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

Yujun He; Weiwei Tang; Jianying Chen; Jie Tang; Yaling Zheng; Xinyuan Wang; Bowen Xing; Xiaojun Li; Yi Xu; Xiaoyi Wang

doi:10.1186/s12882-025-04386-8

. 2025 Aug 9;26:448. doi: 10.1186/s12882-025-04386-8

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

Yujun He ^1,^#, Weiwei Tang ^1,^#, Jianying Chen ^1,^#, Jie Tang ¹, Yaling Zheng ¹, Xinyuan Wang ¹, Bowen Xing ², Xiaojun Li ¹, Yi Xu ^1,^✉, Xiaoyi Wang ^1,^✉

PMCID: PMC12335775 PMID: 40783694

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.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12882-025-04386-8.

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

Introduction

Hypertension is a well-established major risk factor for the development and progression of chronic kidney disease (CKD). The relationship between these two conditions is complex and bidirectional, with hypertension both causing CKD and being exacerbated by the presence of kidney disease [1]. As the global population continues to age, the burden of age-related diseases such as CKD due to hypertension is on the rise.

In the elderly, the prevalence of hypertension is significantly higher compared to younger age groups [2]. The physiological changes associated with aging, such as arterial stiffness and reduced renal function reserve, make the elderly more vulnerable to the deleterious effects of hypertension on the kidneys. CKD not only severely impairs the quality of life of the elderly but also increases the risk of end-stage renal disease (ESRD), cardiovascular events, and all-cause mortality [3].

Previous CKD-related GBD studies, while valuable, have left gaps in our understanding. Ying et al. [2] and Guo et al. [4] provided a broad view of overall CKD but failed to single out CKD due to hypertension for focused analysis. He et al. [5] explored climate change as a risk factor for CKD, yet this work didn’t specifically target CKD due to hypertension and overlooked other important factors like diet-related risks. Liu et al. [6] and Chen et al. [7]. limited their research to the incidence, mortality and disability-adjusted life years (DALYs) of CKD caused by hypertension, neglecting crucial aspects such as prevalence. However, none of their articles provide a systematic frontier analysis of 204 countries and regions, predictions for more than a decade into the future, or a decomposition analysis of epidemiological changes, population growth, and aging. Additionally, since these studies were based on earlier GBD datasets, they may not reflect the current epidemiological situation considering the GBD database has been updated to 2021.

Against this backdrop, our study aims to fill these gaps. By leveraging the GBD 2021 data, we not only understand the epidemiological trends of CKD due to hypertension from 1990 to 2021 and identify the underlying risk factors but also go a step further. We transcend the current data by providing projections up to 2036, complemented by frontier analysis and decomposition analysis. This approach enables us to offer a comprehensive overview that encompasses both the present and the future, which is conducive to formulating appropriate healthcare policies. Our research is thus poised to contribute significantly to public health planning and resource allocation, with a particular emphasis on the aging population.

The GBD 2021 database classifies CKD according to the International Classification of Diseases, 10th Revision (ICD-10). The ICD-10 codes relevant to CKD include D63.1, E10.2, E11.2, E12.2, E13.2, E14.2, I12-I13.9, N02-N08.8, N15.0, N18-N18.9, and Q61-Q62.8. Among them, I12 specifically denotes CKD due to hypertension [8]. The GBD study adopts a comprehensive approach to estimate disease burden, including integrating multi-source data, using the DisMod-MR model for disease modeling, and applying Bayesian statistical frameworks and Monte Carlo methods to quantify uncertainties. These methods collectively form a systematic analytical framework capable of generating comparable and consistent estimates of disease burden [9, 10]. By utilizing the GBD framework, this study systematically analyzes and compares the prevalence, incidence, mortality, and DALYs of CKD due to hypertension at global, regional, and national levels.

