Global, regional, and national burden of Chronic kidney disease due to type 2 diabetes mellitus, 1990-2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021

Global, regional, and national burden of Chronic kidney disease due to type 2 diabetes mellitus, 1990-2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Global, regional, and national burden of Chronic kidney disease due to type 2 diabetes mellitus, 1990-2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021 Jiaqi Liu, Yan Pan, Zuliang Yan, Hong Jiang, Hanglin Li, Ying Yu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6789777/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Importance Chronic kidney disease (CKD) attributable to type 2 diabetes mellitus (T2DM) represents a growing global health concern. However, comprehensive long-term epidemiological trends and projections, stratified by sociodemographic and geographic variables, remain inadequately delineated. Objective To evaluate the global, regional, and national burden of CKD due to T2DM from 1990 to 2021, and to forecast its trends through 2050 using Bayesian age-period-cohort (BAPC) modeling. Design, Setting, and Participants This population-based observational study used data from the Global Burden of Disease Study 2021 (GBD 2021), which includes 204 countries and territories across five sociodemographic index (SDI) quintiles and 21 GBD regions. The study covers the period 1990–2021 with projections to 2050. Exposure Diagnosis of T2DM mellitus as an underlying cause for CKD. Main Outcome Measures Incident and prevalent cases, mortality, and disability-adjusted life-years (DALYs) attributable to T2DM-related CKD. Age-standardized incidence (ASIR), prevalence (ASPR), mortality (ASDR), and DALY (ASR) rates were computed, alongside estimated annual percentage changes (EAPC). Results From 1990 to 2021, the global number of incident CKD cases due to T2DM increased by 167.2%, while the ASIR rose by 21.0% (EAPC: 0.61). Prevalent cases nearly doubled (+85.1%), although ASPR declined slightly (−5.1%, EAPC: −0.17). Deaths surged by 222.6%, and ASDR increased by 37.8% (EAPC: 1.17). DALYs rose by 173.6%, with a 24.0% increase in ASR (EAPC: 0.81). Males and older adults consistently exhibited higher burden across all indicators. Low- and middle-SDI nations experienced the most pronounced burden growth, yet high-SDI regions also registered substantial increases in mortality and DALYs. Geographically, Latin America, Central Asia, and select Sub-Saharan African regions exhibited the most rapid ascents. Marked national disparities were evident, with Pacific Island nations bearing the highest age-standardized rates. Conclusions and Relevance T2DM-related CKD has emerged as a major global health challenge, with sustained increases in incidence, mortality, and DALYs over the past three decades. Despite modest declines in age-standardized prevalence, the absolute burden continues to rise, particularly in lower-resource settings. Projections to 2050 suggest a continued escalation, with incident cases exceeding 2.6 million and deaths surpassing 700,000 annually by mid-century. These findings highlight the urgent need for targeted prevention, early detection, and improved management strategies, particularly in high-growth regions and vulnerable populations. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Key Points Question What are the long-term global, regional, and national trends in CKD attributable to T2DM mellitus from 1990 to 2021, and how will this burden evolve through 2050? Findings This comprehensive population-based analysis, utilizing data from the GBD 2021 and employing BAPC modeling, revealed a 167% increase in incident CKD cases attributable to T2DM globally between 1990 and 2021. Concurrently, mortality and DALYs demonstrated substantial escalation during this period. Modeled projections suggest that by 2050, the global prevalence of T2DM-related CKD will exceed 120 million cases, with annual incident cases surpassing 2.6 million and mortality exceeding 700,000 deaths. Meaning The global burden of CKD attributable to T2DM continues to rise, particularly in low- and middle-income countries. Without targeted interventions in diabetes control and kidney disease prevention, the associated health and economic challenges are expected to intensify through mid-century. Introduction Chronic Kidney Disease (CKD) is a disease characterized by progressive decline in kidney function. As kidney impairment advances, a constellation of clinical manifestations emerges, most notably a substantially elevated risk of cardiovascular morbidity and mortality [1] . It may ultimately progress to a state requiring dialysis or kidney transplantation, leading to a higher risk of death. Epidemiological data from the Global Burden of Disease (GBD) study consistently rank CKD among the leading contributors to global disease burden, establishing it as a critical public health challenge worldwide [2] . Notably, among the causes of CKD, diabetes has become one of the primary factors [3] . The damage to renal microvasculature caused by hyperglycemia plays a key role in the development and progression of CKD. Type 2 diabetes mellitus (T2DM) has emerged as one of the most rapidly expanding global public health challenges in the 21st century [4] . Epidemiological data from the International Diabetes Federation (IDF) indicate that in 2021, approximately 537 million adults worldwide were living with diabetes, with T2DM accounting for over 90% of cases [5] .T2DM Current projections suggest this figure will escalate to 643 million by 2030 and 783 million by 2045, representing a 46% increase within a quarter century. This increase is particularly pronounced in low- and middle-income countries, primarily due to rising obesity rates, aging populations, and unhealthy lifestyles such as high-sugar, high-fat diets and physical inactivity [6] . As a typical example, China currently has around 120 million people with T2DM. About one-third of all diabetic patients will develop diabetic kidney disease (DKD). Data from China in 2017 showed that the prevalence of DKD among adults was 10.4%, and it accounted for 40% of the causes of end-stage renal disease (ESRD) [7,8] . DKD has become a major challenge and focus for both nephrology and diabetology. The therapeutic landscape for DKD remains limited, with current interventions demonstrating only modest efficacy. Following disease onset, DKD typically progresses relentlessly toward ESRD despite conventional management. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines emphasize a multifaceted treatment approach incorporating stringent glycemic control, SGLT-2i and RAASi [9] . However, even with optimal implementation of these evidence-based strategies, many patients experience suboptimal outcomes, including diminished quality of life, multiple comorbidities, and reduced life expectancy. Therefore, finding fundamental solutions to these challenges has become a key focus of research for nephrologists and endocrinologists. Guided by the principle that prevention is better than cure, we may hypothesize that effectively preventing the prevalence of diabetes is central to reducing the occurrence and progression of DKD. Current research efforts remain predominantly focused on CKD or DKD in isolation, with a notable paucity of comprehensive analyses examining the spatiotemporal patterns and sociodemographic determinants of diabetes-related CKD. This knowledge gap significantly impedes evidence-based health policy formulation and optimal resource distribution across healthcare systems. This study innovatively utilizes GBD 2021 data to systematically assess the trends in prevalence, incidence, mortality, and DALYs of T2DM-related CKD at the global, regional, and national levels from 1990 to 2021. Additionally, the Bayesian age-period-cohort (BAPC) model is applied to project the disease burdens up to 2050, addressing a critical gap in predictive research. This research holds particular significance for health policymakers, nephrologists, and endocrinologists by establishing an empirical basis for more effective prevention and control of the growing DKD burden worldwide. Methods Study Design and Framework This study is a descriptive epidemiological analysis based on the GBD 2021 data. Using internationally standardized methods, it focuses on DKD caused by T2DM, the most prevalent form of diabetes, assess epidemiological trends from 1990 to 2021. Additionally, projections for 2050 were generated using the BAPC model. Data Sources The data were sourced from the GBD 2021 database, provided by the Institute for Health Metrics and Evaluation (IHME), covering 204 countries and territories. The database includes various types of data sources (such as demographic statistics, death registries, hospital records, and research literature). All data underwent standardized processing and quality control by IHME. Case Definition CKD is defined as chronic structural and functional abnormalities of the kidneys caused by various etiologies, persisting for more than 3 months. These abnormalities include pathological damage (with or without altered glomerular filtration rate), hematologic or urinary component abnormalities, and imaging abnormalities (ICD-10:‌N18). DKD, a CKD subtype attributable to diabetes mellitus, is clinically defined by either: a glomerular filtration rate (GFR) 30 mg/g, with both conditions persisting for more than 3 months (ICD-10:‌N08.3). The disease burden of DKD secondary to T2DM was quantified via the GBD study’s ‘comparative risk assessment’ framework. This methodology integrates two epidemiological parameters: (1) the causal association strength (expressed as relative risk [RR]) between diabetes and CKD, and (2) the population attributable fraction (PAF). Measures and Indicators The primary evaluation metrics included: Incidence and age-standardized incidence rate (ASIR), Prevalence and age-standardized prevalence rate (ASPR), Mortality and age-standardized mortality rate (ASMR), Disability-adjusted life years (DALYs) and age-standardized DALY rate (ASDR). All indicators were stratified by sex, age group, SDI quintile, region, and country for analysis. Trend Analysis The Estimated Annual Percentage Change (EAPC) was used to assess trends in age-standardized rate (ASR) metrics between 1990 and 2021. EAPC was calculated using a linear regression model with log-transformed ASR as the dependent variable and calendar year as the independent variable. Projection Modeling The BAPC model was employed to project incidence, prevalence, mortality, and DALYs for the period 2030–2050. The model specification included age, period, and birth cohort as covariates, utilizing normal prior distributions and random walk priors. Model implementation and inference were performed using the R packages BAPC and INLA (version 4.4.2). Uncertainty and Ethics All estimates were reported with 95% uncertainty intervals (UI), derived from 1000 Monte Carlo simulations. As a secondary data analysis study involving no personally identifiable information, this research required no ethics approval. Results Global trends Incidence Globally, both the number of incident cases and the ASIR of CKD due to T2DM increased substantially between 1990 and 2021. Incident cases rose from 