3); 697.5 million all-stage CKD cases (UI 649.2-752.0), prevalence 9.1% (8.5-9.8); age-standardised prevalence stable (+1.2%); 35.8 million DALYs (33.7-38.0), diabetic nephropathy almost a third; diabetes and hypertension together contributed to more than half of CKD deaths; 1.4 million cardiovascular deaths (1.2-1.6) and 25.3 million CVD DALYs attributable to impaired kidney function. Egypt 2017: 7,101,539 prevalent CKD cases (6,552,681-7,720,219); age-standardised prevalence 10,572 per 100,000 (9,754-11,521), +5.3% (1.4-9.6) since 1990; 13,115 CKD deaths (11,314-14,968); age-standardised death rate 29.0 per 100,000 (25.0-33.1), change +9.4% (-5.7 to 25.1). North Africa and Middle East: 48.8 million cases; age-standardised death rate 19.7 per 100,000.

Absolute risks

Global CKD prevalence 9.1%; global age-standardised CKD mortality 15.9 per 100,000 (2017); Egypt age-standardised prevalence 10,572 per 100,000 and CKD mortality 29.0 per 100,000 (2017)

Authors' conclusion

Kidney disease has a major effect on global health; CKD is largely preventable and treatable and deserves greater attention.

6. Strengths

• Comprehensive standardised framework covering 195 countries with uncertainty intervals
• Systematic literature reviews plus registries and vital registration
• Explicit correction for eGFR equation differences; exclusion of high-risk clinic samples for prevalence
• Country-level estimates incl. Egypt

7. Weaknesses

• Many countries lack primary population-based CKD data; estimates rely on covariates and neighbouring countries
• Single eGFR/ACR measurement may overestimate prevalence by 25-50% (authors)
• Cause attribution based on one US health-system dataset (Geisinger), limited generalisability
• Anaemia burden in dialysis not estimated (possible underestimation of disability)
• Modelled estimates not directly verifiable; many co-author industry disclosures (outside submitted work)

8. Risk of bias

Orienting tool

No standard tool fits (modelled burden-of-disease estimation); structured validity judgement

Type of assessment

structured assessment based on the full text by a single reviewer (no formal double review)

Full formal assessment

no

Overall risk of bias

some concerns

Rationale

Overall unchanged. Estimates are the standard reference for CKD burden but carry modelling uncertainty, especially for data-poor countries. Simplified single-reviewer judgement; no formal tool applied.

Full-text review (25 October 2026): Added Egypt-specific 2017 estimates (7.1 million cases; age-standardised prevalence 10,572/100,000; 13,115 deaths; 29.0/100,000), regional figures, data sources, case definition, modelling methods, author-stated limitations (single eGFR measurement may overestimate prevalence 25-50%) and COI declarations. Bias overall unchanged with structured domains; regional transferability raised to high.

9. Assessment of the statistical interpretation

Population-level modelled estimates with 95% uncertainty intervals; Egypt shows high CKD prevalence and mortality compared with the global average, with CKD driven substantially by diabetes and hypertension.

10. Relevance to the specific claim

Shows that CKD is common and chronic, driven largely by diabetes; contradicts eliminating kidney failure in two months.

11. Independent contrary findings

Prevention is possible over years, which partly aligns with lifestyle approaches.

12. Transferability to Germany and Europe

High for methods; Egypt-specific estimates are provided directly in the full text.

13. Overall methodological judgement

Authoritative context evidence: CKD is common, chronic and largely driven by diabetes and hypertension; in Egypt about 7.1 million people had CKD in 2017. This makes any claim of eliminating kidney failure and dialysis nationwide within two months implausible.

14. Open questions

Country-level detail for Egypt not given in abstract.

15. Linked fact checks

• He could stop kidney failure and dialysis in all of Egypt within two months and prevent seasonal influenza within three weeks. – Studies contradicting or limiting the claim