Material and methods

Data source

Utilizing recent epidemiological data and enhanced standardized methodologies, the GBD 2021 study quantifies health loss for 371 diseases across 204 countries and territories, integrating metrics of prevalence, incidence, deaths, and DALYs [11]. This comprehensive dataset provides a thorough evaluation of disease burden. The 204 countries and regions, categorized into five socio-demographic index (SDI) quintiles—low, low-middle, middle, high-middle, and high—are classified using the SDI, which incorporates per-capita income, years of schooling, and fertility rate. Based on epidemiological similarity and geographical proximity, the world is further partitioned into 21 GBD regions, such as high-income Asia Pacific, middle Latin America, and the Caribbean, which are aggregated into seven super GBD regions, including the high-income region [12, 13]. Our study focused on four key metrics associated with CKD due to hypertension: prevalence, incidence, deaths, and DALYs. The analysis included 204 countries and territories, grouped into 21 GBD regions based on geographic proximity and subsequently classified into five categories according to the SDI. For comparative analysis purposes, we concurrently extracted the global prevalence, incidence, mortality, and DALYs data of overall CKD and CKD due to diabetes mellitus type 2 (T2DM), and compared them with those of CKD due to hypertension.

Statistical analysis

We initiated our data analysis by assessing the dataset’s structure, estimating numbers and rates for essential metrics including prevalence, incidence, deaths, and DALYs of CKD due to hypertension at global, regional, and national levels. We subsequently analyzed the measure variations from 1990 to 2021 across multiple regions. This was executed for both case numbers and age-standardized rates (ASRs) per 100,000.

To guarantee the dependability of the burden estimation, the GBD study utilizes a Bayesian statistical approach alongside the Monte Carlo technique to determine 95% uncertainty intervals (UIs). The process comprises a series of crucial steps. At the outset, data from various origins are consolidated, and the DisMod-MR 2.1 model is employed for stratified modeling to adjust for potential data biases. Following this, for each parameter, 500 random extractions are executed to delineate the feasible value spectrum. Importantly, uncertainties stemming from measurement error, model presuppositions, and regional heterogeneity are retained and propagated throughout the procedure. Eventually, the 2.5th and 97.5th percentiles derived from the 500 extractions are used to construct the UIs, which offer an extensive assessment of the uncertainty associated with the burden estimates [14]. The 95% UI implies that there is a 95% likelihood of the true value being within the interval. The width of the interval indicates the robustness of the estimate: a broad interval may signal insufficient data or notable model uncertainty, which is commonly observed in low-income countries, whereas a narrow interval suggests ample data and a stable model [15]. The EAPC was utilized to evaluate trends in ASRs based on a generalized linear model with a Gaussian distribution assumption [16]. Calendar year served as the independent variable X, while the natural logarithm of ASR (ln[ASR]) was the dependent variable Y, fitting the model y = a + bx + ε. EAPC was computed via the formula: EAPC = 100 × (exp(β) − 1) [17, 18], using the regression coefficient β. This method is reliable only if ASR changes are stable over the observation period. Statistical tests were performed to validate the EAPC and rule out random influences. The EAPC test is equivalent to testing the slope of the regression line. A t-test was conducted for the slope b (t = b/se_b, with se_b as the standard error of b and degrees of freedom v = number of years − 2). Due to se_b’s impact on the slope and EAPC, the EAPC’s 95% CI was calculated as detailed in references [19, 20]. Calculations and plotting in this section were performed using the tidyverse, broom, viridis, scales, viridis, ggsci, rnaturalearth, rnaturalearthdata, sf, mapdata, patchwork, and ggpubr packages in R version 4.3.3.

The SDI is a composite indicator developed by GBD researchers to assess a region’s socio-economic status. It integrates per capita income, educational achievement, and fertility rates into a unified statistic ranging from 0 to 1, signifying the socio-economic vitality and progress of a region or nation. Increased SDI levels signify enhanced socio-economic conditions and health outcomes. The SDI categorizes regions into quintiles: low (0-0.454743), low-middle (0.454743–0.607679), middle (0.607679–0.689504), high-middle (0.689504–0.805129), and high (0.805129-1). The correlation between the incidence of CKD due to hypertension and the SDI will be analyzed using Pearson correlation analysis [21]. This section utilized the reshape, ggplot2, and ggpubr packages in R version 4.3.3 for calculations and plotting.

Decomposition analysis was employed to elucidate the contributions of population growth, aging, and epidemiological changes to the variations in prevalence, incidence, mortality, and DALYs of CKD due to hypertension from 1990 to 2021. This method allows for the quantification of how each factor independently influences disease burden over time. Specifically, population growth was assessed as the primary driver of changes in absolute numbers, while aging and epidemiological transitions were evaluated for their impact on ASRs. The specific method of decomposition analysis is based on Yan Xie et al.‘s method [2]. This section utilized the dplyr, tidyr, ggplot2, and ggpubr packages in R version 4.3.3 for calculations and plotting.

