Global burden of chronic kidney disease due to hypertension (1990-2021): a systematic analysis of epidemiological trends, risk factors, and projections to 2036 from the GBD 2021 study

Abstract

Background: Hypertension is a major risk factor for chronic kidney disease (CKD), and the global burden of CKD due to hypertension is rising with population aging. Previous GBD-related studies on CKD have limitations, and the updated global burden of disease (GBD) 2021 database can provide a more comprehensive understanding.

Objective: This study aims to analyze the global, regional, and national burden of CKD due to hypertension from 1990 to 2021, identify risk factors, and project trends until 2036.

Method: Data from the GBD 2021 study for 204 countries and territories were used. Prevalence, incidence, deaths, and disability-adjusted life years (DALYs) of CKD due to hypertension were analyzed. Decomposition analysis, frontier analysis, and predictive analysis were performed. The impact of level 3 risk factors was also assessed.

Results: In 2021, the global prevalence of CKD attributed to hypertension exceeded 24 million cases, with an age-standardized prevalence rate of 291.19 per 100,000. The incidence of such CKD cases surpassed 1.28 million, corresponding to an age-standardized incidence rate of 14.97 per 100,000. Mortality from CKD due to hypertension claimed over 454,000 lives, translating to an age-standardized mortality rate of 5.54 per 100,000. Additionally, the disease inflicted more than 10.85 million DALYs, which equates to an age-standardized DALYs rate of approximately 128.41 per 100,000. There were gender and age differences in the disease burden. Decomposition analysis indicated that population growth aggravated the disease burden in different aspects, and epidemiological changes and aging had varying effects. Frontier analysis revealed disparities among regions with different socio-demographic index (SDI) levels. Predictive analysis showed that from 2021 to 2036, the overall prevalence and incidence would remain stable with gender differences, and the age-standardized rates of mortality and DALYs would continue to rise. Dietary risk factors, especially low fruit intake, were the main contributors, along with low-temperature and lead exposure.

Conclusions: Despite a decline in age-standardized prevalence in some aspects, the overall disease burden of CKD due to hypertension has increased. Targeted strategies such as gender-and age-specific prevention, dietary improvements, environmental protection, and optimized medical resource allocation are essential to address this public-health challenge.

Keywords: CKD due to hypertension; Epidemiology and public health; Frontier analysis; Global burden of disease; Predictive analysis; Risk factors.

Fig. 1

The case number of prevalence (A), incidence (B), deaths (C), and (D) DALYs of CKD due to hypertension from 1990 to 2021

Fig. 2

The trends of case number in prevalence (A), incidence (B), deaths (C), and DALYs (D) for CKD due to hypertension categorized by global and 5 SDI regions from 1990 to 2021

Fig. 3

Decomposition analysis results for the global population and five SDI regions for both gender (A. prevalence; B. incidence; C. deaths; D. DALYs). The black dot represents the overall value of change contributed by all 3 components. For each component, the magnitude of a positive value indicates a corresponding increase in disease burden attributed to the component; the magnitude of a negative value indicates a corresponding decrease in disease burden attributed to the related component

Fig. 4

Frontier analysis, represented by the solid black lines, explores the relationship between Socio-Demographic Index (SDI) and Age-Standardized Rate (ASR) for prevalence (A, B), and incidence (C, D) in the context of CKD due to hypertension. The color gradient in graphs A, and C illustrates the progression of years, ranging from light shades representing 1990 to the darkest shades denoting 2021. In graphs B, and D, each dot signifies a specific country or territory for the year 2021, with the top 15 countries displaying the most significant deviation from the frontier labeled in black. Countries with low SDI (> 0.455) and minimal deviation from the frontier are highlighted in blue, while those with high SDI (> 0.805) and notable deviation for their developmental level are emphasized in red. The direction of change from 1990 to 2021 in ASR is indicated by the color of the dots: decrease dots represents a decrease, while increase dots signifies an increase

Fig. 5

Predicted trends of CKD due to hypertension over the next 15 years (2022–2036) (A. ASR of prevalence of male; B. ASR of prevalence of female; C. ASR of incidence of male; D. ASR of incidence of female). Red lines represent the true trend of ASR of CKD due to hypertension during 1990–2021; yellow dot lines and shaded regions represent the predicted trend and its 95% CI