Analysis and trend prediction of disease burden of chronic kidney disease due to type 2 diabetes mellitus in the elderly population globally and in China_West China Medical Journal

Authors：

ZHANG Qiang ^1,2 , ZHAO Xinke ^3,4 , LI Jiali ^3,4 , LIU Fan ^3,4 ,  ZHAO Wenxia ^1,2 , ZHAO Xin ⁵ , YAN Le ¹ , XI Junyu ⁶ , TANG Liyao ⁷ , ZHANG Lihui ¹ , FU Changkuan ⁸ , WANG Haibo ⁹ , SHAO Fanlei ¹ ,  LU Cuncun ⁴

1. Department of Gastroenterology, the First Affiliated Hospital of Henan University of CM, Zhengzhou, Henan 450000, P. R. China;
2. Collaborative Innovation Center of Prevention and Treatment of Major Diseases by Chinese and Western Medicine, Zhengzhou, Henan 450000, P. R. China;
3. School of Traditional Chinese and Western Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu 730101, P. R. China;
4. Institute of Traditional Chinese and Western Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu 730101, P. R. China;
5. Department of Geriatrics, The Third People’s Hospital of Gansu Province, Lanzhou, Gansu 730000, P. R. China;
6. Department of Nephrology and Endocrinology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, P. R. China;
7. Department of Anorectal Surgery, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu 730000, P. R. China;
8. Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, P. R. China;
9. Department of Critical Care Medicine, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu 730000, P. R. China;

Corresponding?author：

ZHAO Wenxia, Email: zhao-wenxia@163.com; LU Cuncun, Email: lu17metrics@163.com

Keywords：

Chronic kidney disease; type 2 diabetes mellitus; disease burden; prevalence; disability-adjusted life years

DOI：

10.7507/1002-0179.202510246

Video：

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Objective To analyze the disease burden and future trends of chronic kidney disease attributable to type 2 diabetes mellitus (CKD-T2DM) among the elderly population globally and in China from 1990 to 2021, and to generate evidence to inform public health strategies and clinical decisions. Methods Data on the burden of CKD-T2DM among individuals aged ≥60 years globally and in China between 1990 and 2021 were obtained from the Global Burden of Disease 2021 database. The Joinpoint regression was employed to calculate the average annual percentage change (AAPC) of age-standardized prevalence rate and age-standardized disability-adjusted life years rate (ASDR), in order to assess temporal trends of the disease burden. The Bayesian age-period-cohort model was applied to project the number of prevalent cases and disability-adjusted life years (DALYs) associated with CKD-T2DM among the elderly population globally and in China from 2022 to 2035. Results Compared with 1990, the number of CKD-T2DM elderly cases globally and in China, including both males and females, increased significantly by 2021. However, the age-standardized prevalence rate demonstrated a significant decline from 1990 to 2021 (both AAPC<0, P<0.001). Similarly, the number of DALYs attributable to CKD-T2DM among the elderly in China also increased, whereas the ASDR showed a statistically significant decrease only among the overall and females’ populations during 1990-2021 (both AAPC<0, P<0.001). Globally, the number of DALYs also increased substantially, and the ASDR exhibited a significant overall upward trend from 1990 to 2021 across all groups (overall, male, and female populations; both AAPC>0, P<0.001). The age group with the most pronounced increase in prevalent cases was 65-69 years, whereas the highest increase in DALYs was observed in the 70-74 age group both globally and in China. Decomposition analysis indicated that population growth was the primary driver of increases in both the number of prevalent cases and DALYs attributable to CKD-T2DM among older adults across all regions. According to Bayesian age-period-cohort projections, the number of prevalent cases and DALYs associated with CKD-T2DM among the elderly is expected to continue increasing globally and in China from 2022 to 2035, with a more pronounced increase anticipated in China compared to the global trend. Conclusions The burden of CKD-T2DM among the elderly remains substantial both globally and in China, and is projected to increase in the coming years. There is an urgent need to develop and implement effective public health policies and targeted disease management strategies to mitigate its growing challenges.