In this study, frontier analysis was utilized to assess the disparity between each country’s actual disease burden and the theoretical optimal level. This was achieved by establishing a “best-performance frontier”, which comprises countries exhibiting the lowest disease burden for a given SDI. Unlike conventional cross-country inequality assessments, this method specifically identifies nations with disproportionately elevated disease burdens within the same SDI category. Such identification may indicate underlying structural flaws in healthcare systems or deficiencies in risk factor management. Moreover, it encourages countries to learn from their frontier-neighboring counterparts with similar SDI levels. This analysis decouples economic development from disease control capacity, offering targeted insights for resource allocation and addressing the limitations of traditional inequality evaluations [22]. It has the potential to identify leading regions that can serve as benchmarks for others. For each country and territory, the ‘effective difference’ was computed. This metric reflects the gap between the current disease burden and the potential burden, adjusted in accordance with the SDI [2]. Statistical analysis and graphical representation were performed using in data.table, ggplot2, ggrepel, and parallel in R version 4.3.3.

To forecast future trends in the burden of CKD due to hypertension in the next 15 years, we employed the autoregressive integrated moving average (ARIMA) model. This model leverages the autocorrelation of time-series data to predict future values based on historical observations. The core principle of ARIMA is that data series are time-dependent random variables, characterized by their autocorrelation structure [23, 24]. The calculation of ARIMA prediction and its 95%CI referred to Forecasting: Principles and Practice (2nd ed) [25]. Predictive utilized the forecast, dplyr, readr, ggplot2, and ggpubr packages in R version 4.3.3 for calculations and plotting.

To assess the impact of level 3 risk factors on the burden of CKD due to hypertension, we utilized data from the GBD 2021 database. In this database, risk factors are only available for mortality and DALYs. Therefore, our analysis focused on these two metrics. The GBD study evaluates the extent to which various risk factors contribute to disease burden by comparing observed levels to a theoretical minimum risk exposure level [11, 26]. The level 3 risk risks associated with CKD due to hypertension in the GBD 2021 database include seven risk factors: diet high in red meat, diet low in whole grains, diet low in vegetables, diet high in sodium, diet high in sugar-sweetened beverages, diet low in fruits, diet high in processed meat, high temperature, low temperature and lead exposure. Analyses of these risk factors were performed using tidyverse and ggplot2 packages R version 4.3.3.

Results

Overview of the global burden

Results of the trend analysis for CKD due to hypertension

From 1990 to 2021, the global burden of CKD due to hypertension exhibited complex trends. The global number of prevalent cases of CKD due to hypertension increased significantly from over 11 million in 1990 to over 24 million in 2021, with a RC of 108.90%. Conversely, the age-standardized prevalence rate (ASPR) decreased from approximately 310.68 per 100,000 in 1990 to about 291.19 per 100,000 in 2021, representing a 6.27% reduction over the study period. The EAPC for the ASR of prevalence was − 0.16%. Among the 21 GBD regions, in 2021, Oceania had the lowest prevalence at 20,497.69 (95% UI: 18,021.87–24,030.06), while East Asia had the highest at 4,640,760.69 (95% UI: 4,269,330.29–5,053,545.82). Regarding ASR, Eastern Sub-Saharan Africa recorded the lowest ASR of 167.40 (95% UI: 153.85–182.19), and Central Asia exhibited the highest ASR at 464.01 (95% UI: 425.02–506.59). In terms of the EAPC from 1990 to 2021, East Asia had the lowest EAPC of -0.59 (95% CI: -0.71, -0.48), whereas High-income North America showed the highest EAPC at 0.24 (95% CI: 0.20, 0.28) (Supplementary Table 1).