753,106 (UI 680,930–826,928) in 1990 to 2,012,025 (1,857,800-2,154,288) in 2021. Over the same period, ASIR increased from 19.07 (17.28-20.83) to 23.07 (21.40-24.72) per 100,000 population, representing a 167.16% (153.53-182.63) increase in incident cases and a 20.97% (14.99-27.49) increase in ASIR. The EAPC in ASIR was 0.61 (0.60-0.63), indicating a sustained upward trend over three decades (Table 1). Sex-specific analysis showed consistently higher disease burden among males, who exhibited both greater absolute case numbers and marginally elevated ASIRs compared to females. Age-stratified analysis identified a unimodal distribution of incidence, with peak rates occurring in the 65-74-year age group for both sexes (Figure 1B). Prevalence From 1990 to 2021, the global prevalence of CKD due to T2DM increased substantially in absolute numbers, while the ASPR showed a modest decline. Prevalent cases increased from 58,105,268 (UI 53,056,992-63,286,818) in 1990 to 107,559,955 (99,170,797-115,994,732) in 2021, representing an 85.11% (78.13-91.41) increase. ASPR declined from 1,327.22 (1,223.26-1,439.42) to 1,259.63 (1,161.99-1,359.92) per 100,000 population, a 5.09% reduction (UI −7.46 to −2.98), with an EAPC of −0.17(−0.20 to −0.13), indicating a modest reduction in individual-level risk after adjusting for demographic shifts (Table S1). Subsequently, the burden was higher in males across nearly all age groups, particularly those older than 55 years. The 65-74-year age group accounted for the highest number of prevalent cases, and the highest ASPR was observed in individuals aged 75-79 years (Figure 1A). Mortality Between 1990 and 2021, the global mortality burden from CKD attributable to T2DM increased markedly in both total number of deaths and the age-standardized DALY rate (ASDR). Global deaths increased from 147,970 (UI 124,179-176,413) to 477,273 (401,541-565,951), while ASDR rose from 4.15 (3.50-4.94) to 5.72 (4.83-6.79) per 100,000 population. This corresponds to a 222.55% (177.43-253.83) increase in total deaths and a 37.79% (19.17-49.63) increase in ASDR. EAPC for ASDR was 1.17 (1.10-1.24), confirming a consistent upward trend (Table S2). Mortality was consistently higher in males, with the sex gap widening with age, especially after 65 years. The number of deaths increased markedly after age 45, peaking between 65 and 84 years. ASDR rose linearly with age, reaching its highest levels in individuals aged 80 years and older (Figure 1C). DALYs DALYs attributable to CKD due to T2DM increased significantly from 1990 to 2021, reflecting a growing public health burden. DALYs rose from 4,122,919 (UI 3,498,980-4,818,958) in 1990 to 11,278,935 (9,682,785-13,103,871) in 2021, an increase of 173.57% (140.54-194.35). The global ASDR increased from 105.71 (90.68-122.67) to 131.08 (112.75-152.49) per 100,000 population, a 24.00% increase (9.26-33.00), with an EAPC of 0.81 (0.74-0.87) (Table S3). The increase was primarily driven by population ageing, rising diabetes prevalence, and insufficient management of CKD progression. The burden was consistently higher in males, particularly beyond 55 years. DALYs increased sharply from age 45 onwards, peaking between 65 and 79 years. ASDR increased exponentially with age, reaching its peak among individuals aged 80-89 years (Figure 1D). SDI Regional Trends Incidence Between 1990 and 2021, the number of incident CKD cases due to T2DM increased across all five sociodemographic index (SDI) quintiles, with the largest relative growth observed in lower SDI regions. In high SDI countries, incident cases increased from 289,954 (95% UI 263,980-316,807) to 595,271 (547,943-636,879), a 105.30% rise (93.99-117.68). The ASIR increased from 25.59 to 28.34 per 100,000 population, a 10.75% increase (4.83-17.36), with an EAPC of 0.28 (0.24-0.33). In high-middle SDI countries, incident cases rose by 157.48% (142.69-175.18), ASIR increased from 15.72 to 20.09 per 100,000 (27.83% increase, 20.71-36.27), and EAPC was 0.91 (0.88-0.95). Middle SDI countries experienced the fastest growth in incidence, with cases rising from 181,844 to 635,311 (249.37% increase, 224.15-276.80), ASIR increasing by 33.96% (25.11-43.94), and the highest EAPC at 0.99 (0.97-1.02). In low-middle SDI countries, incident cases increased by 210.05% (195.02-226.94), ASIR rose by 33.57% (27.59-40.00), and EAPC was 0.77 (0.70-0.85). Low SDI countries also demonstrated notable growth, with incident cases increasing by 181.08% (165.79-198.45), ASIR rising by 26.76% (20.00-34.42), and an EAPC of 0.65 (0.56-0.74) (Table 1, Figure 2B). Prevalence All five SDI levels saw marked increases in the number of prevalent CKD cases due to T2DM between 1990 and 2021. However, ASPRs generally declined, indicating that increases in prevalence were largely driven by demographic factors and diabetes expansion rather than increases in individual-level risk. In high SDI countries, prevalent cases rose from 11,068,895 (95% UI 10,251,403-11,847,690) to 18,097,946 (16,763,917-19,359,376), a 63.50% increase (59.59-67.22). ASPR declined from 1,037.34 to 997.07 per 100,000 population (−3.88%, −5.62 to −2.23), with an EAPC of −0.09 (−0.14 to −0.05). In high-middle SDI countries, prevalence increased by 59.14% (51.57-65.58), ASPR declined by −8.99% (−11.95 to −6.58), and EAPC was −0.25 (−0.32 to −0.19). In middle SDI countries, prevalence increased by 102.56%, ASPR declined by -7.00% (-9.53 to -4.81), and EAPC was −0.20 (−0.25 to −0.16). In low-middle SDI countries, prevalent cases rose by 98.80% (91.34-105.59), ASPR declined from 1,586.44 to 1,474.59 (−7.05%, −9.36 to −4.89), and EAPC was −0.31 (−0.36 to −0.27). Low SDI countries saw the greatest absolute increase in prevalence (113.05%, 106.34–119.42), ASPR declined by −6.34% (−8.66 to −4.41), and EAPC was −0.28 (−0.32 to −0.25) (Table S1, Figure 2A). Mortality Across all SDI quintiles, the number of CKD-related deaths due to T2DM increased substantially from 1990 to 2021. However, trends in ASDRs and EAPCs varied widely, reflecting differences in mortality control across development levels. In high SDI countries, deaths increased from 26,431 (95% UI 21,843-31,511) to 111,565 (93,260-132,404), a 322.09% increase (275.84-369.99). ASDR rose from 2.36 to 4.62 per 100,000, a 95.35% increase (79.50-113.48), with the highest EAPC among all quintiles (2.51, 2.37-2.66). In high-middle SDI countries, deaths increased by 169.70% (120.17-213.53), ASDR rose by 21.54% (0.64-39.87), and EAPC was 0.73 (0.57-0.89). In middle SDI countries, deaths rose from 56,152 to 182,160 (224.40% increase, 164.58-265.78), ASDR increased modestly from 6.77 to 7.51 (10.99%, −9.44 to 23.65), and EAPC was 0.44 (0.37-0.52). Low-middle SDI countries experienced a 223.52% increase in deaths, ASDR increased by 31.24% (4.75-51.55), and EAPC was 0.89 (0.84-0.94). In low SDI countries, deaths rose from 13,362 to 29,491 (120.72% increase, 93.16-151.04), while ASDR remained relatively stable (from 7.16 to 7.36 per 100,000), a marginal 2.76% increase (−10.13 to 15.91), with an EAPC of 0.02 (−0.11 to 0.15) (Table S2, Figure 2C). DALYs From 1990 to 2021, all SDI quintiles experienced significant increases in DALYs due to CKD from T2DM, though ASDR trends and EAPCs varied. In high SDI countries, DALYs rose from 692,418 (UI 588,252-796,294) to 2,202,413 (1,928,998-2,486,233), a 218.08% increase (194.09-242.35). ASDR increased from 62.47 to 102.65 per 100,000 population (64.31%, 53.89-74.81), with the highest EAPC of 1.90 (1.78-2.02). High-middle SDI countries saw DALYs increase by 121.59%, ASDR rose slightly from 78.21 to 84.71 (8.31%, -7.26 to 21.94), and EAPC was 0.37 (0.23-0.52). In middle SDI countries, DALYs increased by 183.36%, ASDR rose from 157.87 to 167.06 (5.82%, -10.75 to 16.44), and EAPC was 0.29 (0.22-0.37). In low-middle SDI countries, DALYs rose from 747,142 to 2,202,184 (194.75% increase, 145.31-235.42), ASDR increased from 125.03 to 155.33 (24.24%, 3.35-40.98), and EAPC was 0.71 (0.68-0.74). Low SDI countries had a DALY increase of 111.14% (89.26-137.06), while ASDR declined slightly from 166.43 to 160.88 (−3.33%, −13.70 to 8.02), with a negative EAPC of −0.21 (−0.31 to −0.12) (Table S3, Figure 2D). Geographic Regional Trends Incidence From 1990 to 2021, the burden of incident CKD attributable to T2DM increased markedly across most GBD regions, with the most rapid rises observed in middle- and low-income regions. In Andean Latin America, incident cases increased from 3,349 (95% UI 2,930-3,786) to 18,008 (16,151-20,131), representing a 437.77% (393.34-489.42) increase. The ASIR rose from 16.41 to 30.50 per 100,000 population, an 85.88% increase (70.26-103.58), with an EAPC of 2.31 (2.20-2.41), among the highest globally. Central Latin America showed a 331.19% (292.77-374.92) increase in incident cases and a 45.13% (32.75-59.53) increase in ASIR, with an EAPC of 1.32 (1.26-1.39). In Central Asia, incident cases rose by 218.84% (199.58-240.90), ASIR by 77.14% (67.20-88.55), and EAPC was 2.02 (1.86-2.17). The Caribbean reported a 62.77% (51.62-74.99) increase in ASIR and an EAPC of 1.70 (1.60-1.80). Conversely, high-income regions like Western Europe exhibited only modest changes, with a 6.21% (−0.55 to 13.66) increase in ASIR and an EAPC of 0.23 (0.18-0.28). In East Asia, incident cases increased from 1.34 million to 3.74 million (+178.21%, 155.85-205.14), but ASIR increased only slightly from 15.32 to 16.59 (+8.29%, 0.50-17.94), with an EAPC of 0.42 (0.35-0.50), reflecting the influence of demographic changes rather than increasing individual-level risk. Southeast Asia experienced a 292.07% increase in incident cases, with ASIR increasing by 50.29% (40.51-61.07) and an EAPC of 1.30 (1.25-1.35)-the highest in the Asia-Pacific region. In South Asia, incident cases rose by 199.66% (182.57-219.55), ASIR increased by 20.85% (14.72-27.27), and EAPC was 0.36 (0.26-0.45). In high-income Asia Pacific countries (e.g., Japan, South Korea), incident cases increased by 124.74% (110.88-139.35), but ASIR remained largely stable (+1.18%, −3.23 to 6.71), with a low EAPC of 0.07 (0.02-0.12). Despite a smaller population, Oceania saw incident cases rise by 220.07% (191.37-249.05), ASIR increase by 27.92% (16.64-39.16), and EAPC of 0.75 (0.68-0.82) (Table 1, Figure 3B). Prevalence Between 1990 and 2021, the number of prevalent CKD cases due to T2DM rose significantly in all GBD regions. However, most regions exhibited declining or stable ASPRs, indicating that total burden increases were primarily driven by population growth and rising diabetes prevalence. Regions with over 100% growth included North Africa and the Middle East (+143.59%), Central Latin America (+138.31%), Eastern Sub-Saharan Africa (+131.54%), and Western Sub-Saharan Africa (+127.30%). Nonetheless, ASPRs declined in many regions, and most EAPCs were negative, reflecting slight reductions in individual-level risk. In East Asia, prevalent cases increased by 75.96% (66.54-85.04), but ASPR declined by 13.12%, with an EAPC of −0.25 (−0.39 to −0.10). Southeast Asia recorded a 114.37% increase in cases and a 2.65% reduction in ASPR, with an EAPC of −0.18 (−0.23 to −0.13). In South Asia, prevalent cases increased by 103.65% (95.77-111.73), ASPR declined by 9.66%, and EAPC was −0.44 (−0.52 to −0.36)-the largest decline in the Asia-Pacific region. High-income