Abstract
BACKGROUND: Diabetic kidney disease (DKD) is a leading cause of renal failure and mortality in diabetic patients. This study aims to describe and assess the burden of diabetic kidney disease in China, based on the global burden of disease (GBD) 2021 data and to provide a crucial scientific foundation for the prevention and control of this life-threatening disease. METHODS: This study utilizes data from the 2021 Global Burden of Disease (GBD) study database. During the study, we systematically assessed the disease burden characteristics of diabetic kidney disease (DKD) in the Chinese population through comprehensive analysis of key epidemiological indicators including prevalence, incidence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs). We also used Joinpoint decomposition analysis and age-period-cohort (APC) analysis methods to interpret DKD epidemiological characteristics. Furthermore, we extended the autoregressive integrated moving average (ARIMA) model to predict the disease burden of DKD in 2041. RESULTS: Age-standardized rates in terms of prevalence (ASPR), incidence (ASIR), mortality (ASMR), DALYs, YLDs, and YLLs of DKD-T1DM in 2021 were 28.32 cases (95% CI:23.95,33.23) per 100,000, 0.7 new cases (95% CI:0.38,1.14) per 100,000, 1.06 deaths (95% CI:0.79,1.38) per 100,000, 47.95 DALYs (95% CI: 36.9,60.73) per 100,000, 4.55 YLDs (95% CI:3,6.25) per 100,000, and 43.4 YLLs (95% CI:33.05,55.97) per 100,000. Age-standardized rates in terms of prevalence (ASPR), incidence (ASIR), mortality (ASMR), DALYs, YLDs, and YLLs of DKD-T2DM in 2021 were 1053.92 cases (95% CI: 971.11, 1139.64) per 100,000, 16.29 new cases (95% CI: 14.92,17.53) per 100,000, 5.64 deaths (95% CI: 4.46,7) per 100,000, 122.15 DALYs (95% CI: 99.62,146.99) per 100,000, 23.3 YLDs (95% CI: 16.29,30.54) per 100,000, and 98.85 YLLs (95% CI:78.16,123.45) per 100,000. The average annual percentage change (AAPC) in age-standardized prevalence, incidence and mortality rates for T1DM-DKD in China were 0.79 (95% CI:0.75,0.84), -0.62 (95% CI:-0.66,-0.59), -1.72 (95% CI:-1.91,-1.53) and for T2DM-DKD they were - 0.46 (95% CI:-0.49,-0.42), 0.22 (95% CI:0.20,0.26),-0.6417 (95% CI:-0.82,-0.47). The effects of age, period, and cohort on incidence and mortality rates differed.The age-standardized mortality rate (ASMR) of DKD-T1DM is projected to decline from 1.06(95% CI: 0.79-1.38) per 100,000 in 2021 to 0.60(95% CI: 0.32-0.88) per 100,000 in 2041. In contrast, while the ASMR of DKD-T2DM is expected to decrease from 5.64(95%CI: 4.46-7.00) in 2021 to 4.84(95% CI: 3.66-6.02) per 100,000 in 2041.The trend of ASIR in DKD-T1DM is predicted to decrease slightly, but in DKD-T2DM will show an obvious upward trend, it will increase from 16.29(95% CI: 14.92-17.53) per 100,000 in 2021 to 24.14(95% CI: 14.78-33.50) per 100,000 in 2041. CONCLUSIONS: The burden of diabetic kidney disease (DKD) in China exhibits a dual trajectory: declining mortality in type 1 diabetes-related DKD (DKD-T1DM), alongside rising incidence of type 2 diabetes-related DKD (DKD-T2DM). This epidemiological divergence is associated with China's vast population base, demographic aging, and evolving risk profiles, though projections require cautious interpretation given ARIMA model limitations in accounting for unforeseen healthcare disruptions or policy shifts. Sustainable mitigation necessitates precision prevention strategies, enhanced primary healthcare services, and targeted interventions to address urban-rural diagnostic disparities, particularly underestimated burdens in resource-limited rural settings, alongside multidisciplinary coordination to address this growing public health challenge.