The researchers, led by a team from the Department of Pediatrics at The Third Xiangya Hospital of Central South University in Changsha, China, focused on four core metrics: prevalence, incidence, deaths, and disability-adjusted life years, or DALYs. DALYs combine years of life lost with years lived in disability, offering a composite measure of how much disease steals from a young life. Across both regions, the news was largely encouraging. Death rates from chronic kidney disease fell sharply, with the average annual percentage change in DALYs dropping by 2.43 percent per year in South-East Asia and 2.87 percent per year in the Western Pacific. Incidence rates also declined modestly, from 27.93 to 26.72 per 100,000 in South-East Asia and from 24.34 to 20.92 per 100,000 in the Western Pacific.

Yet the picture is far from uniformly bright. Prevalence, the proportion of young people living with the disease at any given time, moved in opposite directions in the two regions. In South-East Asia, prevalence climbed from 785.2 to 920.36 per 100,000, while in the Western Pacific it fell from 559.62 to 475.41 per 100,000. The authors suggest this divergence may partly reflect improved detection and awareness in South-East Asia following historically limited screening, alongside better survival as disease management has improved. In the Western Pacific, more established healthcare systems may be more effectively preventing and managing the condition and its risk factors. The researchers caution, however, that differences in data quality and reporting practices could also shape these observed trends.

Age tells a story of two very different burdens. Children under five had the highest incidence rates, at 53.97 per 100,000 in South-East Asia and 49.29 per 100,000 in the Western Pacific, reflecting the prominence of congenital anomalies of the kidney and urinary tract, the leading cause of pediatric kidney disease worldwide. But adolescents aged 15 to 19 carried the heaviest overall weight, with prevalence reaching 2,630.63 per 100,000 in South-East Asia and 1,445.9 per 100,000 in the Western Pacific, alongside the highest death and DALY rates of any age group. Notably, while incidence fell among the youngest children, it rose in every other age bracket, with the steepest climb among adolescents, at an average annual increase of 0.74 percent in South-East Asia and 1.06 percent in the Western Pacific.

Sex differences added another layer of complexity. Males consistently experienced higher death and DALY rates than females in both regions, with death rates of 0.79 per 100,000 in South-East Asia and 0.51 per 100,000 in the Western Pacific for males, compared with 0.55 and 0.42 respectively for females. DALY rates followed the same pattern, at 73.25 versus 52.65 per 100,000 in South-East Asia and 44.64 versus 38.69 per 100,000 in the Western Pacific. The researchers note that males tend to experience faster kidney function decline, which may push them toward more advanced stages of disease. However, they also point out that much of the evidence on sex disparities comes from adult populations, and the biological and epidemiological differences between children and adults mean these findings require validation through pediatric-specific research.

Perhaps the most sobering finding concerns geography and wealth. The 42 countries and territories studied were grouped by Socio-demographic Index, a composite measure incorporating fertility rates, disposable income, and educational attainment, ranging from 0.41 in Papua New Guinea to 0.88 in the Republic of Korea. In high-SDI countries, the burden of kidney disease deaths and DALYs fell consistently as development increased. But among countries with low and low-middle SDI, incidence actually rose with rising SDI, while death and DALY rates showed little change. Japan and the Republic of Korea recorded the lowest disease burden, while several Pacific Island nations, despite being classified as middle- or high-SDI, exhibited disproportionately high rates.

The Pacific Island pattern demands particular attention. Palau, Micronesia, and Guam recorded the highest incidence rates, while Niue, Tokelau, and Fiji had the highest death rates. Palau saw the largest increase in incidence, with an average annual percentage change of 1.16, and Niue the largest increase in deaths, at 0.63. The authors point to the ecological fragility of island nations, their heavy dependence on marine ecosystems, and their heightened vulnerability to climate change. Growing epidemiological evidence links high-temperature exposure to increased kidney-related morbidity and mortality, with repeated heat exposure leading to dehydration and potential renal damage. Environmental pollution and constrained medical systems may compound these pressures.

The causes behind pediatric kidney disease also shifted over the study period. CKD of unknown etiology accounted for the largest share of the burden in both regions, a category the authors acknowledge limits the usefulness of cause-specific interventions. Prevalence of CKD due to type 1 diabetes mellitus rose steadily in both regions, while incidence of CKD due to hypertension showed an increasing trend, particularly in South-East Asia. Death and DALY rates from all causes declined. The researchers note that GBD 2021 lacks data on CKD caused by type 2 diabetes and hypertension in children under 15, and that congenital anomalies and hereditary kidney diseases are not distinguished in detail, constraining etiological interpretation.

The study’s authors argue that their findings underscore the need for age- and gender-specific interventions, with particular attention to low-SDI countries and Pacific Island nations. They recommend routine kidney disease screening for children and adolescents with risk factors, strengthened primary healthcare capacity, early-life risk factor management, and improved access to timely referral and treatment services. Kidney replacement therapy, including dialysis and transplantation, remains constrained in many low- and middle-income settings by limited availability and high out-of-pocket costs, in stark contrast to the widespread access seen in high-income countries.

While the overall trajectory across Asia-Pacific offers grounds for cautious optimism, the analysis makes clear that progress has not been shared equally. Adolescents, males, Pacific Islanders, and children in the poorest countries continue to face disproportionate risks, and the researchers emphasize that targeted public health strategies, improved early screening, and enhanced access to pediatric kidney care in high-burden regions will be essential to closing these persistent gaps.

Subject of Research: Chronic kidney disease burden among children and adolescents in the South-East Asia and Western Pacific regions, 1990 to 2021

Article Title: Burden of chronic kidney disease among children and adolescents in the South-East Asia and Western Pacific regions, 1990 to 2021

Article References: Yang, Y., Xu, Y., Xue, X., Zhao, M., & He, Q. (2026). Burden of chronic kidney disease among children and adolescents in the South-East Asia and Western Pacific regions, 1990 to 2021. International Journal of Public Health, 71, Article 1609313. https://doi.org/10.3389/ijph.2026.1609313

Image Credits: AI Generated

DOI: 10.3389/ijph.2026.1609313

Keywords: chronic kidney disease, children, adolescents, Global Burden of Disease, South-East Asia, Western Pacific, Pacific Island countries, public health, health inequality, Socio-demographic Index, Burden, chronic