Asia Pacific saw a 58.60% increase in cases and an ASPR decline of 11.80%, with an EAPC of −0.47 (−0.54 to −0.41). In Oceania, prevalence increased by 129.68% (119.44-140.62), ASPR declined by 4.28%, and EAPC was −0.15 (−0.16 to −0.13) (Table S1, Figure 3A). Mortality Between 1990 and 2021, CKD-related deaths due to T2DM increased substantially across all GBD regions, though changes in ASDR varied markedly. High-income North America recorded the largest increases: a 596.18% rise in deaths (95% UI 499.10-709.23) and a 259.94% increase in ASDR, with an EAPC of 4.71. Central Latin America experienced a 422.05% increase in deaths, a 49.89% rise in ASDR, and an EAPC of 1.82. Eastern Europe and Central Asia also reported more than 200% increases in deaths and EAPCs above 2.90. By contrast, East Asia, high-income Asia Pacific, and Southern Latin America showed stable or declining ASDRs. In East Asia, deaths increased by 149.66%, while ASDR declined by 16.63%, with an EAPC of -0.53 (-0.63 to -0.44). Southeast Asia recorded a 248.93% rise in deaths, ASDR increased by 31.45%, and EAPC was 0.90 (0.86-0.94). South Asia experienced a 248.59% increase in deaths, ASDR rose by 28.48%, and EAPC was 0.72 (0.61-0.84). In high-income Asia Pacific, deaths rose by 201.51%, ASDR declined by 18.27%, and EAPC was −0.57 (−0.69 to −0.44). In Oceania, deaths increased by 237.35%, ASDR rose by 27.25%, and EAPC was 0.69 (0.58-0.81) (Table S2, Figure 3C). DALYs From 1990 to 2021, the total DALYs due to CKD caused by T2DM increased markedly across all GBD regions, although ASDR trends varied substantially. High-income North America recorded the largest growth, with DALYs increasing by 408.43% (UI 357.41-469.54) and ASDR by 168.37%, with an EAPC of 3.66. Central Latin America showed a 401.34% increase in DALYs, 56.58% in ASDR, and an EAPC of 1.86. Andean Latin America, Central Asia, and the Caribbean also had EAPCs above 1.0. Conversely, East Asia reported a 20.88% reduction in ASDR (EAPC −0.65, 95% CI −0.76 to −0.55), and high-income Asia Pacific had an 18.89% decline (EAPC −0.49, −0.63 to −0.36). In Southern Latin America, ASDR declined by 8.30%. Within the Asia-Pacific region, East Asia’s DALYs rose by 107.87% (UI 68.86-149.50), while ASDR declined from 158.73 to 125.58 per 100,000. Southeast Asia experienced a 218.98% increase in DALYs, ASDR rose by 23.47%, and EAPC was 0.72 (0.69-0.75). South Asia had a 215.46% increase in DALYs, ASDR rose by 22.08%, and EAPC was 0.60 (0.54-0.66). In high-income Asia Pacific, DALYs increased by 119.26%, ASDR declined from 92.69 to 75.19, and EAPC was −0.49 (−0.63 to −0.36). Oceania reported a 218.14% increase in DALYs, ASDR increased from 250.33 to 309.80 (+23.76%), and EAPC was 0.63 (0.52-0.74) (Table S3, Figure 3D). National Trends Incidence Among the 204 countries and territories analyzed, most experienced substantial increases in the number of incident CKD cases attributable to T2DM between 1990 and 2021. However, ASIRs remained stable or declined in many countries, suggesting that rising case counts were largely driven by demographic and epidemiological transitions. Countries with the greatest increases in ASIR included Greenland (+29.65%, EAPC: 0.89), Canada (+8.83%, EAPC: 0.35), and Argentina (+7.21%, EAPC: 0.29). In contrast, the most pronounced declines were observed in Italy (−20.69%, EAPC: −0.60), Ireland (−14.60%, EAPC: −0.51), China (−13.24%, EAPC: −0.24), and India (−10.76%, EAPC: −0.48). In the Asia-Pacific region, China’s incident cases increased from 11,890,522 to 20,911,520 (+75.87%), despite a decline in ASIR from 1,214.76 to 1,053.92 per 100,000 (EAPC: −0.24). India’s incident cases nearly doubled from 10,452,093 to 20,825,525 (+99.25%), while ASIR declined from 1,777.93 to 1,586.69 (EAPC: −0.48). In Indonesia, cases rose by 113.49%, accompanied by a slight ASIR decrease of −2.27% (EAPC: −0.25). Japan, Malaysia, South Korea, and the Philippines all reported over 100% increases in case counts, with corresponding reductions in ASIRs. Notably, Malaysia’s ASIR declined only marginally (−3.67%, EAPC: −0.01), while South Korea saw an ASIR drop of −11.09% (EAPC: −0.59) (Table S4, Figure 4B, Figure S2). Prevalence Across most countries, the absolute number of prevalent CKD cases due to T2DM increased markedly between 1990 and 2021. However, the ASPR remained stable or declined in many settings, suggesting that population growth and increased diabetes prevalence were the main drivers of the total burden. In 2021, the highest ASPRs were observed in Pacific Island nations, including the Marshall Islands (3,057.63 per 100,000), Micronesia (3,009.87), and Kiribati (2,849.42), reflecting the region’s extreme diabetes burden and limited nephrology care access. The lowest ASPRs were found in Niger (359.90), Chad (379.62), and Guinea (400.25), likely influenced by underdiagnosis and competing early mortality risks. In Asia-Pacific, China’s prevalent cases increased from 37,040,156 to 63,313,187 (+70.91%), while ASPR declined from 1,214.76 to 1,053.92 (EAPC: −0.24). India experienced an 84.85% increase in cases, with ASPR falling from 1,712.63 to 1,547.31 (EAPC: −0.44). Other countries with similar trends included Japan (ASPR change: −10.99%, EAPC: −0.39), South Korea (−11.80%, EAPC: −0.47), Indonesia (−4.57%, EAPC: −0.17), and the Philippines (−7.66%, EAPC: −0.35). Vietnam reported a 131.83% increase in cases and an ASPR increase of 8.05% (EAPC: 0.25) (Table S5, Figure 4A, Figure S1). Mortality From 1990 to 2021, CKD-related deaths due to T2DM rose across nearly all countries. However, trends in the ASDR varied widely. High-income and upper-middle-income countries saw substantial increases in ASDR, whereas some low-income countries recorded minor changes or declines, potentially due to early mortality from other causes or limited diagnostic capacity. In 2021, the highest ASDRs were observed in the Marshall Islands (94.77 per 100,000), Micronesia (91.63), and Kiribati (85.12), while the lowest were reported in Niger (1.57), Guinea-Bissau (1.67), and Guinea (1.70). Within Asia-Pacific, China’s deaths rose from 47,774 to 115,064 (+140.94%), with ASDR decreasing from 6.99 to 5.83 (EAPC: −0.53). In India, deaths increased by 248.59%, with an ASDR rise from 4.10 to 5.26 (EAPC: 0.72). Japan, South Korea, and Malaysia all experienced more than 200% increases in death counts, although Japan and South Korea recorded notable ASDR reductions. Indonesia, the Philippines, and Vietnam experienced sharp increases in both death counts and ASDRs, with EAPCs ranging from 0.85 to 1.06 (Table S6, Figure 4C, Figure S3). DALYs From 1990 to 2021, most countries experienced more than a twofold increase in total DALYs attributable to CKD due to T2DM. However, changes in ASDR varied substantially. The highest ASDRs in 2021 were in the Marshall Islands (2,213.44 per 100,000), Micronesia (2,091.27), and Kiribati (1,987.56), underscoring the extreme CKD burden in these small island nations. Conversely, the lowest ASDRs were reported in Niger (132.84), Guinea-Bissau (136.90), and Mali (140.73). In Asia-Pacific, China’s DALYs increased from 1,297,562 to 2,697,278 (+107.87%), with ASDR declining from 158.73 to 125.58 (EAPC: −0.65). India’s DALYs rose from 626,652 to 1,976,809 (+215.46%), with ASDR increasing from 110.09 to 134.39 (EAPC: 0.60). Japan (ASDR: −18.89%, EAPC: −0.49), South Korea (−17.06%, EAPC: −0.53), and China all recorded reductions in DALY rates, whereas Indonesia, the Philippines, and Vietnam reported increases in both DALYs and ASDRs, with EAPCs above 0.80 (Table S7, Figure 4D, Figure S4). Future Burden Projections Based on BAPC Modeling According to projections based on the BAPC model, the global burden of CKD attributable to T2DM is expected to continue rising through 2050. The number of individuals living with CKD due to T2DM is projected to increase from approximately 108 million in 2021 to over 120 million by 2050. The global ASPR is also forecasted to rise modestly, from around 1,260 per 100,000 population in 2021 to nearly 1,400 per 100,000 by 2050 (Figure 5A). Globally, the number of incident CKD cases due to T2DM is predicted to grow from roughly 2 million in 2021 to over 2.6 million in 2050. While the absolute number of new cases continues to rise, the ASIR is also expected to increase steadily, from 23.07 per 100,000 population in 2021 to approximately 36 per 100,000 by 2050 (Figure 5B). In terms of mortality, approximately 150,000 deaths were attributable to CKD due to T2DM in 1990. This number has increased persistently, reaching nearly 480,000 by 2021. Projections estimate that the global number of deaths will exceed 700,000 by 2050, with the ASDR anticipated to rise to approximately 6.7 per 100,000 population (Figure 5C). The global number of DALYs due to CKD from T2DM is also forecasted to continue increasing. From an estimated 11.3 million in 2021, DALYs are expected to reach nearly 15 million by 2050-an increase of over 30%. Concurrently, the ASR is projected to rise steadily from around 130 per 100,000 in 2021 to nearly 200 per 100,000 by 2050 (Figure 5D). Discussion DKD has emerged as a predominant etiology of ESKD, with its global prevalence demonstrating a significant increase from 22.1% to 31.3% in recent epidemiological studies [10] . Compared to patients with diabetes alone, those with DKD face substantially higher risks of all-cause mortality and cardiovascular-related death [11] . Beyond its severe impact on public health, DKD imposes a considerable economic burden on healthcare systems worldwide [12] . Consequently, analyzing current epidemiological data on DKD incidence and trends in DALYs is crucial for predicting disease risk and assessing its future burden. Such insights will inform evidence-based policy-making and help address existing gaps in DKD prevention and treatment strategies. The present study's findings demonstrate significant global increases in incidence, prevalence, mortality, and DALYs attributable to DKD secondary to T2DM between 1990 and 2021. While age-standardized prevalence and mortality rates exhibited stabilization or decline in some high SDI countries, but rose significantly in low-middle SDI countries. BAPC projections suggest that the burden of prevalence will increase further by 2050, particularly in low- and middle-income regions. Notably, the ASPR demonstrated a consistent downward trajectory, declining from 1,327.22 (1,223.26-1,439.42) to 1,259.63 (1,161.99-1,359.92) per 100,000 population, consistent with the 2019 edition of the GBD data. The results of this study also showed that the decline in ASPR coexisted with a rise in total prevalence, which was associated with the increasing ageing of the population, the increasing prevalence of diabetes mellitus from year to year, and the continuous improvement in the diagnostic methods for DKD. Our analyses revealed a consistently elevated disease burden among male populations across nearly all age strata, with particularly pronounced disparities in individuals aged >55 years. This gender disparity likely stems from multiple interrelated factors: higher baseline morbidity rates among males, reduced healthcare-seeking behavior, poorer treatment adherence, and psychosocial dimensions [13-15] . The results of the study show that the stabilization or decline in ASDR in