Early-Onset CKD Mortality Declines Globally as Incidence Continues to Rise

Although mortality and disability associated with early-onset chronic kidney disease (CKD) have declined globally, the number of new cases continues to rise among children and young adults, according to a recent analysis published in Clinical Kidney Journal, underscoring the need for earlier detection and targeted prevention strategies for younger populations.¹

Early-Onset CKD Remains a Growing Global Health Challenge

CKD is often viewed as a disease affecting older adults, but kidney disease that begins in childhood, adolescence, or early adulthood can result in lifelong consequences, including progressive kidney dysfunction, cardiovascular complications, and premature mortality.² Despite the clinical importance of early-onset CKD, comprehensive evaluations of disease burden among individuals aged 0 to 25 years have remained limited.¹

To better understand global patterns, researchers analyzed data from the Global Burden of Disease (GBD) 2021 study to evaluate trends in incidence, mortality, prevalence, and disability-adjusted life years (DALYs) associated with early-onset CKD between 1990 and 2021. The study also assessed differences across socio-demographic index (SDI) regions and projected future disease burden through 2050.

CKD Incidence Increased Despite Declining Mortality Rates

The investigators identified a divergence in global early-onset CKD trends over the 31-year study period. While mortality and DALYs declined, incidence increased, suggesting that improvements in survival and case detection have occurred alongside persistent risk factors contributing to disease development.

The number of individuals living with early-onset CKD increased from 32.88 million in 1990 to 41.8 million in 2021. During the same period, the number of new cases increased from approximately 713,780 to 886,208. However, deaths declined from 42,959 to 38,204, and DALYs decreased from 3.77 million to 3.32 million.

Annually, age-standardized mortality rates declined by 0.87%, whereas age-standardized incidence rates increased by 0.31%. The researchers suggested that these opposing trends may reflect improved management of CKD complications and increased detection of cases, while underlying risk exposures remain unresolved.

Disease Burden Differs Across Childhood and Young Adulthood

The impact of early-onset CKD varied substantially by age group. Children younger than 5 years represented the largest proportion of new cases (45.58%). In contrast, individuals aged 20 to 24 years experienced the greatest contribution to overall health loss, accounting for 32.32% of DALYs.

Researchers noted that these findings reflect different drivers of CKD throughout the life course, with unknown causes accounting for the majority of early-onset CKD cases, representing approximately 58% to 68% of disease burden. Younger children are more likely to experience congenital, hereditary, or early developmental kidney disorders, whereas adolescents and young adults may increasingly experience kidney disease associated with conditions such as diabetes, hypertension, and other acquired risk factors.

Socioeconomic Disparities Persist in Early-Onset CKD Outcomes

The burden of early-onset CKD varied according to socioeconomic development. Although mortality reductions were observed across lower- and middle-SDI regions, these areas also experienced some of the greatest increases in incidence.

Researchers suggested that differences in access to early diagnosis, kidney disease monitoring, and specialized treatment may contribute to these disparities. Lower-resource settings may face additional challenges related to screening availability, limited nephrology services, and delayed identification of progressive kidney disease.³

Earlier Detection and Prevention Strategies Needed

Using Bayesian age-period-cohort modeling, the investigators projected that early-onset CKD will remain an ongoing global health concern through 2050.¹ They emphasized that reducing future disease burden will require improved surveillance systems, earlier diagnosis, and interventions tailored to the needs of children, adolescents, and young adults.

The researchers also highlighted the importance of addressing gaps in CKD etiology, particularly given the large proportion of cases with unknown causes. Expanding research into disease mechanisms and improving access to kidney health resources may help identify opportunities for prevention and reduce disparities worldwide.

Lastly, the authors acknowledged several limitations, including the use of modeled GBD estimates and uncertainty surrounding disease classification. Still, the researchers emphasized that the findings reinforce the need to prioritize kidney health earlier in life and strengthen global efforts to prevent CKD progression among younger populations.

“These estimates are most useful for awareness, planning, and advocacy and should be interpreted with appropriate caution given the model-based nature of GBD data,“ they concluded.

References

1. Chen A, Liu Y, Chen X, Zhang C, Wang L, Yue C. Global trends and projections of early-onset CKD burden: a GBD 2021 analysis. Clin Kidney J. 2026;19(7):sfag206. doi:10.1093/ckj/sfag206
2. Ene-Iordache B, Perico N, Bikbov B, et al. Chronic kidney disease and cardiovascular risk in six regions of the world (ISN-KDDC): a cross-sectional study. Lancet Glob Health. 2016;4(5):e307-e319. doi:10.1016/S2214-109X(16)00071-1
3. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2024;105(4S):S117-S314. doi:10.1016/j.kint.2023.10.018