Global burden of chronic kidney disease attributable to hypertension due to high body mass index: projections to 2050

Chronic kidney disease (CKD) affects approximately 9.1% of the global population, equivalent to approximately 843 million individuals as of 2021, with hypertension (HTN) as a major contributor. High body mass index (BMI) exacerbates HTN-related kidney injury, but the global burden of HTN-related CKD attributable to high BMI remains poorly characterized. Using data from the Global Burden of Disease (GBD) 2021 study for 1990-2021, we estimated attributable deaths, disability-adjusted life years (DALYs), the age-standardized mortality rate (ASMR), and the age-standardized disability-adjusted life-year rate (ASDR). Temporal trends were assessed using the estimated annual percentage change (EAPC), and a Bayesian age-period-cohort model was used to project rates to 2050. Attributable deaths increased from 36,476 in 1990 to 179,788 in 2021, and DALYs increased from 1.01 million to 4.26 million. ASMR increased from 1.09 to 2.19 per 100,000 (EAPC, 4.22%), and ASDR increased from 26.04 to 50.11 per 100,000 (EAPC, 3.63%). Central Sub-Saharan Africa had the highest ASMR (7.66 per 100,000), whereas High-income North America had the fastest increase in ASMR (EAPC, 5.63%). ASMR and ASDR were higher in men than in women. Death counts peaked at ages 85-89 years in both sexes, whereas DALYs peaked at ages 60-64 years in men and 65-69 years in women. Crude rates were higher in populations with a higher sociodemographic index (SDI), whereas the relative burden became more concentrated in lower-SDI populations; concentration indices changed from -0.10 to -0.17 for deaths and from -0.06 to -0.08 for DALYs. By 2050, ASMR is projected to reach 4.44 per 100,000 (95% credible interval [CI], 3.70-5.20), and ASDR is projected to reach 77.15 per 100,000 (95% CI, 1.81-152.49). The high BMI-attributable burden of HTN-related CKD is increasing and remains unequally distributed. These findings support integrated obesity prevention and hypertension control, with priority given to high-risk regions and older adults.