Regarding the incidence, the number of incident cases increased from over 460,000 in 1990 to over 1.28 million in 2021, showing a 176.38% increase. Meanwhile, the age-standardized incidence rate (ASIR) rose from about 12.24 per 100,000 to approximately 14.97 per 100,000, with a 22.3% increase. The EAPC for the ASR of incidence was 0.66%. Among the 21 GBD regions, in 2021, Oceania demonstrated the lowest incidence at 738.16 (95% UI: 652.30–827.18), whereas East Asia exhibited the highest incidence of 234,238.92 (95% UI: 214,857.00–251,659.40). Regarding ASR, Eastern Sub-Saharan Africa had the lowest ASR at 7.37 (95% UI: 6.79–8.04), and North Africa and Middle East showed the highest ASR of 25.72 (95% UI: 23.77–27.66). From 1990 to 2021, High-income North America experienced the lowest EAPC at 0.17 (95% CI: 0.10, 0.23), while Andean Latin America recorded the highest EAPC of 2.35 (95% CI: 2.23, 2.46) (Supplementary Table 2).

In terms of DALYs, the global DALYs increased from over 4.34 million in 1990 to over 10.85 million in 2021, an increase of 149.74%. The age-standardized DALYs rate (ASDR) increased from about 107.77 per 100,000 to approximately 128.41 per 100,000. The EAPC for the ASR of DALYs was 0.63%. Among the 21 GBD regions, in 2021, Oceania registered the lowest DALYs at 6,826.22 (95% UI: 5,363.48–8,628.05), whereas Southeast Asia reported the highest DALYs of 1,410,238.82 (95% UI: 1,111,379.15–1,721,997.03). In terms of ASR, Eastern Europe had the lowest ASR of 23.83 (95% UI: 19.29–28.46), and Southeast Asia exhibited the highest ASR at 339.64 (95% UI: 282.05–395.38). Between 1990 and 2021, East Asia displayed the lowest EAPC of -0.95 (95% CI: -1.04, -0.86), while High-income North America showed the highest EAPC of 2.88 (95% CI: 2.70, 3.06) (Supplementary Table 4).

Comprehensive analyses of prevalence, incidence, mortality, and DALYs across 204 countries and territories are illustrated in Fig. 1 and Supplementary Tables 5–8 and Supplementary Fig. 1–4. Among the 204 countries and regions globally, in terms of prevalence, China had a high number of cases at 4,436,793.66 (95% UI: 4,078,455.44–4,836,064.40). Nicaragua exhibited the highest ASR at 538.34 (95% UI: 482.52–604.36), and El Salvador showed the highest EAPC at 0.51 (95% CI: 0.39, 0.63). For incidence, China reported the highest number of cases at 222,288.12 (95% UI: 203,329.26–239,289.98). The United Arab Emirates had the highest ASR of 31.35 (95% UI: 28.11–34.91), and Estonia had the highest EAPC at 2.91 (95% CI: 2.81, 3.02). Regarding deaths, China had the highest number of fatalities at 65,304.56 (95% UI: 49,343.84–82,521.09). Mauritius recorded the highest ASR of 35.20 (95% UI: 30.06–39.96), and Ukraine showed the highest EAPC at 13.10 (95% CI: 11.04, 15.20). In terms of DALYs, China reported the highest DALYs at 1,628,173.25 (95% UI: 1,300,311.31–1,988,418.45). Mauritius had the highest ASR of 857.32 (95% UI: 733.76–973.40), and Lesotho exhibited the highest EAPC at 3.50 (95% CI: 3.03, 3.98). These results highlight the unique disease burdens among these nations.

Comparison with overall CKD and CKD due to T2DM reveals that except for ASPR, which shows little variation over the years, all other outcomes exhibit an increasing trend in both absolute numbers and ASRs. Notably, while CKD due to T2DM presents a significantly higher disease burden in terms of prevalence and incidence than CKD due to hypertension, the two exhibit almost the same disease burden in mortality and DALYs. Nevertheless, the trends of all disease burden for overall CKD, CKD due to T2DM, and CKD due to hypertension are consistent. (Supplementary Fig. 5–6).

Results of the trends by year, sex and age for CKD due to hypertension

Over the past 30 years, the absolute number of CKD due to hypertension cases has risen yearly globally and in all 5 SDI regions (Fig. 2). Despite the fact that the ASPR of CKD due to hypertension has declined in nearly all global and five SDI regions, the ASRs of incidence, mortality, and DALYs have mostly shown an upward trend, indicating that the disease burden remains severe. (Supplementary Fig. 7). Detailed analyses across 21 GBD regions are in Supplementary Fig. 8–9.

