In distributed databases I've worked with, there's usually something like a B-tree per key range, but there can be thousands of key ranges distributed over all the nodes in the cluster in parallel, each handling modifications in a LSM. The goal there is to distribute the storage and processing over all nodes equally, and that's why predictable/clustered IDs fail to do so well. That's different to the Postgres/MySQL scenario where you have one large B-tree per index.