BACKGROUND Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. METHODS The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. FINDINGS Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, -1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, -1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. INTERPRETATION Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI. FUNDING Bill & Melinda Gates Foundation.

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1990-2017年全球，区域和国家慢性肾脏病负担：《 2017年全球疾病负担研究》的系统分析。

背景技术卫生系统规划需要仔细评估慢性肾脏病（CKD）流行病学，但是在许多国家中，这种疾病的发病率和死亡率数据很少或不存在。在《 2017年全球疾病，伤害和危险因素研究》中，我们估算了CKD的全球，区域和国家负担，以及归因于肾功能受损的心血管疾病和痛风的负担。指可直接归因于CKD所有阶段的发病率和死亡率，并且我们使用术语肾功能受损指心血管疾病和痛风带来的CKD附加风险。方法我们使用的主要数据来源是已发表的文献，生命登记系统，晚期肾脏疾病登记簿和家庭调查。CKD负担的估计是使用死亡原因模型和贝叶斯元回归分析工具得出的，包括发病率，患病率，残障生存年限，死亡率，丧失生命年限和残障调整生命年（DALYs）。 。使用比较风险评估方法来估计可归因于肾功能受损的心血管疾病和痛风负担的比例。结果在全球范围内，2017年，死于CKD的人数为1·200万人（95％不确定区间[UI] 1·2至1·3）。在1990年至2017年之间，尽管年龄标准化死亡率没有显着变化（2·8％，但CKD的全球总年龄死亡率增加了41·5％（95％UI 35·2至46·5））。 -1·5至6·3）。2017年，记录了所有阶段的CKD 697·500万（UI 649·2至752·0的95％），全球患病率为9·1％（8·5至9·8）。自1990年以来，全球CKD的全年龄患病率增加了29·3％（95％UI 26·4至32·6），而年龄标准化的患病率保持稳定（1·2％，-1·1至3·5） ）。CKD在2017年导致35,800万（95％UI 33·7至38·0）DALYs，其中糖尿病肾病几乎占DALYs的三分之一。CKD的大部分负担都集中在社会人口指数（SDI）的最低的五分之三上。在一些地区，特别是大洋洲，撒哈拉以南非洲和拉丁美洲，CKD的负担远高于发展水平的预期，而在撒哈拉以南非洲西部，东部和中部非洲，东亚，南亚，中欧和东欧，大洋洲和西欧均低于预期。肾功能受损可导致1·400万（95％UI 1·2至1·6）与心血管疾病相关的死亡和25·300万（22·2至28·9）心血管疾病DALY。解释肾脏疾病对全球健康具有重大影响，既是全球发病率和死亡率的直接原因，又是心血管疾病的重要危险因素。CKD在很大程度上是可以预防和治疗的，在全球卫生政策决策中，尤其是在SDI较低和中等的地区，应该得到更多的关注。资金比尔和梅琳达·盖茨基金会。既是全球发病率和死亡率的直接原因，也是心血管疾病的重要危险因素。CKD在很大程度上是可以预防和治疗的，在全球卫生政策决策中，尤其是在SDI中低的地区，应得到更多的关注。资金比尔和梅琳达·盖茨基金会。既是全球发病率和死亡率的直接原因，也是心血管疾病的重要危险因素。CKD在很大程度上是可以预防和治疗的，在全球卫生政策决策中，尤其是在SDI中低的地区，应得到更多的关注。资金比尔和梅琳达·盖茨基金会。