Global Analysis Reveals Rising Pediatric CKD Burden and Persistent Health Ineities
Chronic kidney disease (CKD) continues to impose a substantial and uneven health burden on children and adolescents worldwide, according to a comprehensive analysis of Global Burden of Disease (GBD) 2021 data. The study offers one of the most detailed evaluations to date of CKD incidence, mortality, disability-adjusted life years (DALYs), and long-term trends among individuals aged 0–19 years, highlighting widening disparities linked to socioeconomic development, healthcare infrastructure, and access to specialized treatment.
Incidence Remains High, with Growth Concentrated in Lower-SDI Regions
In 2021, an estimated 7.54 million children and adolescents were newly diagnosed with CKD globally, corresponding to an age-standardized incidence rate (ASIR) of 28.62 per 100,000 population. Central Asia reported the highest incidence rates, while regions classified within the low-middle Socio-Demographic Index (SDI) experienced the fastest increases over time. These trends suggest that health system capacity, early detection strategies, and environmental exposures may play a significant role in shaping disease patterns.
Notably, demographic changes—including population growth in lower-income regions—are compounding the overall burden. In many countries, paediatric kidney services remain limited, and routine screening for early-stage kidney disease is uncommon, resulting in delayed diagnosis and poorer outcomes.
Adolescent Burden Increasing Rapidly
The steepest rise was observed among adolescents aged 14–19 years, with incidence increasing by more than 44% over the study period. Hormonal changes, higher rates of obesity and hypertension, increasing prevalence of type 2 diabetes in youth, and improved survival of children with congenital kidney disorders may all contribute to this upward trend.
The analysis further demonstrated that mortality rates are strongly correlated with socioeconomic development. Lower-SDI regions experienced disproportionately higher death rates, reflecting limited access to specialist nephrology care, delayed referral pathways, and restricted availability of kidney replacement therapy (KRT). The concentration index for CKD-related DALYs became increasingly negative between 1990 and 2021, confirming that disease burden is progressively concentrated among disadvantaged populations.
Access to Kidney Replacement Therapy Remains a Critical Determinant
Availability of KRT—including dialysis and kidney transplantation—emerged as one of the most significant determinants of outcome. Regions with well-established paediatric nephrology services consistently reported lower disability burdens and improved survival rates. In contrast, in many low-resource settings, dialysis remains scarce or unaffordable, and paediatric transplantation programmes are limited or nonexistent.
Beyond survival, limited access to treatment has long-term developmental implications. Children with untreated or poorly managed CKD face growth impairment, neurocognitive delays, reduced educational attainment, and increased cardiovascular risk in adulthood.
Projections to 2050: Improvement Possible but Uneven
Using a Bayesian Age-Period-Cohort model, researchers project that global incidence rates may gradually decline by 2050, with ASIR potentially decreasing to approximately 25.54 per 100,000 population. However, these gains are unlikely to be distributed equitably without targeted policy interventions.
Urbanisation, environmental pollution, climate-related water stress, and increasing rates of childhood metabolic disorders could offset projected improvements in certain regions. Furthermore, survival gains may paradoxically increase prevalence, as more children live longer with chronic disease.
The Case for Early Detection and Policy Action
The findings underscore the urgency of strengthening early screening programmes, particularly in lower-SDI regions where burden remains highest. Integrating kidney function testing into school health programmes, primary care check-ups, and maternal-child health services may enable earlier identification of at-risk children.
Additional priority areas include:
Expanding training in pediatric nephrology
Increasing affordability and geographic distribution of dialysis services
Scaling up transplantation infrastructure
Addressing modifiable risk factors such as obesity, hypertension, and diabetes
Investing in clean water, infection control, and maternal health
Importantly, CKD in childhood often progresses silently. By the time symptoms appear, irreversible kidney damage may already be present. Strengthening surveillance systems and investing in equitable healthcare delivery could substantially reduce future cardiovascular disease and end-stage kidney failure in adult populations.
A Global Equity Challenge
While pediatric CKD remains a worldwide concern, the study makes clear that it is also a matter of health equity. Without deliberate investment in early intervention, infrastructure, and socioeconomic development, disparities are likely to widen further.
Ultimately, reversing current trends will require coordinated global action—combining clinical innovation, public health strategies, and policy reform—to ensure that children and adolescents everywhere have access to timely diagnosis, effective treatment, and long-term care.