#3354 Temporal trends in acute kidney injury-related mortality across 43 countries, 1996–2021, with projections up to 2050: a global time series analysis and modelling study

Abstract Background and Aims Acute kidney injury (AKI) is a major global public health concern. However, a major challenge in addressing the AKI burden is the lack of global data on AKI-related mortality and its predictions, leaving significant limitations in understanding its trends over time. Therefore, we aimed to estimate AKI-related mortality rate trends and forecast future deaths. Method We evaluated the temporal trends in age-standardized AKI-related mortality from 1996 to 2021 across 43 countries using the World Health Organization Mortality Database, with future projections through 2050. Temporal trends were assessed using locally weighted scatter plot smoother curves based on age-standardized mortality rates, and future projections up to 2050 were calculated using a predictive model that considered attributable risk factors from the Global Burden of Disease Study. This analysis aimed to identify specific patterns of variation in AKI-related mortality rates across different age groups, sexes, income levels (categorized according to the World Bank country classification), and levels of human development (classified according to the United Nations Human Development Index [HDI]). Furthermore, a decomposition analysis was conducted to assess the contributions of population growth, aging, and epidemiological changes to the variations in AKI-related deaths over time. Results Age-standardized AKI-related mortality rate per 1,000,000 people remained stable from 1996 to 2021 (10.47 [95% confidence interval, 8.84–12.11] to 9.94 [8.32–11.57]). The overall mortality rate is lower in high-income countries (HICs) than in low-to-middle income countries (LMICs). However, HICs revealed an upward trend in mortality (5.83 [4.21–7.46] to 7.3 [5.66–8.95]), while LMICs demonstrated a decline (19.66 [16.78–22.53] to 15.33 [12.37–18.29]). Similar trends were observed when countries were compared based on the HDI. Increasing trends in age-standardized AKI-related mortality rates among older populations were found in females, HICs, and countries with very high HDI, whereas rates declined in the young population. Future age-standardized AKI-related mortality was predicted to increase gradually (9.94 per 1,000,000 people [8.32–11.57] in 2021 to 11.36 [10.65–12.07] in 2050), and the primary contributor was population aging. Conclusion This global time-series and modelling study found that countries with higher socioeconomic status and older populations have increasing trends in age-standardized AKI-related mortality, a trend projected to continue through 2050. This study provides valuable information for developing strategies to reduce the global burden of AKI-related mortality.