Trends in type 1 and type 2 diabetic kidney disease in China, the USA, and the UK, 1990-2023.

BACKGROUND: We compared the burden and temporal trends of chronic kidney disease due to type 1 diabetes (T1DM-DKD) and type 2 diabetes (T2DM-DKD) in China, the United States, and the United Kingdom from 1990 to 2023 using Global Burden of Disease (GBD) 2023 data. METHODS: We extracted incidence, mortality, and disability-adjusted life-year (DALY) estimates, including 95% uncertainty intervals (UIs), and analysed age-standardized rates by country, age, and sex. Temporal trends were assessed using Joinpoint regression with annual percent change (APC) and average annual percent change (AAPC). Selected T2DM-DKD risk factors were evaluated using the GBD comparative risk assessment framework. RESULTS: China showed overall declines in age-standardized DKD incidence and mortality, whereas T2DM-DKD mortality increased in the USA and UK. In 2023, the T2DM-DKD age-standardized mortality rate was 8.42 per 100,000 (95% UI, 7.02-9.76) in the USA versus 1.27 (95% UI, 0.87-1.68) in China; the corresponding USA AAPC was 4.8% (95% CI, 4.5-5.0). Mortality and DALY rates were highest in the oldest age groups. High body mass index had a comparatively high model-based population-attributable fraction in the USA. CONCLUSIONS: DKD burden patterns differed across countries, supporting region-specific prevention, metabolic risk control, and equitable kidney-protective care.