Chronic kidney disease (CKD) is a major public health problem globally, with prevalence and incidence rates that have increased in the past 30 years by 40% (1). Recent reports suggested that there were 697 million cases of CKD globally and 41.5 million disability-adjusted life years (DALYs) associated with the disease, resulting in an enormous health and economic burden (2). CKD is not only associated with high mortality from cardiovascular disease, but also results in a significant number of healthy life years lost (3, 4).

Red meat refers to mammalian muscle, mainly including beef, lamb, pork, etc. Red meat is characterized by a high level of myoglobin, which gives it a red color in the raw meat state. Red meat is an important part of many cultural diets and is rich in protein, vitamins, and minerals. These nutrients are essential for growth, repair, and the maintenance of normal physiological functions in the body (5, 6). With economic growth, the global demand for red meat has surged in both developed and developing countries. The dangers of red meat have also attracted a lot of attention in recent years. Studies have shown that high intake of red meat is associated with an increased risk of cardiovascular disease and cancer (7, 8). The International Agency for Research on Cancer (IARC) classifies red meat as a probable human carcinogen (9).

There is a significant association between red meat intake and the risk of CKD. Studies have shown that consuming higher amounts of red meat increases the risk of developing CKD and end-stage renal disease (10, 11). This increased risk may be related to the high levels of iron in red meat. In addition, red meat is often accompanied by high levels of sodium and fat, which are considered to be one of the main factors contributing to the development of metabolic disorders and obesity-related diseases such as type 2 diabetes mellitus (T2DM), hypertension and cardiovascular diseases. The combination of these dietary factors may lead to impaired renal vascularization, steatosis and inflammation, thus increasing the incidence of CKD (12). The heating process of red meat produces a number of harmful chemicals such as heterocyclic aromatic amines, N-nitrosamines, polycyclic aromatic hydrocarbons and acrylamide, which may adversely affect kidney health (13). There are significant differences in red meat intake around the world, which are not only related to geographic location but are also closely linked to a number of factors, including the level of economic development, cultural habits and dietary preferences (14).

The Global Burden of Disease (GBD) study is a comprehensive research initiative that systematically quantifies health loss from hundreds of diseases, injuries, and risk factors across populations worldwide. Its primary aim is to provide a standardized, comparable measurement of health trends to inform policy and prioritize health systems planning. GBD 2021 data-base provides comprehensive epidemiological data on 371 diseases and 88 attributable risk factors across 204 countries and territories, spanning the years 1990 to 2021. The GBD framework employs a rigorous methodology that integrates vast amounts of epidemiological data using advanced statistical models, such as disease model-Bayesian meta-regression (DisMod-MR) 2.1 and Spatio-Temporal Gaussian Process Regression (ST-GPR), to produce estimates of incidence, prevalence, mortality, and disability (15). Previous GBD studies primarily focused on the various disease burdens associated with increased red meat consumption, and there was a lack of detailed reports on the disease burden of CKD related to increased red meat intake. Therefore, this study aims to utilize the GBD 2021 data to determine the Deaths and DALYs trends due to CKD attributable to red meat consumption at the global, regional, and national levels, stratified by sex, age, and socio-demographic index (SDI), providing a unique opportunity to explore the epidemiology of CKD related to increased red meat intake, and to offer evidence for policymakers.

Our study comprehensively analyzed the global burden of CKD attributable to increased red meat consumption from 1990 to 2021, stratified by year, age, sex, region, and SDI. Our findings indicated that, globally, the DALYs and deaths of CKD attributed to high red meat consumption remained substantial and significantly increased from 1990 to 2021. This suggests that the burden of CKD due to increased red meat consumption continues to be a major global public health issue.

According to the GBD 2019, CKD ranked 12th among the 133 leading causes of death in the GBD Study (19), with nearly 700 million CKD patients globally, surpassing the numbers for chronic diseases like diabetes and chronic obstructive pulmonary disease (2, 20). This study focused on the burden of CKD attributable to increased red meat consumption, suggesting an underestimation of the potential burden of CKD caused by excessive red meat consumption.

The burden of disease is closely linked to socioeconomic development. In our study, we found that at both regional and national levels, as SDI increased, both ASMR and ASDR also rose, aligning with the levels of red meat consumption across different regions and countries. High-income countries consumed about five times more red meat than low-income countries (21). Although red meat consumption has decreased in high-income countries over the past decade, the overall consumption remains higher than in low-income countries. Previous study showed that high SDI region and countries exhibited a lower CKD burden caused by high blood sugar (22). However, our findings indicated the opposite, with SDI positively correlated with ASMR and ASDR, and high SDI region experiencing the most significant growth in mortality burden. This suggests that the CKD burden due to excessive red meat consumption has not been fully recognized by the public, warranting further development of public health measures to mitigate this trend. Additionally, a potential explanation for this trend is the difficulty in conducting comprehensive CKD screening in areas with limited medical facilities and laboratory diagnostic services, leading to underreporting of CKD data in low SDI region. Therefore, we should interpret these results cautiously and avoid viewing the association between red meat-attributed CKD burden and SDI as simple or linear.

