In the United States (US), the burden of chronic kidney disease (CKD) has increased substantially since the start of the new millennium.

From 2002 to 2016, the number of healthy life-years lost from CKD increased 52.6% to nearly 2 million. In addition, deaths related to CKD spiked 58.3%, Ziyad Al-Aly, MD, of Veterans Affairs St Louis Health Care System, and colleagues reported in JAMA Network Open.

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While the team found decreased strain from all causes and non-communicable diseases such as cardiovascular diseases, neoplasms, chronic respiratory diseases, digestive diseases, musculoskeletal disorders, and diabetes, CKD load increased at a rapid rate.

All states experienced an increase in their CKD burden, with Southern states faring the worst. In 2016, age-standardized disability-adjusted life years (DALYs) per 100,000 persons were highest (in descending order) in Mississippi (697), Louisiana (681), Alabama (604), West Virginia (587), Georgia (560), Arkansas (553), South Carolina (550), Kentucky (550), Indiana (515), and North Carolina (515).

Overall, the increase in CKD DALYs was attributable to increased risk exposure (40.3%), aging (32.3%), and population growth (27.4%), according to the investigators. Age-standardized CKD DALY rates increased by 18.6%, with metabolic and dietary risk factors contributing to 93.8% and 5.3% of this change.

CKD from diabetes contributed to a 26.8% and 25.6% increased probability of CKD-related death among adults aged 20 to 54 and 55 to 89 years, respectively.

Metabolic risk factors contributing to increases in CKD DALYs included high fasting plasma glucose levels, high body mass index, and high systolic blood pressure, Dr Al-Aly’s team reported. With regard to dietary risk factors increasing CKD burden, the authors implicated high intake of sugar-sweetened beverages and sodium.

“Earlier in life, CKD portends serious consequences, which manifest in a higher probability of death among the segment of the population that contributes considerably to economic prosperity, representing significant loss of human capital,” Dr Al-Aly and his colleagues stated.

“The findings suggest that an effort to target the reduction of CKD through greater attention to metabolic and dietary risks, especially among younger adults, is necessary.”

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Bowe B, Xie Y, Li T, et al. Changes in the US burden of chronic kidney disease From 2002 to 2016: An analysis of the Global Burden of Disease Study. JAMA Network Open. 2018;1(7):e184412. DOI:10.1001/jamanetworkopen.2018.4412