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Type 2 diabetes mellitus (T2DM) and systemic arterial hypertension (SAH) are the most incident causes of chronic kidney disease (CKD) worldwide. T2DM has prevailed in most countries, while SAH domains in Brazil. However, recent studies show this scenario is changing. This study aims to analyze the prevalence of T2DM and SAH as secondary causes of CKD mortality in Brazil, Latin America and the World, since shifts in CKD death outcomes are strongly related with its etiological pattens.
A retrospective study was conducted with data from the Global Burden of Disease study. Anual absolute death numbers and rates were collected on mortality by CKD secondary to T2DM and SAH in Brazil, Latin America, and the World, from 2000 to 2019.
Deaths from CKD secondary to T2DM and SAH were respectively quantified in 151,468.13 versus 166,959.38 in Brazil (T2D/SAH ratio: 0.91), 699,594.83 versus 692,716.66 in Latin America (T2D/SAH ratio: 1.01), and 6,166,195.69 versus 6,669,832.91 in the World (T2D/SAH ratio: 0.92). In Brazil, SAH rates (deaths/100,000 people) prevailed throughoutthrougout the years, with relatively significant differences from T2DM rates, displaying no approximation trends (figure 1). In Latin America, rates for T2DM prevailed by very few over the ones for SAH, with shifts occurringoccuring 2014 and 2015, and recent trends indicating T2DM prevalence (figure 2). In the World, SAH prevailed over T2DM in the period analysed, with stable numbers, and slightly higher differences after 2010 (figure 3).
Understanding the trends that T2DM and SAH perform as secondary causes of CKD mortality is essential as an indicator of shifts in their prevalence as etiological agents of CKD. Our results showed that SAH prevailed in Brazil over the 20 years back 2019, was very similar to T2DM in Latin America, with shifts in prevalence over the years analysed, and prevailed in the World. SAH has prevailed over T2DM as the main cause of CDK in Brazil through the last years, but recent studies indicate that rates have been less distant and that an overcome by T2DM is possible. However, shifts in mortality take longer to occur, since a time gap generally exists between CKD development and mortality outcomes. Results from Latin America reveal a balance, which might be strongly influenced by Brazil. However, T2DM recovered its position by 2016. Diabetes mellitus is already the main cause of CKD in the developing countries, but hasn’t domained in all countries, in a way that countries in which SAH still prevails can lift the graphics towards a Worldwide prevalence of hypertension as the main secondary cause of CKD mortality. Finally, we can conclude that SAH is still the most prevalent secondary cause of CKD mortality in Brazil, Latin America displays a consistent balance between SAH and T2DM, SAH prevails in the World, and shifts in etiology of CKD, with the expected Global domain of T2DM for the nexos years, may take some more time to interfere in CKD mortality.