high-income countries is associated with the establishment of better DKD management systems. In contrast, ASDR and ASR are high but slow-growing in low-SDI countries, and may be associated with underdiagnosis and early deaths. This study shows that the rapidly increasing burden in parts of Asia, especially in South and Southeast Asia and parts of Africa, needs to be of global concern, possibly through upgrading preventive and medical technologies and increasing investment in healthcare resources, which provides a reference and basis for countries to formulate healthcare policies [16] . Given the distinctive epidemiological patterns of DKD incidence, this study systematically evaluates three key intervention domains for improving prevention efficacy, reducing disease incidence, and alleviating healthcare burdens. It was found that early intervention in diabetes control strategies can slow down the rising trend of DKD, strengthen the training of healthcare workers and the education of patients, and the joint intervention of doctors and patients can help to prevent and control DKD [17-19] . In high-burden areas, early screening and standardized treatment of DKD can also effectively slow down the rising trend of DKD [20] . Furthermore, strategic reallocation of medical resources to high-incidence regions, combined with optimization of existing healthcare infrastructure, represents a viable approach for both reducing DKD incidence and mitigating associated economic burdens on healthcare systems [21] . Strengths of this study: This research is based on the latest GBD 2021 data, covering 204 countries, ensuring that the long-term trend analysis and BAPC predictions are highly representative. A multi-level stratified analysis by sex, age, SDI, and region enhances the generalizability and applicability of the findings. Limitations of this study: The GBD relies on modeled estimates, which may introduce inaccuracies in regions with limited data. Additionally, the study lacks precise predictions regarding the impact of comorbid conditions on DKD prognosis. The BAPC model projections are based on historical trends and may underestimate future changes resulting from public health interventions. To summarize the conclusions of the study: DKD due to T2DM mellitus has become a significant global burden and is expected to continue to grow in the future. It is recommended that future research should strengthen the identification of DKD subtypes, the evaluation of intervention effectiveness, and the optimization of global resource allocation. Declarations Data Sharing Statement The original contributions presented in the study are included in the article/Supplementary Material. Further inquiries can be directed to the corresponding authors. Ethics Approval and Consent to Participate None Author Contributions The authors Jiaqi Liu and Ying Yu were responsible for the research design. The coauthors Yan Pan and Hanglin Li were responsible for information collection. The coauthors Zuliang Yan and Hong Jiang were responsible for data measurement. The corresponding author, Ying Yu, was responsible for research guidance. All the authors contributed to the article and approved the submitted version. Disclosure statement No potential conflicts of interest were reported by the authors. Funding This work was supported by the Accented Project of Natural Science Research in University of Anhui Province[2023AH051936]; Project of National Univercity Student Innovation Training Program[2023103670013]. References Hirohito Goto, Ken Iseri , Noriko Hida. Fibrates and the risk of cardiovascular outcomes in chronic kidney disease patients[J]. Nephrol Dial Transplant. 2024 May 31;39(6):1016-1022. Junjie Hu , Runjiang Ke, Wilhem Teixeira, et al. Global, Regional, and National Burden of CKD due to Glomerulonephritis from 1990 to 2019: A Systematic Analysis from the Global Burden of Disease Study 2019[J]. Clin J Am Soc Nephrol. 2023 Jan 1;18(1):60-71. Xiao Ma, Rong Liu, Xiang Xi, et al. Global burden of chronic kidney disease due to diabetes mellitus, 1990-2021, and projections to 2050[J]. Front Endocrinol (Lausanne). 2025 Feb 21:16:1513008. Yuejun Liu, Ying Chen, Jianhua Ma, et al. Dapagliflozin plus calorie restriction for remission of type 2 diabetes: multicentre, double blind, randomised, placebo controlled trial[J]. BMJ. 2025 Jan 22;388:e081820. Hong Sun, Pouya Saeedi, Suvi Karuranga, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045[J]. Diabetes Res Clin Pract. 2022 Jan 183:109119. NCD Risk Factor Collaboration. Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants[J]. Lancet. 2024 Nov 23;404(10467):2077-2093. CDS Microvascular complications Group. Chinese clinical practice guideline of diabetic kidney disease[J]. Chinese Journal of Diabetes. 2019 11(1): 15-28. Meng Y, Bai H, Yu Q, et al. High-resistant starch, low-protein flour intervention on patients with early type 2 diabetic nephropathy: a randomized trial[J]. J Ren Nutr. 2019;29(5):386–393. Magdalena Madero, Adeera Levin, Sofia B Ahmed, et al. Evaluation and Management of Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2024 Clinical Practice Guideline[J]. Ann Intern Med. 2025 Mar 11. Hui-Teng Cheng, Xiaoqi Xu, Paik Seong Lim, et al. Worldwide Epidemiology of Diabetes-Related End-Stage Renal Disease, 2000-2015[J]. Diabetes Care. 2021 Jan 44(1):89-97. Giuseppe Penno, Anna Solini, Emanuela Orsi, et al. Insulin resistance, diabetic kidney disease, and all-cause mortality in individuals with type 2 diabetes: a prospective cohort study[J]. BMC Med. 2021 Mar 15;19(1):66. Peipei Zhou, Zhenning Hao, Yu Chen, et al. Association between gut microbiota and diabetic microvascular complications: a two-sample Mendelian randomization study[J]. Front Endocrinol (Lausanne). 2024 Aug 2;15:1364280. Jingyu Wang, Juhong Yang, Wenhui Jiang, et al. Effect of semaglutide on primary prevention of diabetic kidney disease in people with type 2 diabetes: A post hoc analysis of the SUSTAIN 6 randomized controlled trial[J]. Diabetes Obes Metab. 2024 Nov 26(11):5157-5166. Yukai Wang, Mengmeng Chen, Lin Wang, et al. Cardiometabolic traits mediating the effect of education on the risk of DKD and CKD: a Mendelian randomization study[J]. Front Nutr. 2024 Aug 13:11:1400577. Kesavadev J, Abraham G, Chandni R, et al. Type 2 diabetes in women: differences and difficulties[J]. Curr Diabetes Rev 2022; 18: e081221198651. Kibum Kim, Jacob Crook, Chao-Chin Lu, et al. Healthcare Costs Across Diabetic Kidney Disease Stages: A Veterans Affairs Study[J]. Kidney Med. 2024 Jul 18;6(9):100873. Wensu Wang, Yan Huang, Jianguo Shen, et al. Associations Between Serum IL‐17A, Renal Function and Diabetic Retinopathy in Type 2 Diabetes Mellitus: Evidence From a Chinese Han Population[J]. Endocrinol Diabetes Metab. 2025 Feb 13;8(2):e70033. Kayo Waki, Mitsuhiko Nara, Syunpei Enomoto, et al. Effectiveness of DialBetesPlus, a self-management support system for diabetic kidney disease: Randomized controlled trial NPJ Digit Med[J]. 2024 Apr 27;7:104. Di-fei Duan, Yue Wen, Yu Yan, et al. Chinese Healthcare Workers’ Knowledge, Attitudes, and Practices in Diabetic Kidney Management: A Multi-Centered Cross-Sectional Study Risk Manag Healthc Policy[J]. 2024 May 9;17:1211–1225. Iris Friedli, Seema Baid-Agrawal, Robert Unwin, et al. Magnetic Resonance Imaging in Clinical Trials of Diabetic Kidney Disease[J]. J Clin Med. 2023 Jul 11;12(14):4625. Adrian Liew, Sunita Bavanandan, Chuan‐Ming Hao, et al. Executive Summary of the Asian Pacific Society of Nephrology Clinical Practice Guideline on Diabetic Kidney Disease-2025 Update[J]. Nephrology (Carlton). 2025 May 5;30(5):e70031. Table 1 Table 1 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Supplementaryfiles.docx Table1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6789777","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":468094454,"identity":"119bd5d6-cd69-4ce4-824d-72dbcbefc88d","order_by":0,"name":"Jiaqi Liu","email":"","orcid":"","institution":"Bengbu Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jiaqi","middleName":"","lastName":"Liu","suffix":""},{"id":468094455,"identity":"c389b993-21f0-432d-b5d4-75b09fc2f482","order_by":1,"name":"Yan Pan","email":"","orcid":"","institution":"The First Affiliated Hospital of Bengbu Medical 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11:24:50","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":20929,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6789777/v1/989eba16d1134531bbca720c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Global, regional, and national burden of Chronic kidney disease due to type 2 diabetes mellitus, 1990-2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021","fulltext":[{"header":"Key Points","content":"\u003cp\u003e\u003cstrong\u003eQuestion\u0026nbsp;\u003c/strong\u003eWhat are the long-term global, regional, and national trends in CKD attributable to T2DM mellitus from 1990 to 2021, and how will this burden evolve through 2050?\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFindings\u0026nbsp;\u003c/strong\u003eThis comprehensive population-based analysis, utilizing data from the GBD 2021 and employing BAPC modeling, revealed a 167% increase in incident CKD cases attributable to T2DM globally between 1990 and 2021. Concurrently, mortality and DALYs demonstrated substantial escalation during this period. Modeled projections suggest that by 2050, the global prevalence of T2DM-related CKD will exceed 120 million cases, with annual incident cases surpassing 2.6 million and mortality exceeding 700,000 deaths.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeaning\u0026nbsp;\u003c/strong\u003eThe global burden of CKD attributable to T2DM continues to rise, particularly in low- and middle-income countries. Without targeted interventions in diabetes control and kidney disease prevention, the associated health and economic challenges are expected to intensify through mid-century.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eChronic Kidney Disease (CKD) is a disease characterized by progressive decline in kidney function. As kidney impairment advances, a constellation of clinical manifestations emerges, most notably a substantially elevated risk of cardiovascular morbidity and mortality\u003csup\u003e[1]\u003c/sup\u003e. It may ultimately progress to a state requiring dialysis or kidney transplantation, leading to a higher risk of death. Epidemiological data from the Global Burden of Disease (GBD) study consistently rank CKD among the leading contributors to global disease burden, establishing it as a critical public health challenge worldwide\u003csup\u003e[2]\u003c/sup\u003e. Notably, among the causes of CKD, diabetes has become one of the primary factors\u003csup\u003e[3]\u003c/sup\u003e. The damage to renal microvasculature caused by hyperglycemia plays a key role in the development and progression of CKD.