Global Burden of Cardiovascular Disease Attributable to Kidney Dysfunction, 1990-2021: A Comprehensive Analysis of Trends and Forecasts to 2050

INTRODUCTION: Kidney dysfunction (KD) is a major metabolic risk factor for cardiovascular disease (CVD) and has been playing an increasingly significant role in the global burden of disease. However, there is still a lack of comprehensive, long-term, and systematic research assessing the global burden of CVD attributable to KD. METHODS: Using data from the Global Burden of Disease (GBD) 2021 database, we extracted burden indicators related to KD-associated CVD, including the number of deaths, disability-adjusted life years (DALYs), years of life lost (YLLs), years lived with disability (YLDs), and their corresponding age-standardized rates, and evaluated annual trends using estimated annual percentage change. We performed decomposition analysis to identify three main drivers of burden changes-population, aging, and epidemiological change; and applied an autoregressive integrated moving average model to project future trends from 2022 to 2050. RESULTS: From 1990 to 2021, the global absolute numbers of deaths, DALYs, YLLs, and YLDs caused by KD-related CVD increased, while the corresponding age-standardized rates generally declined. Males exhibited a higher disease burden compared to females, and the elderly population, particularly those aged 75-84 years, represented the primary burden group. Middle-SDI countries experienced the highest burden, while inequality remained pronounced in low-SDI countries. Decomposition analysis revealed that, however, the increase in burden was primarily driven by population and aging, epidemiological change showed improvement. Forecasting results indicated that by 2050, the total number of cases will continue to rise, age-standardized rates will keep declining, but the YLD among females is expected to increase. CONCLUSION: The burden of CVD attributable to KD is expected to continue rising in the future, characterized by increasing absolute numbers and declining age-standardized rates. This trend suggests that stratified prevention strategies may be needed across countries with varying SDI levels, with particular attention to older populations and integrated heart-kidney disease management to reduce the global burden of the disease.