DO: dissolved oxygen. Percentage changes were calculated from unrounded annual means and may differ slightly from changes computed from the rounded values shown.
Declarations
Author contributions
TR: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Software, Visualization, Writing—original draft, Writing—review & editing. ZZ: Conceptualization, Investigation, Methodology, Validation, Writing—review & editing. TR and ZZ contributed equally to this work. Both authors read and approved the submitted version.
Conflicts of interest
The authors declare that there are no conflicts of interest.
Ethical approval
This study used publicly available, de-identified aggregate data. No ethical review was required.
Consent to participate
Not applicable.
Consent to publication
Not applicable.
Availability of data and materials
The CKD burden data analyzed in this study were obtained from the Institute for Health Metrics and Evaluation (IHME) GBD Results Tool (https://vizhub.healthdata.org/gbd-results/), subject to IHME data-use terms. The downloaded IHME citation identified the release as Global Burden of Disease Study 2023 (GBD 2023) Results, and the present analysis was restricted to country-year estimates from 2010 to 2017. Water quality data were obtained from public monitoring sources in China, Canada, and Ireland, as documented in the source file. Derived datasets and analysis code are available from the corresponding author upon reasonable request.
Funding
This work was supported by the Yunnan Provincial Department of Education Science Research Fund (grant numbers 2026J2256 and 2024J2133). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.
References
Institute for Health Metrics and Evaluation (IHME). GBD Results [Internet].Seattle, WA: IHME, University of Washington; c2026 [cited 2026 Jan 30]. Available from: https://vizhub.healthdata.org/gbd-results/
Xie K, Cao H, Ling S, Zhong J, Chen H, Chen P, et al. Global, regional, and national burden of chronic kidney disease, 1990-2021: a systematic analysis for the global burden of disease study 2021.Front Endocrinol (Lausanne). 2025;16:1526482. [DOI] [PubMed] [PMC]
Deng L, Guo S, Liu Y, Zhou Y, Liu Y, Zheng X, et al. Global, regional, and national burden of chronic kidney disease and its underlying etiologies from 1990 to 2021: a systematic analysis for the Global Burden of Disease Study 2021.BMC Public Health. 2025;25:636. [DOI] [PubMed] [PMC]
GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.Lancet. 2020;395:709–33. [DOI] [PubMed] [PMC]
Ying M, Shao X, Qin H, Yin P, Lin Y, Wu J, et al. Disease Burden and Epidemiological Trends of Chronic Kidney Disease at the Global, Regional, National Levels from 1990 to 2019.Nephron. 2023;148:113–23. [DOI] [PubMed] [PMC]
Desquilbet L, Mariotti F. Dose-response analyses using restricted cubic spline functions in public health research.Stat Med. 2010;29:1037–57. [DOI] [PubMed]
Ward MH, Jones RR, Brender JD, de Kok TM, Weyer PJ, Nolan BT, et al. Drinking Water Nitrate and Human Health: An Updated Review.Int J Environ Res Public Health. 2018;15:1557. [DOI] [PubMed] [PMC]
Ward MH, deKok TM, Levallois P, Brender J, Gulis G, Nolan BT, et al. Workgroup Report: Drinking-Water Nitrate and Health—Recent Findings and Research Needs.Environ Health Perspect. 2005;113:1607–14. [DOI] [PubMed] [PMC]
Li W, Wu H, Xu X, Zhang Y. Environmental exposure to perchlorate, nitrate, and thiocyanate in relation to chronic kidney disease in the general US population, NHANES 2005–2016.Chin Med J. 2023;136:1573–82. [DOI] [PubMed] [PMC]
Chen D, Parks CG, Beane Freeman LE, Hofmann JN, Sinha R, Madrigal JM, et al. Ingested nitrate and nitrite and end-stage renal disease in licensed pesticide applicators and spouses in the Agricultural Health Study.J Expo Sci Environ Epidemiol. 2024;34:322–32. [DOI] [PubMed] [PMC]
Dai Y, Yin J, Li S, Li J, Han X, Deji Q, et al. Long-term exposure to fine particulate matter constituents in relation to chronic kidney disease: evidence from a large population-based study in China.Environ Geochem Health. 2024;46:174. [DOI] [PubMed]