\u003c/p\u003e\n\u003cp\u003eType 2 diabetes mellitus (T2DM) has emerged as one of the most rapidly expanding global public health challenges in the 21st century\u003csup\u003e[4]\u003c/sup\u003e. Epidemiological data from the International Diabetes Federation (IDF) indicate that in 2021, approximately 537 million adults worldwide were living with diabetes, with T2DM accounting for over 90% of cases\u003csup\u003e[5]\u003c/sup\u003e.T2DM Current projections suggest this figure will escalate to 643 million by 2030 and 783 million by 2045, representing a 46% increase within a quarter century. This increase is particularly pronounced in low- and middle-income countries, primarily due to rising obesity rates, aging populations, and unhealthy lifestyles such as high-sugar, high-fat diets and physical inactivity\u003csup\u003e[6]\u003c/sup\u003e. As a typical example, China currently has around 120 million people with T2DM. About one-third of all diabetic patients will develop diabetic kidney disease (DKD). Data from China in 2017 showed that the prevalence of DKD among adults was 10.4%, and it accounted for 40% of the causes of end-stage renal disease (ESRD)\u003csup\u003e[7,8]\u003c/sup\u003e. DKD has become a major challenge and focus for both nephrology and diabetology. The therapeutic landscape for DKD remains limited, with current interventions demonstrating only modest efficacy. Following disease onset, DKD typically progresses relentlessly toward ESRD despite conventional management. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines emphasize a multifaceted treatment approach incorporating stringent glycemic control, SGLT-2i and RAASi\u003csup\u003e[9]\u003c/sup\u003e. However, even with optimal implementation of these evidence-based strategies, many patients experience suboptimal outcomes, including diminished quality of life, multiple comorbidities, and reduced life expectancy. Therefore, finding fundamental solutions to these challenges has become a key focus of research for nephrologists and endocrinologists.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGuided by the principle that prevention is better than cure, we may hypothesize that effectively preventing the prevalence of diabetes is central to reducing the occurrence and progression of DKD. Current research efforts remain predominantly focused on CKD or DKD in isolation, with a notable paucity of comprehensive analyses examining the spatiotemporal patterns and sociodemographic determinants of diabetes-related CKD. This knowledge gap significantly impedes evidence-based health policy formulation and optimal resource distribution across healthcare systems. This study innovatively utilizes GBD 2021 data to systematically assess the trends in prevalence, incidence, mortality, and DALYs of T2DM-related CKD at the global, regional, and national levels from 1990 to 2021. Additionally, the Bayesian age-period-cohort (BAPC) model is applied to project the disease burdens up to 2050, addressing a critical gap in predictive research. This research holds particular significance for health policymakers, nephrologists, and endocrinologists by establishing an empirical basis for more effective prevention and control of the growing DKD burden worldwide.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Framework\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is a descriptive epidemiological analysis based on the GBD 2021 data. Using internationally standardized methods, it focuses on DKD caused by T2DM, the most prevalent form of diabetes, assess epidemiological trends from 1990 to 2021. Additionally, projections for 2050 were generated using the BAPC model.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Sources\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data were sourced from the GBD 2021 database, provided by the Institute for Health Metrics and Evaluation (IHME), covering 204 countries and territories. The database includes various types of data sources (such as demographic statistics, death registries, hospital records, and research literature). All data underwent standardized processing and quality control by IHME.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Definition\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCKD is defined as chronic structural and functional abnormalities of the kidneys caused by various etiologies, persisting for more than 3 months. These abnormalities include pathological damage (with or without altered glomerular filtration rate), hematologic or urinary component abnormalities, and imaging abnormalities (ICD-10:\u0026zwnj;N18). DKD, a CKD subtype attributable to diabetes mellitus, is clinically defined by either: a glomerular filtration rate (GFR) \u0026lt;60 mL/min/1.73m\u0026sup2;, or a urinary albumin-to-creatinine ratio (UACR) \u0026gt;30 mg/g, with both conditions persisting for more than 3 months (ICD-10:\u0026zwnj;N08.3). The disease burden of DKD secondary to T2DM was quantified via the GBD study\u0026rsquo;s \u0026lsquo;comparative risk assessment\u0026rsquo; framework. This methodology integrates two epidemiological parameters: (1) the causal association strength (expressed as relative risk [RR]) between diabetes and CKD, and (2) the population attributable fraction (PAF).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasures and Indicators\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary evaluation metrics included: Incidence and age-standardized incidence rate (ASIR), Prevalence and age-standardized prevalence rate (ASPR), Mortality and age-standardized mortality rate (ASMR), Disability-adjusted life years (DALYs) and age-standardized DALY rate (ASDR). All indicators were stratified by sex, age group, SDI quintile, region, and country for analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrend Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Estimated Annual Percentage Change (EAPC) was used to assess trends in age-standardized rate (ASR) metrics between 1990 and 2021. EAPC was calculated using a linear regression model with log-transformed ASR as the dependent variable and calendar year as the independent variable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProjection Modeling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe BAPC model was employed to project incidence, prevalence, mortality, and DALYs for the period 2030\u0026ndash;2050. The model specification included age, period, and birth cohort as covariates, utilizing normal prior distributions and random walk priors. Model implementation and inference were performed using the R packages BAPC and INLA (version 4.4.2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUncertainty and Ethics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll estimates were reported with 95% uncertainty intervals (UI), derived from 1000 Monte Carlo simulations. As a secondary data analysis study involving no personally identifiable information, this research required no ethics approval.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eGlobal trends\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIncidence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGlobally, both the number of incident cases and the ASIR of CKD due to T2DM increased substantially between 1990 and 2021. Incident cases rose from 753,106 (UI 680,930\u0026ndash;826,928) in 1990 to 2,012,025 (1,857,800-2,154,288) in 2021. Over the same period, ASIR increased from 19.07 (17.28-20.83) to 23.07 (21.40-24.72) per 100,000 population, representing a 167.16% (153.53-182.63) increase in incident cases and a 20.97% (14.99-27.49) increase in ASIR. The EAPC in ASIR was 0.61 (0.60-0.63), indicating a sustained upward trend over three decades (Table 1). Sex-specific analysis showed consistently higher disease burden among males, who exhibited both greater absolute case numbers and marginally elevated ASIRs compared to females. Age-stratified analysis identified a unimodal distribution of incidence, with peak rates occurring in the 65-74-year age group for both sexes (Figure 1B).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom 1990 to 2021, the global prevalence of CKD due to T2DM increased substantially in absolute numbers, while the ASPR showed a modest decline. Prevalent cases increased from 58,105,268 (UI 53,056,992-63,286,818) in 1990 to 107,559,955 (99,170,797-115,994,732) in 2021, representing an 85.11% (78.13-91.41) increase. ASPR declined from 1,327.22 (1,223.26-1,439.42) to 1,259.63 (1,161.99-1,359.92) per 100,000 population, a 5.09% reduction (UI \u0026minus;7.46 to \u0026minus;2.98), with an EAPC of \u0026minus;0.17(\u0026minus;0.20 to \u0026minus;0.13), indicating a modest reduction in individual-level risk after adjusting for demographic shifts (Table S1). Subsequently, the burden was higher in males across nearly all age groups, particularly those older than 55 years. The 65-74-year age group accounted for the highest number of prevalent cases, and the highest ASPR was observed in individuals aged 75-79 years (Figure 1A).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMortality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBetween 1990 and 2021, the global mortality burden from CKD attributable to T2DM increased markedly in both total number of deaths and the age-standardized DALY rate (ASDR). Global deaths increased from 147,970 (UI 124,179-176,413) to 477,273 (401,541-565,951), while ASDR rose from 4.15 (3.50-4.94) to 5.72 (4.83-6.79) per 100,000 population. This corresponds to a 222.55% (177.43-253.83) increase in total deaths and a 37.79% (19.17-49.63) increase in ASDR. EAPC for ASDR was 1.17 (1.10-1.24), confirming a consistent upward trend (Table S2). Mortality was consistently higher in males, with the sex gap widening with age, especially after 65 years. The number of deaths increased markedly after age 45, peaking between 65 and 84 years. ASDR rose linearly with age, reaching its highest levels in individuals aged 80 years and older (Figure 1C).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDALYs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDALYs attributable to CKD due to T2DM increased significantly from 1990 to 2021, reflecting a growing public health burden. DALYs rose from 4,122,919 (UI 3,498,980-4,818,958) in 1990 to 11,278,935 (9,682,785-13,103,871) in 2021, an increase of 173.57% (140.54-194.35). The global ASDR increased from 105.71 (90.68-122.67) to 131.08 (112.75-152.49) per 100,000 population, a 24.00% increase (9.26-33.00), with an EAPC of 0.81 (0.74-0.87) (Table S3). The increase was primarily driven by population ageing, rising diabetes prevalence, and insufficient management of CKD progression. The burden was consistently higher in males, particularly beyond 55 years. DALYs increased sharply from age 45 onwards, peaking between 65 and 79 years. ASDR increased exponentially with age, reaching its peak among individuals aged 80-89 years (Figure 1D).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSDI Regional Trends\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIncidence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBetween 1990 and 2021, the number of incident CKD cases due to T2DM increased across all five sociodemographic index (SDI) quintiles, with the largest relative growth observed in lower SDI regions. In high SDI countries, incident cases increased from 289,954 (95% UI 263,980-316,807) to 595,271 (547,943-636,879), a 105.30% rise (93.99-117.68). The ASIR increased from 25.59 to 28.34 per 100,000 population, a 10.75% increase (4.83-17.36), with an EAPC of 0.28 (0.24-0.33). In high-middle SDI countries, incident cases rose by 157.48% (142.69-175.18), ASIR increased from 15.72 to 20.09 per 100,000 (27.83% increase, 20.71-36.27), and EAPC was 0.91 (0.88-0.95). Middle SDI countries experienced the fastest growth in incidence, with cases rising from 181,844 to 635,311 (249.37% increase, 224.15-276.80), ASIR increasing by 33.96% (25.11-43.94), and the highest EAPC at 0.99 (0.97-1.02). In low-middle SDI countries, incident cases increased by 210.05% (195.02-226.94), ASIR rose by 33.57% (27.59-40.00), and EAPC was 0.77 (0.70-0.85). Low SDI countries also demonstrated notable growth, with incident cases increasing by 181.08% (165.79-198.45), ASIR rising by 26.76% (20.00-34.42), and an EAPC of 0.65 (0.56-0.74) (Table 1, Figure 2B).