Citation： ZHANG Qiang, ZHAO Xinke, LI Jiali, LIU Fan, ZHAO Wenxia, ZHAO Xin, YAN Le, XI Junyu, TANG Liyao, ZHANG Lihui, FU Changkuan, WANG Haibo, SHAO Fanlei, LU Cuncun. Analysis and trend prediction of disease burden of chronic kidney disease due to type 2 diabetes mellitus in the elderly population globally and in China. West China Medical Journal, 2026, 41(6): 940-946. doi: 10.7507/1002-0179.202510246 Copy

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1. Sagoo MK, Gnudi L. Diabetic nephropathy: an overview. Methods Mol Biol, 2020, 2067: 3-7.
2. 中華醫學會內分泌學分會, 中國內分泌代謝病專科聯盟. 中國糖尿病合并慢性腎臟病臨床管理共識. 中華內分泌代謝雜志, 2024, 40(6): 455-461.
3. 趙曉曉, 柯立鑫, 荀楊芹, 等. 1990—2021 年全球與中國老年 2 型糖尿病的疾病負擔調查與未來趨勢預測. 中國全科醫學, 2025, 28(16): 2050-2058.
4. Han YZ, Du BX, Zhu XY, et al. Lipid metabolism disorder in diabetic kidney disease. Front Endocrinol (Lausanne), 2024, 15: 1336402.
5. Zhao M, Cao Y, Ma L. New insights in the treatment of DKD: recent advances and future prospects. BMC Nephrol, 2025, 26(1): 72.
6. 韓娟娟, 張新安, 孟欣. 數智賦能老年主動健康的多維困境與破解策略. 廣州體育學院學報, 2025, 45(4): 34-40, 50.
7. 屈秋瓊, 吳波, 彭瑾, 等. 2015—2021 年重慶市萬州區 4 種重大慢性病過早死亡率分析. 中國初級衛生保健, 2022, 36(7): 76-79, 83.
8. 中國中西醫結合學會內分泌專業委員會糖尿病腎臟病專家委員會, 中國微循環學會中醫與微循環專業委員會. 糖尿病腎臟病中西醫結合防治專家共識(2023 版). 中華糖尿病雜志, 2023, 15(8): 690-702.
9. 中華醫學會糖尿病學分會, 國家基本公共衛生服務項目基層糖尿病防治管理辦公室. 國家基層糖尿病腎臟病防治技術指南(2023). 中華內科雜志, 2023, 62(12): 1394-1405.
10. 中華中醫藥學會, 北京中醫藥大學東直門醫院, 北京中醫藥大學, 等. 糖尿病腎臟疾病中西醫結合診療指南. 北京中醫藥大學學報, 2024, 47(4): 580-592.
11. 趙振平, 王麗敏. 中國慢性腎臟病防控面臨的挑戰和建議. 中華流行病學雜志, 2025, 46(1): 9-17.
12. GBD 2021 diseases and injuries collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the GlobalBurden of Disease Study 2021. Lancet, 2024, 403(10440): 2133-2161.
13. GBD 2021 risk factors collaborators. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440): 2162-2203.
14. 劉璠, 盧存存, 李嘉麗, 等. 1990 年—2021 年全球與中國老年人群缺血性心臟病發病與死亡負擔的分析. 華西醫學, 2026, 41(5): 748-755.
15. 張強, 趙曉曉, 王海博, 等. 1990—2021 年全球與中國老年人群代謝功能障礙相關脂肪性肝病的疾病負擔分析. 醫學新知, 2026, 36(4): 428-437.
16. 李輝章, 杜靈彬. Joinpoint 回歸模型在腫瘤流行病學時間趨勢分析中的應用. 中華預防醫學雜志, 2020, 54(8): 908-912.
17. Xie Y, Bowe B, Mokdad AH, et al. Analysis of the Global Burden of Disease study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016. Kidney Int, 2018, 94(3): 567-581.
18. Liang P, Zhang S, Yan M, et al. Trends and predictive research on the global burden of ischemic heart disease from 1990 to 2021: an analysis of the global burden of disease study 2021. Front Public Health, 2025, 13: 1569179.
19. 張強, 趙文霞, 丁韻涵, 等. 疾病負擔研究的報告標準(STROBOD 聲明)解讀. 中國循證醫學雜志, 2025, 25(4): 467-474.