Wasana HM, Aluthpatabendi D, Kularatne WM, Wijekoon P, Weerasooriya R, Bandara J. Drinking water quality and chronic kidney disease of unknown etiology (CKDu): synergic effects of fluoride, cadmium and hardness of water.Environ Geochem Health. 2016;38:157–68. [DOI] [PubMed]
Liyanage DND, Diyabalanage S, Dunuweera SP, Rajapakse S, Rajapakse RMG, Chandrajith R. Significance of Mg-hardness and fluoride in drinking water on chronic kidney disease of unknown etiology in Monaragala, Sri Lanka.Environ Res. 2022;203:111779. [DOI] [PubMed]
Fernando TD, Mathota Arachchige YLN, Sanjeewani KVP, Rajaguru RAMTS. Comprehensive Groundwater Quality Analysis in Chronic Kidney Disease of Unknown Etiology (CKDu) Prevalence Areas of Sri Lanka to Investigate the Responsible Culprit.J Chem. 2022;2022:1094427. [DOI]
Balasooriya S, Munasinghe H, Herath AT, Diyabalanage S, Ileperuma OA, Manthrithilake H, et al. Possible links between groundwater geochemistry and chronic kidney disease of unknown etiology (CKDu): an investigation from the Ginnoruwa region in Sri Lanka.Expo Health. 2019;12:823–34. [DOI]
Chang KY, Wu IW, Huang BR, Juang JG, Wu JC, Chang SW, et al. Associations between Water Quality Measures and Chronic Kidney Disease Prevalence in Taiwan.Int J Environ Res Public Health. 2018;15:2726. [DOI] [PubMed] [PMC]
Wang L, Liu W, Yang J, Zhao Y, Hu X, Huang X, et al. Neighborhood environmental burden and chronic kidney disease in the US: A cross-sectional study.Public Health. 2025;248:105927. [DOI] [PubMed]
Li Q. Assessing and adjusting for bias in ecological analysis using multiple sample datasets.BMC Med Res Methodol. 2025;25:112. [DOI] [PubMed] [PMC]
Hladik ML, Markus A, Helsel D, Nowell LH, Polesello S, Rüdel H, et al. Evaluating the reliability of environmental concentration data to characterize exposure in environmental risk assessments.Integr Environ Assess Manag. 2024;20:981–1003. [DOI] [PubMed]
Canadian Council of Ministers of the Environment. Canadian Water Quality Guidelines for the Protection of Aquatic Life: CCME Water Quality Index 1.0 Technical Report [Internet].Winnipeg: CCME; c2001 [cited 2026 Jan 30]. Available from: https://unstats.un.org/unsd/envaccounting/ceea/archive/Water/CCME_Canada.PDF
DerSimonian R, Laird N. Meta-analysis in clinical trials.Control Clin Trials. 1986;7:177–88. [DOI] [PubMed]
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis.Stat Med. 2002;21:1539–58. [DOI] [PubMed]
Harrell FE Jr. Regression Modeling Strategies. 2nd ed. Cham: Springer; 2015.
Zhang Z, Heerspink HJL, Chertow GM, Correa-Rotter R, Gasparrini A, Jongs N, et al. Ambient heat exposure and kidney function in patients with chronic kidney disease: a post-hoc analysis of the DAPA-CKD trial.Lancet Planet Health. 2024;8:e225–33. [DOI] [PubMed]
Jones DA, Beirne AM, Kelham M, Wynne L, Andiapen M, Rathod KS, et al. Inorganic nitrate benefits contrast-induced nephropathy after coronary angiography for acute coronary syndromes: the NITRATE-CIN trial.Eur Heart J. 2024;45:1647–58. [DOI] [PubMed] [PMC]
Wang F, Wang W, Zhang F, Yang C, Li P, Wang J, et al. Non-optimum temperatures modified the associations between PM2.5 and its components and hospitalizations for chronic kidney disease in China.Glob Transit. 2024;6:194–202. [DOI]
Vlahos P, Schensul SL, Anand S, Shipley E, Diyabalanage S, Hu C, et al. Water sources and kidney function: investigating chronic kidney disease of unknown etiology in a prospective study.npj Clean Water. 2021;4:50. [DOI]
Babagana-Kyari M, Yaro NA, Yakasai KM. GIS-based analysis of water quality risk factors and CKDu prevalence in Northern Yobe State, Nigeria.Indones J Appl Environ Stud. 2024;5:65–83. [DOI]
Qin K, Qing J, Wang Q, Li Y. Epidemiological shifts in chronic kidney disease: a 30-year global and regional assessment.BMC Public Health. 2024;24:3519. [DOI] [PubMed] [PMC]
Li Z, He R, Wang Y, Qu Z, Liu J, Yu R, et al. Global trends of chronic kidney disease from 1990 to 2021: a systematic analysis for the global burden of disease study 2021.BMC Nephrol. 2025;26:385. [DOI] [PubMed] [PMC]