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll five SDI levels saw marked increases in the number of prevalent CKD cases due to T2DM between 1990 and 2021. However, ASPRs generally declined, indicating that increases in prevalence were largely driven by demographic factors and diabetes expansion rather than increases in individual-level risk. In high SDI countries, prevalent cases rose from 11,068,895 (95% UI 10,251,403-11,847,690) to 18,097,946 (16,763,917-19,359,376), a 63.50% increase (59.59-67.22). ASPR declined from 1,037.34 to 997.07 per 100,000 population (\u0026minus;3.88%, \u0026minus;5.62 to \u0026minus;2.23), with an EAPC of \u0026minus;0.09 (\u0026minus;0.14 to \u0026minus;0.05). In high-middle SDI countries, prevalence increased by 59.14% (51.57-65.58), ASPR declined by \u0026minus;8.99% (\u0026minus;11.95 to \u0026minus;6.58), and EAPC was \u0026minus;0.25 (\u0026minus;0.32 to \u0026minus;0.19). In middle SDI countries, prevalence increased by 102.56%, ASPR declined by -7.00% (-9.53 to -4.81), and EAPC was \u0026minus;0.20 (\u0026minus;0.25 to \u0026minus;0.16). In low-middle SDI countries, prevalent cases rose by 98.80% (91.34-105.59), ASPR declined from 1,586.44 to 1,474.59 (\u0026minus;7.05%, \u0026minus;9.36 to \u0026minus;4.89), and EAPC was \u0026minus;0.31 (\u0026minus;0.36 to \u0026minus;0.27). Low SDI countries saw the greatest absolute increase in prevalence (113.05%, 106.34\u0026ndash;119.42), ASPR declined by \u0026minus;6.34% (\u0026minus;8.66 to \u0026minus;4.41), and EAPC was \u0026minus;0.28 (\u0026minus;0.32 to \u0026minus;0.25) (Table S1, Figure 2A).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMortality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcross all SDI quintiles, the number of CKD-related deaths due to T2DM increased substantially from 1990 to 2021. However, trends in ASDRs and EAPCs varied widely, reflecting differences in mortality control across development levels. In high SDI countries, deaths increased from 26,431 (95% UI 21,843-31,511) to 111,565 (93,260-132,404), a 322.09% increase (275.84-369.99). ASDR rose from 2.36 to 4.62 per 100,000, a 95.35% increase (79.50-113.48), with the highest EAPC among all quintiles (2.51, 2.37-2.66). In high-middle SDI countries, deaths increased by 169.70% (120.17-213.53), ASDR rose by 21.54% (0.64-39.87), and EAPC was 0.73 (0.57-0.89). In middle SDI countries, deaths rose from 56,152 to 182,160 (224.40% increase, 164.58-265.78), ASDR increased modestly from 6.77 to 7.51 (10.99%, \u0026minus;9.44 to 23.65), and EAPC was 0.44 (0.37-0.52). Low-middle SDI countries experienced a 223.52% increase in deaths, ASDR increased by 31.24% (4.75-51.55), and EAPC was 0.89 (0.84-0.94). In low SDI countries, deaths rose from 13,362 to 29,491 (120.72% increase, 93.16-151.04), while ASDR remained relatively stable (from 7.16 to 7.36 per 100,000), a marginal 2.76% increase (\u0026minus;10.13 to 15.91), with an EAPC of 0.02 (\u0026minus;0.11 to 0.15) (Table S2, Figure 2C).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDALYs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom 1990 to 2021, all SDI quintiles experienced significant increases in DALYs due to CKD from T2DM, though ASDR trends and EAPCs varied. In high SDI countries, DALYs rose from 692,418 (UI 588,252-796,294) to 2,202,413 (1,928,998-2,486,233), a 218.08% increase (194.09-242.35). ASDR increased from 62.47 to 102.65 per 100,000 population (64.31%, 53.89-74.81), with the highest EAPC of 1.90 (1.78-2.02). High-middle SDI countries saw DALYs increase by 121.59%, ASDR rose slightly from 78.21 to 84.71 (8.31%, -7.26 to 21.94), and EAPC was 0.37 (0.23-0.52). In middle SDI countries, DALYs increased by 183.36%, ASDR rose from 157.87 to 167.06 (5.82%, -10.75 to 16.44), and EAPC was 0.29 (0.22-0.37). In low-middle SDI countries, DALYs rose from 747,142 to 2,202,184 (194.75% increase, 145.31-235.42), ASDR increased from 125.03 to 155.33 (24.24%, 3.35-40.98), and EAPC was 0.71 (0.68-0.74). Low SDI countries had a DALY increase of 111.14% (89.26-137.06), while ASDR declined slightly from 166.43 to 160.88 (\u0026minus;3.33%, \u0026minus;13.70 to 8.02), with a negative EAPC of \u0026minus;0.21 (\u0026minus;0.31 to \u0026minus;0.12) (Table S3, Figure 2D).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeographic Regional Trends\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIncidence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom 1990 to 2021, the burden of incident CKD attributable to T2DM increased markedly across most GBD regions, with the most rapid rises observed in middle- and low-income regions. In Andean Latin America, incident cases increased from 3,349 (95% UI 2,930-3,786) to 18,008 (16,151-20,131), representing a 437.77% (393.34-489.42) increase. The ASIR rose from 16.41 to 30.50 per 100,000 population, an 85.88% increase (70.26-103.58), with an EAPC of 2.31 (2.20-2.41), among the highest globally. Central Latin America showed a 331.19% (292.77-374.92) increase in incident cases and a 45.13% (32.75-59.53) increase in ASIR, with an EAPC of 1.32 (1.26-1.39). In Central Asia, incident cases rose by 218.84% (199.58-240.90), ASIR by 77.14% (67.20-88.55), and EAPC was 2.02 (1.86-2.17). The Caribbean reported a 62.77% (51.62-74.99) increase in ASIR and an EAPC of 1.70 (1.60-1.80). Conversely, high-income regions like Western Europe exhibited only modest changes, with a 6.21% (\u0026minus;0.55 to 13.66) increase in ASIR and an EAPC of 0.23 (0.18-0.28). In East Asia, incident cases increased from 1.34 million to 3.74 million (+178.21%, 155.85-205.14), but ASIR increased only slightly from 15.32 to 16.59 (+8.29%, 0.50-17.94), with an EAPC of 0.42 (0.35-0.50), reflecting the influence of demographic changes rather than increasing individual-level risk. Southeast Asia experienced a 292.07% increase in incident cases, with ASIR increasing by 50.29% (40.51-61.07) and an EAPC of 1.30 (1.25-1.35)-the highest in the Asia-Pacific region. In South Asia, incident cases rose by 199.66% (182.57-219.55), ASIR increased by 20.85% (14.72-27.27), and EAPC was 0.36 (0.26-0.45). In high-income Asia Pacific countries (e.g., Japan, South Korea), incident cases increased by 124.74% (110.88-139.35), but ASIR remained largely stable (+1.18%, \u0026minus;3.23 to 6.71), with a low EAPC of 0.07 (0.02-0.12). Despite a smaller population, Oceania saw incident cases rise by 220.07% (191.37-249.05), ASIR increase by 27.92% (16.64-39.16), and EAPC of 0.75 (0.68-0.82) (Table 1, Figure 3B).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBetween 1990 and 2021, the number of prevalent CKD cases due to T2DM rose significantly in all GBD regions. However, most regions exhibited declining or stable ASPRs, indicating that total burden increases were primarily driven by population growth and rising diabetes prevalence. Regions with over 100% growth included North Africa and the Middle East (+143.59%), Central Latin America (+138.31%), Eastern Sub-Saharan Africa (+131.54%), and Western Sub-Saharan Africa (+127.30%). Nonetheless, ASPRs declined in many regions, and most EAPCs were negative, reflecting slight reductions in individual-level risk. In East Asia, prevalent cases increased by 75.96% (66.54-85.04), but ASPR declined by 13.12%, with an EAPC of \u0026minus;0.25 (\u0026minus;0.39 to \u0026minus;0.10). Southeast Asia recorded a 114.37% increase in cases and a 2.65% reduction in ASPR, with an EAPC of \u0026minus;0.18 (\u0026minus;0.23 to \u0026minus;0.13). In South Asia, prevalent cases increased by 103.65% (95.77-111.73), ASPR declined by 9.66%, and EAPC was \u0026minus;0.44 (\u0026minus;0.52 to \u0026minus;0.36)-the largest decline in the Asia-Pacific region. High-income Asia Pacific saw a 58.60% increase in cases and an ASPR decline of 11.80%, with an EAPC of \u0026minus;0.47 (\u0026minus;0.54 to \u0026minus;0.41). In Oceania, prevalence increased by 129.68% (119.44-140.62), ASPR declined by 4.28%, and EAPC was \u0026minus;0.15 (\u0026minus;0.16 to \u0026minus;0.13) (Table S1, Figure 3A).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMortality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBetween 1990 and 2021, CKD-related deaths due to T2DM increased substantially across all GBD regions, though changes in ASDR varied markedly. High-income North America recorded the largest increases: a 596.18% rise in deaths (95% UI 499.10-709.23) and a 259.94% increase in ASDR, with an EAPC of 4.71. Central Latin America experienced a 422.05% increase in deaths, a 49.89% rise in ASDR, and an EAPC of 1.82. Eastern Europe and Central Asia also reported more than 200% increases in deaths and EAPCs above 2.90. By contrast, East Asia, high-income Asia Pacific, and Southern Latin America showed stable or declining ASDRs. In East Asia, deaths increased by 149.66%, while ASDR declined by 16.63%, with an EAPC of -0.53 (-0.63 to -0.44). Southeast Asia recorded a 248.93% rise in deaths, ASDR increased by 31.45%, and EAPC was 0.90 (0.86-0.94). South Asia experienced a 248.59% increase in deaths, ASDR rose by 28.48%, and EAPC was 0.72 (0.61-0.84). In high-income Asia Pacific, deaths rose by 201.51%, ASDR declined by 18.27%, and EAPC was \u0026minus;0.57 (\u0026minus;0.69 to \u0026minus;0.44). In Oceania, deaths increased by 237.35%, ASDR rose by 27.25%, and EAPC was 0.69 (0.58-0.81) (Table S2, Figure 3C).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDALYs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom 1990 to 2021, the total DALYs due to CKD caused by T2DM increased markedly across all GBD regions, although ASDR trends varied substantially. High-income North America recorded the largest growth, with DALYs increasing by 408.43% (UI 357.41-469.54) and ASDR by 168.37%, with an EAPC of 3.66. Central Latin America showed a 401.34% increase in DALYs, 56.58% in ASDR, and an EAPC of 1.86. Andean Latin America, Central Asia, and the Caribbean also had EAPCs above 1.0. Conversely, East Asia reported a 20.88% reduction in ASDR (EAPC \u0026minus;0.65, 95% CI \u0026minus;0.76 to \u0026minus;0.55), and high-income Asia Pacific had an 18.89% decline (EAPC \u0026minus;0.49, \u0026minus;0.63 to \u0026minus;0.36). In Southern Latin America, ASDR declined by 8.30%. Within the Asia-Pacific region, East Asia\u0026rsquo;s DALYs rose by 107.87% (UI 68.86-149.50), while ASDR declined from 158.73 to 125.58 per 100,000. Southeast Asia experienced a 218.98% increase in DALYs, ASDR rose by 23.47%, and EAPC was 0.72 (0.69-0.75). South Asia had a 215.46% increase in DALYs, ASDR rose by 22.08%, and EAPC was 0.60 (0.54-0.66). In high-income Asia Pacific, DALYs increased by 119.26%, ASDR declined from 92.69 to 75.19, and EAPC was \u0026minus;0.49 (\u0026minus;0.63 to \u0026minus;0.36). Oceania reported a 218.14% increase in DALYs, ASDR increased from 250.33 to 309.80 (+23.76%), and EAPC was 0.63 (0.52-0.74) (Table S3, Figure 3D).