20. Deng W, Zhao L, Chen C, et al. National burden and risk factors of diabetes mellitus in China from 1990 to 2021: results from the global burden of disease study 2021. J Diabetes, 2024, 16(10): e70012.
21. 中華醫學會糖尿病學分會微血管并發癥學組. 中國糖尿病腎臟疾病防治臨床指南. 中華糖尿病雜志, 2019, 11(1): 15-28.
22. 張俊清, 蘇白海, 張捷, 等. 糖尿病腎臟疾病早期預測與診斷專家共識. 中華內科雜志, 2021, 60(6): 522-532.
23. 吳珍, 郗雅琪, 胡琳琳. 我國體重管理政策的工具選擇與組合特征: 基于 2016—2025 年國家政策文本的內容分析. 中國全科醫學, 2026, 29(20): 2766-2774.
24. Herring J, Park YH, Luo Q, et al. Medicaid primary care utilization and area-level social vulnerability. JAMA Health Forum, 2025, 6(9): e253020.
25. 雷紫微, 嚴文浩, 胡偉男, 等. 我國基層醫療衛生資源配置均衡性分析. 南京醫科大學學報(社會科學版), 2023, 23(5): 404-408.
26. Lv Y, Fan L, Zhou J, et al. Burden of non-communicable diseases due to population ageing in China: challenges to healthcare delivery and long term care services. BMJ, 2024, 387: e076529.
27. Clotet-Freixas S, Zaslaver O, Kotlyar M, et al. Sex differences in kidney metabolism may reflect sex-dependent outcomes in human diabetic kidney disease. Sci Transl Med, 2024, 16(737): eabm2090.
28. Efiong EE, Maedler K, Effa E, et al. Decoding diabetic kidney disease: a comprehensive review of interconnected pathways, molecular mediators, and therapeutic insights. Diabetol Metab Syndr, 2025, 17(1): 192.
29. Lay AC, Tran VDT, Nair V, et al. Profiling of insulin-resistant kidney models and human biopsies reveals common and cell-type-specific mechanisms underpinning diabetic kidney disease. Nat Commun. 2024 , 15(1): 10018.
30. Meteku BT, Quigley M, Turner T, et al. Barriers to and facilitators of living guidelines use in low-income and middle-income countries: a scoping review. BMJ Open, 2024, 14(1): e074311.
31. 腎臟創新與轉化聯盟腎臟病領域“十大創新方向”專家組. 腎臟病領域“十大創新方向”中國專家共識(2024 年版). 中華腎臟病雜志, 2024, 40(5): 426-430.
32. Drake C, Rader A, Clipper C, et al. Adaptation to telehealth of personalized group visits for late stage diabetic kidney disease. Kidney360, 2023, 4(12): 1708-1716.
33. 陳歷艷, 彭丹丹, 杜麗. 尿微量白蛋白/肌酐比值對糖尿病腎病的早期診斷價值. 糖尿病新世界, 2025, 28(11): 44-46, 50.
34. 楊光燃. 新型降糖藥物對 2 型糖尿病患者的腎臟獲益及應用前景. 中國全科醫學, 2021, 24(18): 2245-2250.
35. Chen JC, Fang YW, Liu YF, et al. GLP-1 receptor agonist therapy and cardiorenal outcomes in patients≥80 years old with type 2 diabetes. J Am Geriatr Soc, 2026, 74(1): 96-106.
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West China Medical Journal

Analysis and trend prediction of disease burden of chronic kidney disease due to type 2 diabetes mellitus in the elderly population globally and in China

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