At the regional level, SLA and TLA had the highest ASMR and ASDR, consistent with previous research findings (22, 23). In contrast, South Asian had the lowest ASMR and ASDR, which may be influenced by cultural or religious dietary habits in these countries. For instance, in predominantly Buddhist South Asian countries like India, Sri Lanka, and Bangladesh, diets typically prioritize vegetables, legumes, grains, and dairy products over red meat. In India, Hindu reverence for cows prohibits their slaughter, resulting in minimal beef consumption (24).

Recent investigations have revealed that, in addition to a high red meat diet, high body mass index (BMI) and high fasting plasma glucose are also significant contributors to the increasing burden of CKD. However, there are notable differences in the relative contributions of these risk factors across different regions and diseases. Tan et al. examined the global burden of CKD attributable to high BMI using GBD 2021 data and confirmed that the global burden of CKD attributable to high BMI has risen markedly over the past three decades, particularly in high-SDI regions (25). Besides, recent studies have shown that while the proportion of deaths and DALYs attributed to high BMI has increased globally, the contributions of high fasting plasma glucose have shown a smaller upward trend (25–28). In all, our study demonstrates a significant global burden of CKD attributable to high red meat consumption, with distinct geographical and demographic patterns. These findings align with and diverge from other GBD-based studies on dietary and metabolic risk factors, such as high BMI and high fasting plasma glucose, highlighting both shared and unique public health challenges.

We further employed decomposition analysis to explicitly disentangle the contributions of demographic drivers from true epidemiological shifts to the changing burden of CKD attributable to red meat consumption. The analysis clearly distinguished that for DALYs, the burden in the high-middle SDI region was primarily driven by demographic aging. In contrast, the low-middle SDI region was most affected by an epidemiological shift (reflected in changing ASMR), while the low SDI region’s burden was predominantly driven by population growth. A similar pattern was observed for mortality, where the high SDI region faced the largest demographic driver of aging, while population growth was the key demographic driver in other regions. These findings logically align with broader population trends: severe aging in high-middle SDI regions and rapid growth in low SDI regions. Therefore, while the risk factor (red meat) is epidemiological, its resulting burden is simultaneously modulated by independent demographic forces. This underscores that public health measures should be tailored with different focuses for regions with varying SDI levels.

The results of this study showed that for individuals aged 25 and above, both the ASMR and ASDR attributable to red meat consumption increased with age in both men and women, reaching their peak at the age of 95. This suggests that older adults are at higher risk for CKD, with a higher prevalence of the disease, which is consistent with previous research findings (23). From 1990 to 2021, men have consistently experienced a higher burden of CKD attributable to red meat consumption. However, the gender gap has gradually narrowed over time, particularly in the USA. This phenomenon may be attributed to higher red meat consumption among men, but with socio-economic progress, the economic and social status gap between men and women has gradually narrowed (29), leading to an increase in women’s red meat consumption, thus reducing the gender difference in CKD burden.

We further explored the cause of CKD due to increased red meat consumption and found that T2DM was the main cause. Consuming large amounts of red meat leads to increased intake of saturated fats, cholesterol, iron, and salt, as well as excessive acid load. It may also result in the gut microbiota producing higher levels of uremic toxins, such as trimethylamine N-oxide, indole sulfate, and p-cresyl sulfate. These metabolic disturbances and uremic toxins are closely associated with an increased risk of T2DM (5). Previous studies have confirmed that red meat consumption is associated with an increased risk of T2DM, with a stronger correlation in Western environments and no gender differences (30–32). Moreover, even without considering the quantity, cooking red meat with direct flame or at high temperatures was also associated with an increased risk of T2DM (33, 34).

The highest number of CKD deaths due to high red meat intake occurred in the USA, followed by China, a result that caught our attention. Decomposition analysis indicated that the main effect on both ASDR and ASMR in both SDI regions was aging. China and the USA rank first and third in global population size, respectively, which suggests that both a large population base and aging could contribute to the two countries having the highest red meat intake associated CKD death tolls worldwide.

This study has certain limitations. We used the GBD 2021 database, which primarily consists of national and regional data without individual-level data, making it impossible to validate our conclusions on a personal level. Besides, GBD 2021 does not include dietary survey results, thus it does not establish a causal relationship between red meat consumption and CKD. Lastly, individuals who consume high amounts of red meat may also have other unhealthy lifestyle habits, such as low vegetable and fruit consumption, lack of exercise, smoking, and other confounding factors such as overweight status and lower education levels. These confounders may influence the relationship between red meat consumption and CKD.

Between 1990 and 2021, CKD caused by high red meat consumption led to a continuous rise in global ASDR and ASMR, with high and middle SDI regions bearing the brunt of the burden. Older adults and men exhibited a higher disease burden, however, the gender gap has gradually narrowed over time. In light of these findings, governments worldwide should strengthen education on diet, particularly in high and middle SDI regions to reduce the CKD burden caused by increased red meat consumption.