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNational Trends\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIncidence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 204 countries and territories analyzed, most experienced substantial increases in the number of incident CKD cases attributable to T2DM between 1990 and 2021. However, ASIRs remained stable or declined in many countries, suggesting that rising case counts were largely driven by demographic and epidemiological transitions. Countries with the greatest increases in ASIR included Greenland (+29.65%, EAPC: 0.89), Canada (+8.83%, EAPC: 0.35), and Argentina (+7.21%, EAPC: 0.29). In contrast, the most pronounced declines were observed in Italy (\u0026minus;20.69%, EAPC: \u0026minus;0.60), Ireland (\u0026minus;14.60%, EAPC: \u0026minus;0.51), China (\u0026minus;13.24%, EAPC: \u0026minus;0.24), and India (\u0026minus;10.76%, EAPC: \u0026minus;0.48).\u003c/p\u003e\n\u003cp\u003eIn the Asia-Pacific region, China\u0026rsquo;s incident cases increased from 11,890,522 to 20,911,520 (+75.87%), despite a decline in ASIR from 1,214.76 to 1,053.92 per 100,000 (EAPC: \u0026minus;0.24). India\u0026rsquo;s incident cases nearly doubled from 10,452,093 to 20,825,525 (+99.25%), while ASIR declined from 1,777.93 to 1,586.69 (EAPC: \u0026minus;0.48). In Indonesia, cases rose by 113.49%, accompanied by a slight ASIR decrease of \u0026minus;2.27% (EAPC: \u0026minus;0.25). Japan, Malaysia, South Korea, and the Philippines all reported over 100% increases in case counts, with corresponding reductions in ASIRs. Notably, Malaysia\u0026rsquo;s ASIR declined only marginally (\u0026minus;3.67%, EAPC: \u0026minus;0.01), while South Korea saw an ASIR drop of \u0026minus;11.09% (EAPC: \u0026minus;0.59) (Table S4, Figure 4B, Figure S2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcross most countries, the absolute number of prevalent CKD cases due to T2DM increased markedly between 1990 and 2021. However, the ASPR remained stable or declined in many settings, suggesting that population growth and increased diabetes prevalence were the main drivers of the total burden. In 2021, the highest ASPRs were observed in Pacific Island nations, including the Marshall Islands (3,057.63 per 100,000), Micronesia (3,009.87), and Kiribati (2,849.42), reflecting the region\u0026rsquo;s extreme diabetes burden and limited nephrology care access. The lowest ASPRs were found in Niger (359.90), Chad (379.62), and Guinea (400.25), likely influenced by underdiagnosis and competing early mortality risks.\u003c/p\u003e\n\u003cp\u003eIn Asia-Pacific, China\u0026rsquo;s prevalent cases increased from 37,040,156 to 63,313,187 (+70.91%), while ASPR declined from 1,214.76 to 1,053.92 (EAPC: \u0026minus;0.24). India experienced an 84.85% increase in cases, with ASPR falling from 1,712.63 to 1,547.31 (EAPC: \u0026minus;0.44). Other countries with similar trends included Japan (ASPR change: \u0026minus;10.99%, EAPC: \u0026minus;0.39), South Korea (\u0026minus;11.80%, EAPC: \u0026minus;0.47), Indonesia (\u0026minus;4.57%, EAPC: \u0026minus;0.17), and the Philippines (\u0026minus;7.66%, EAPC: \u0026minus;0.35). Vietnam reported a 131.83% increase in cases and an ASPR increase of 8.05% (EAPC: 0.25) (Table S5, Figure 4A, Figure S1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMortality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom 1990 to 2021, CKD-related deaths due to T2DM rose across nearly all countries. However, trends in the ASDR varied widely. High-income and upper-middle-income countries saw substantial increases in ASDR, whereas some low-income countries recorded minor changes or declines, potentially due to early mortality from other causes or limited diagnostic capacity. In 2021, the highest ASDRs were observed in the Marshall Islands (94.77 per 100,000), Micronesia (91.63), and Kiribati (85.12), while the lowest were reported in Niger (1.57), Guinea-Bissau (1.67), and Guinea (1.70).\u003c/p\u003e\n\u003cp\u003eWithin Asia-Pacific, China\u0026rsquo;s deaths rose from 47,774 to 115,064 (+140.94%), with ASDR decreasing from 6.99 to 5.83 (EAPC: \u0026minus;0.53). In India, deaths increased by 248.59%, with an ASDR rise from 4.10 to 5.26 (EAPC: 0.72). Japan, South Korea, and Malaysia all experienced more than 200% increases in death counts, although Japan and South Korea recorded notable ASDR reductions. Indonesia, the Philippines, and Vietnam experienced sharp increases in both death counts and ASDRs, with EAPCs ranging from 0.85 to 1.06 (Table S6, Figure 4C, Figure S3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDALYs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom 1990 to 2021, most countries experienced more than a twofold increase in total DALYs attributable to CKD due to T2DM. However, changes in ASDR varied substantially. The highest ASDRs in 2021 were in the Marshall Islands (2,213.44 per 100,000), Micronesia (2,091.27), and Kiribati (1,987.56), underscoring the extreme CKD burden in these small island nations. Conversely, the lowest ASDRs were reported in Niger (132.84), Guinea-Bissau (136.90), and Mali (140.73).\u003c/p\u003e\n\u003cp\u003eIn Asia-Pacific, China\u0026rsquo;s DALYs increased from 1,297,562 to 2,697,278 (+107.87%), with ASDR declining from 158.73 to 125.58 (EAPC: \u0026minus;0.65). India\u0026rsquo;s DALYs rose from 626,652 to 1,976,809 (+215.46%), with ASDR increasing from 110.09 to 134.39 (EAPC: 0.60). Japan (ASDR: \u0026minus;18.89%, EAPC: \u0026minus;0.49), South Korea (\u0026minus;17.06%, EAPC: \u0026minus;0.53), and China all recorded reductions in DALY rates, whereas Indonesia, the Philippines, and Vietnam reported increases in both DALYs and ASDRs, with EAPCs above 0.80 (Table S7, Figure 4D, Figure S4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFuture Burden Projections Based on BAPC Modeling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to projections based on the BAPC model, the global burden of CKD attributable to T2DM is expected to continue rising through 2050. The number of individuals living with CKD due to T2DM is projected to increase from approximately 108 million in 2021 to over 120 million by 2050. The global ASPR is also forecasted to rise modestly, from around 1,260 per 100,000 population in 2021 to nearly 1,400 per 100,000 by 2050 (Figure 5A).\u003c/p\u003e\n\u003cp\u003eGlobally, the number of incident CKD cases due to T2DM is predicted to grow from roughly 2 million in 2021 to over 2.6 million in 2050. While the absolute number of new cases continues to rise, the ASIR is also expected to increase steadily, from 23.07 per 100,000 population in 2021 to approximately 36 per 100,000 by 2050 (Figure 5B).\u003c/p\u003e\n\u003cp\u003eIn terms of mortality, approximately 150,000 deaths were attributable to CKD due to T2DM in 1990. This number has increased persistently, reaching nearly 480,000 by 2021. Projections estimate that the global number of deaths will exceed 700,000 by 2050, with the ASDR anticipated to rise to approximately 6.7 per 100,000 population (Figure 5C).\u003c/p\u003e\n\u003cp\u003eThe global number of DALYs due to CKD from T2DM is also forecasted to continue increasing. From an estimated 11.3 million in 2021, DALYs are expected to reach nearly 15 million by 2050-an increase of over 30%. Concurrently, the ASR is projected to rise steadily from around 130 per 100,000 in 2021 to nearly 200 per 100,000 by 2050 (Figure 5D).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDKD has emerged as a predominant etiology of ESKD, with its global prevalence demonstrating a significant increase from 22.1% to 31.3% in recent epidemiological studies\u003csup\u003e[10]\u003c/sup\u003e. Compared to patients with diabetes alone, those with DKD face substantially higher risks of all-cause mortality and cardiovascular-related death\u003csup\u003e[11]\u003c/sup\u003e. Beyond its severe impact on public health, DKD imposes a considerable economic burden on healthcare systems worldwide\u003csup\u003e[12]\u003c/sup\u003e. Consequently, analyzing current epidemiological data on DKD incidence and trends in DALYs is crucial for predicting disease risk and assessing its future burden. Such insights will inform evidence-based policy-making and help address existing gaps in DKD prevention and treatment strategies.\u003c/p\u003e\n\u003cp\u003eThe present study\u0026apos;s findings demonstrate significant global increases in incidence, prevalence, mortality, and DALYs attributable to DKD secondary to T2DM between 1990 and 2021. While age-standardized prevalence and mortality rates exhibited stabilization or decline in some high SDI countries, but rose significantly in low-middle SDI countries. BAPC projections suggest that the burden of prevalence will increase further by 2050, particularly in low- and middle-income regions.\u0026nbsp;\u0026nbsp;Notably, the ASPR demonstrated a consistent downward trajectory, declining from 1,327.22 (1,223.26-1,439.42) to 1,259.63 (1,161.99-1,359.92) per 100,000 population, consistent with the 2019 edition of the GBD data. The results of this study also showed that the decline in ASPR coexisted with a rise in total prevalence, which was associated with the increasing ageing of the population, the increasing prevalence of diabetes mellitus from year to year, and the continuous improvement in the diagnostic methods for DKD. Our analyses revealed a consistently elevated disease burden among male populations across nearly all age strata, with particularly pronounced disparities in individuals aged \u0026gt;55 years. This gender disparity likely stems from multiple interrelated factors: higher baseline morbidity rates among males, reduced healthcare-seeking behavior, poorer treatment adherence, and psychosocial dimensions\u003csup\u003e[13-15]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe results of the study show that the stabilization or decline in ASDR in high-income countries is associated with the establishment of better DKD management systems. In contrast, ASDR and ASR are high but slow-growing in low-SDI countries, and may be associated with underdiagnosis and early deaths. This study shows that the rapidly increasing burden in parts of Asia, especially in South and Southeast Asia and parts of Africa, needs to be of global concern, possibly through upgrading preventive and medical technologies and increasing investment in healthcare resources, which provides a reference and basis for countries to formulate healthcare policies\u003csup\u003e[16]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eGiven the distinctive epidemiological patterns of DKD incidence, this study systematically evaluates three key intervention domains for improving prevention efficacy, reducing disease incidence, and alleviating healthcare burdens. It was found that early intervention in diabetes control strategies can slow down the rising trend of DKD, strengthen the training of healthcare workers and the education of patients, and the joint intervention of doctors and patients can help to prevent and control DKD\u003csup\u003e[17-19]\u003c/sup\u003e. In high-burden areas, early screening and standardized treatment of DKD can also effectively slow down the rising trend of DKD\u003csup\u003e[20]\u003c/sup\u003e. Furthermore, strategic reallocation of medical resources to high-incidence regions, combined with optimization of existing healthcare infrastructure, represents a viable approach for both reducing DKD incidence and mitigating associated economic burdens on healthcare systems\u003csup\u003e[21]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eStrengths of this study: This research is based on the latest GBD 2021 data, covering 204 countries, ensuring that the long-term trend analysis and BAPC predictions are highly representative. A multi-level stratified analysis by sex, age, SDI, and region enhances the generalizability and applicability of the findings. Limitations of this study: The GBD relies on modeled estimates, which may introduce inaccuracies in regions with limited data. Additionally, the study lacks precise predictions regarding the impact of comorbid conditions on DKD prognosis. The BAPC model projections are based on historical trends and may underestimate future changes resulting from public health interventions.