Chronic kidney disease due to hypertension in China, Japan, and the Republic of Korea: trends from the Global Burden of Disease Study 1990-2023.
TL;DR
The burden of hypertension-attributed CKD has followed markedly divergent trajectories across East Asia, with Japan bearing a disproportionately high and recently accelerating incidence, underscoring the need for age-targeted screening and country-specific prevention strategies.
Abstract
Objective
To evaluate the burden and temporal trends of chronic kidney disease (CKD) attributable to hypertension in China, Japan, and the Republic of Korea from 1990 to 2023 using Global Burden of Disease (GBD) 2023 data.
Methods
Age-standardized incidence, mortality, and DALYs rates (ASIR, ASMR, and ASDR [age-standardized DALYs rate], respectively) and estimated annual percentage change (EAPC) were calculated for the three countries and globally. Segmented regression identified phase-specific inflections in incidence trends, decomposition analysis partitioned absolute changes into population growth, aging, and epidemiological contributions, and age-period-cohort (APC) analysis characterized drivers of ASDR. Attributable fractions ranked modifiable risk factors for cause-specific mortality.
Results
In 2023, Japan had the highest ASIR (37.43 per 100,000) while China had the lowest (17.50 per 100,000); all three countries fell below the global ASMR and ASDR. China and the Republic of Korea achieved significant declines across all standardized rates, whereas Japan's near-null overall incidence trend concealed a marked late-period acceleration (2017-2023 APC = 0.86%). Globally, ASMR and ASDR rose significantly. Burden concentrated in adults aged 75-79 years and was consistently higher in males globally. Epidemiological change strongly offset demographic pressures in all three countries, and descriptive APC examination identified protective period- and cohort-related patterns in China and the Republic of Korea but an emerging adverse cohort-related pattern in Japan. High systolic blood pressure dominated attributable mortality (67%-89% in 2023), with the contribution of high body-mass index rising substantially over the study period.
Conclusion
The burden of hypertension-attributed CKD has followed markedly divergent trajectories across East Asia, with Japan bearing a disproportionately high and recently accelerating incidence, underscoring the need for age-targeted screening and country-specific prevention strategies.