\u003c/p\u003e\n\u003cp\u003eTo summarize the conclusions of the study: DKD due to T2DM mellitus has become a significant global burden and is expected to continue to grow in the future. It is recommended that future research should strengthen the identification of DKD subtypes, the evaluation of intervention effectiveness, and the optimization of global resource allocation.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData Sharing Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe original contributions presented in the study are included in the article/Supplementary Material. Further inquiries can be directed to the corresponding authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors Jiaqi Liu and Ying Yu were responsible for the research design. The coauthors Yan Pan and Hanglin Li were responsible for information collection. The coauthors Zuliang Yan and Hong Jiang were responsible for data measurement. The corresponding author, Ying Yu, was responsible for research guidance. All the authors contributed to the article and approved the submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo potential conflicts of interest were reported by the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Accented Project of Natural Science Research in University of Anhui Province[2023AH051936]; Project of National Univercity Student Innovation Training Program[2023103670013].\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHirohito Goto, Ken Iseri , Noriko Hida. Fibrates and the risk of cardiovascular outcomes in chronic kidney disease patients[J]. Nephrol Dial Transplant. 2024 May 31;39(6):1016-1022.\u003c/li\u003e\n\u003cli\u003eJunjie Hu , Runjiang Ke, Wilhem Teixeira, et al. Global, Regional, and National Burden of CKD due to Glomerulonephritis from 1990 to 2019: A Systematic Analysis from the Global Burden of Disease Study 2019[J]. Clin J Am Soc Nephrol. 2023 Jan 1;18(1):60-71.\u003c/li\u003e\n\u003cli\u003eXiao Ma, Rong Liu, Xiang Xi, et al. Global burden of chronic kidney disease due to diabetes mellitus, 1990-2021, and projections to 2050[J]. Front Endocrinol (Lausanne). 2025 Feb 21:16:1513008.\u003c/li\u003e\n\u003cli\u003eYuejun Liu, Ying Chen, Jianhua Ma, et al. Dapagliflozin plus calorie restriction for remission of type 2 diabetes: multicentre, double blind, randomised, placebo controlled trial[J]. BMJ. 2025 Jan 22;388:e081820.\u003c/li\u003e\n\u003cli\u003eHong Sun, Pouya Saeedi, Suvi Karuranga, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045[J]. Diabetes Res Clin Pract. 2022 Jan 183:109119.\u003c/li\u003e\n\u003cli\u003eNCD Risk Factor Collaboration. Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants[J]. Lancet. 2024 Nov 23;404(10467):2077-2093.\u003c/li\u003e\n\u003cli\u003eCDS Microvascular complications Group. Chinese clinical practice guideline of diabetic kidney disease[J]. Chinese Journal of Diabetes. 2019 11(1): 15-28. \u003c/li\u003e\n\u003cli\u003eMeng Y, Bai H, Yu Q, et al. High-resistant starch, low-protein flour intervention on patients with early type 2 diabetic nephropathy: a randomized trial[J]. J Ren Nutr. 2019;29(5):386\u0026ndash;393.\u003c/li\u003e\n\u003cli\u003eMagdalena Madero, Adeera Levin, Sofia B Ahmed, et al. Evaluation and Management of Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2024 Clinical Practice Guideline[J]. Ann Intern Med. 2025 Mar 11.\u003c/li\u003e\n\u003cli\u003eHui-Teng Cheng, Xiaoqi Xu, Paik Seong Lim, et al. Worldwide Epidemiology of Diabetes-Related End-Stage Renal Disease, 2000-2015[J]. Diabetes Care. 2021 Jan 44(1):89-97.\u003c/li\u003e\n\u003cli\u003eGiuseppe Penno, Anna Solini, Emanuela Orsi, et al. Insulin resistance, diabetic kidney disease, and all-cause mortality in individuals with type 2 diabetes: a prospective cohort study[J]. BMC Med. 2021 Mar 15;19(1):66.\u003c/li\u003e\n\u003cli\u003ePeipei Zhou, Zhenning Hao, Yu Chen, et al. Association between gut microbiota and diabetic microvascular complications: a two-sample Mendelian randomization study[J]. Front Endocrinol (Lausanne). 2024 Aug 2;15:1364280. \u003c/li\u003e\n\u003cli\u003eJingyu Wang, Juhong Yang, Wenhui Jiang, et al. Effect of semaglutide on primary prevention of diabetic kidney disease in people with type 2 diabetes: A post hoc analysis of the SUSTAIN 6 randomized controlled trial[J]. Diabetes Obes Metab. 2024 Nov 26(11):5157-5166.\u003c/li\u003e\n\u003cli\u003eYukai Wang, Mengmeng Chen, Lin Wang, et al. Cardiometabolic traits mediating the effect of education on the risk of DKD and CKD: a Mendelian randomization study[J]. Front Nutr. 2024 Aug 13:11:1400577.\u003c/li\u003e\n\u003cli\u003eKesavadev J, Abraham G, Chandni R, et al. Type 2 diabetes in women: differences and difficulties[J]. Curr Diabetes Rev 2022; 18: e081221198651.\u003c/li\u003e\n\u003cli\u003eKibum Kim, Jacob Crook, Chao-Chin Lu, et al. Healthcare Costs Across Diabetic Kidney Disease Stages: A Veterans Affairs Study[J]. Kidney Med. 2024 Jul 18;6(9):100873.\u003c/li\u003e\n\u003cli\u003eWensu Wang, Yan Huang, Jianguo Shen, et al. Associations Between Serum IL‐17A, Renal Function and Diabetic Retinopathy in Type 2 Diabetes Mellitus: Evidence From a Chinese Han Population[J]. Endocrinol Diabetes Metab. 2025 Feb 13;8(2):e70033. \u003c/li\u003e\n\u003cli\u003eKayo Waki, Mitsuhiko Nara, Syunpei Enomoto, et al. Effectiveness of DialBetesPlus, a self-management support system for diabetic kidney disease: Randomized controlled trial NPJ Digit Med[J]. 2024 Apr 27;7:104.\u003c/li\u003e\n\u003cli\u003eDi-fei Duan, Yue Wen, Yu Yan, et al. Chinese Healthcare Workers\u0026rsquo; Knowledge, Attitudes, and Practices in Diabetic Kidney Management: A Multi-Centered Cross-Sectional Study Risk Manag Healthc Policy[J]. 2024 May 9;17:1211\u0026ndash;1225.\u003c/li\u003e\n\u003cli\u003eIris Friedli, Seema Baid-Agrawal, Robert Unwin, et al. Magnetic Resonance Imaging in Clinical Trials of Diabetic Kidney Disease[J]. J Clin Med. 2023 Jul 11;12(14):4625.\u003c/li\u003e\n\u003cli\u003eAdrian Liew, Sunita Bavanandan, Chuan‐Ming Hao, et al. Executive Summary of the Asian Pacific Society of Nephrology Clinical Practice Guideline on Diabetic Kidney Disease-2025 Update[J]. Nephrology (Carlton). 2025 May 5;30(5):e70031. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 1","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6789777/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6789777/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eImportance\u003c/strong\u003e Chronic kidney disease (CKD) attributable to type 2 diabetes mellitus (T2DM) represents a growing global health concern. However, comprehensive long-term epidemiological trends and projections, stratified by sociodemographic and geographic variables, remain inadequately delineated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e To evaluate the global, regional, and national burden of CKD due to T2DM from 1990 to 2021, and to forecast its trends through 2050 using Bayesian age-period-cohort (BAPC) modeling.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDesign, Setting, and Participants\u003c/strong\u003e This population-based observational study used data from the Global Burden of Disease Study 2021 (GBD 2021), which includes 204 countries and territories across five sociodemographic index (SDI) quintiles and 21 GBD regions. The study covers the period 1990–2021 with projections to 2050.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExposure\u003c/strong\u003e Diagnosis of T2DM mellitus as an underlying cause for CKD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMain Outcome Measures\u003c/strong\u003e Incident and prevalent cases, mortality, and disability-adjusted life-years (DALYs) attributable to T2DM-related CKD. Age-standardized incidence (ASIR), prevalence (ASPR), mortality (ASDR), and DALY (ASR) rates were computed, alongside estimated annual percentage changes (EAPC).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e From 1990 to 2021, the global number of incident CKD cases due to T2DM increased by 167.2%, while the ASIR rose by 21.0% (EAPC: 0.61). Prevalent cases nearly doubled (+85.1%), although ASPR declined slightly (−5.1%, EAPC: −0.17). Deaths surged by 222.6%, and ASDR increased by 37.8% (EAPC: 1.17). DALYs rose by 173.6%, with a 24.0% increase in ASR (EAPC: 0.81). Males and older adults consistently exhibited higher burden across all indicators. Low- and middle-SDI nations experienced the most pronounced burden growth, yet high-SDI regions also registered substantial increases in mortality and DALYs. Geographically, Latin America, Central Asia, and select Sub-Saharan African regions exhibited the most rapid ascents. Marked national disparities were evident, with Pacific Island nations bearing the highest age-standardized rates.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions and Relevance\u003c/strong\u003e T2DM-related CKD has emerged as a major global health challenge, with sustained increases in incidence, mortality, and DALYs over the past three decades. Despite modest declines in age-standardized prevalence, the absolute burden continues to rise, particularly in lower-resource settings. Projections to 2050 suggest a continued escalation, with incident cases exceeding 2.6 million and deaths surpassing 700,000 annually by mid-century. These findings highlight the urgent need for targeted prevention, early detection, and improved management strategies, particularly in high-growth regions and vulnerable populations.\u003c/p\u003e","manuscriptTitle":"Global, regional, and national burden of Chronic kidney disease due to type 2 diabetes mellitus, 1990-2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-10 11:24:44","doi":"10.21203/rs.3.rs-6789777/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"de733bbf-9527-4263-91d3-1ec2f363a85b","owner":[],"postedDate":"June 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-10T13:11:42+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-10 11:24:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6789777","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6789777","identity":"rs-6789777","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}