On a global scale, an analysis of CKD due to hypertension in different age groups and genders reveals a series of characteristic trends. In terms of the number of cases, the number of male cases is higher than that of female cases in all age groups. Moreover, as the age increases, the number of cases for both genders gradually rises from a relatively low level in the younger age groups.

Regarding the ASR, the prevalence rate, incidence rate, mortality rate, and DALYs rate all show a trend of first increasing and then reaching a high level with age. Specifically, for the ASPR of both men and women is relatively low in the younger age groups and then gradually increases. Before the age of 75–79, the ASR of men is higher than that of women, but starting from the age of 80–84, the ASR of women is higher than that of men, and it generally peaks around the age of 65–74 (Supplementary Fig. 5A). For the ASIR is extremely low in the younger age groups and increases with age. Before the age of 70–74, the ASR of men is higher than that of women, and starting from the age of 75–79, the ASR of women is higher than that of men, with the peak occurring around the age of 70–74 (Supplementary Fig. 5B). For the age-standardized mortality rate (ASMR), it is nearly zero in the younger age groups and increases with age. Before the age of 80–84, the ASR of men is higher than that of women, and starting from the age of 85–89, the ASR of women is higher than that of men, reaching its peak between the ages of 80–89 (Supplementary Fig. 5C). The ASDR is very low in the younger age groups and reaches a relatively high level after the age of 70–74 as age increases. The ASR of DALYs for men is generally higher than that for women, and there is no gender reversal similar to the above-mentioned indicators. The peak of the ASR of DALYs occurs between the ages of 60–74 (Supplementary Fig. 5D). Detailed analyses for the gender-age trends in the five SDI regions and 21 GBD regions are in Supplementary Figs. 10–36.

Results of the relationship between CKD due to hypertension burden and SDI

Globally, the SDI exhibited complex non-linear associations with ASR of prevalence, incidence, mortality, and DALYs for CKD due to hypertension. For prevalence, the global trend curve of ASPR showed two inflection points at SDI values of approximately 0.6 and 0.8, characterized by an initial increase followed by a decline and subsequent fluctuations. High-SDI regions such as North America demonstrated a peak-and-decline pattern, whereas regions like South Asia experienced fluctuating trends with increasing SDI. Notably, Central Asia maintained consistently elevated ASPR across all SDI levels (Supplemental Figs. 37 A).

In terms of incidence, ASIR displayed a positive correlation with SDI overall, though growth rates adjusted at SDI thresholds of 0.6 and 0.7. All regions showed significant increases in ASIR with rising SDI, underscoring the role of aging populations and lifestyle changes in high-SDI settings (Supplemental Figs. 37B).

Mortality and DALYs trends both featured an initial decline up to SDI ~ 0.5–0.6, followed by a reversal and subsequent adjustments at SDI ~ 0.8–0.9. Low-SDI regions, particularly Western Sub-Saharan Africa and Central Sub-Saharan Africa, consistently reported elevated mortality rates, reflecting healthcare resource disparities. DALYs mirrored mortality trends closely, highlighting the burden of CKD due to hypertension in these regions (Supplemental Figs. 37 C-D).

The relationship across 204 countries and territories is in Supplemental Fig. 38.

Results of the decomposition analysis for CKD due to hypertension

The results of the decomposition analysis show that, in terms of prevalence, aging (59.93%) and population growth (86.59%) both aggravated the disease burden, while epidemiological change (-46.52%) alleviated it (Fig. 3A). For incidence, aging (-48.59%) alleviated the disease burden, whereas population growth (90.34%) and epidemiological change (58.25%) aggravated it (Fig. 3B). Regarding mortality, aging (31.15%), population growth (34.33%), and epidemiological change (34.53%) all aggravated the burden (Fig. 3C). As for DALYs, aging (36.31%), population growth (41.77%), and epidemiological change (21.92%) all contributed to aggravating the burden (Fig. 3D). The decomposition analysis results for different sex and 21 GBD regions are in Supplemental Fig. 39–43.

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

Results of the frontier analysis for CKD due to hypertension

Frontier analysis revealed SDI’s impact on CKD due to hypertension’s ASRs: In low-to-medium SDI regions, prevalence generally decreased with increasing SDI, but interannual data points overlapped, indicating dynamic relationships influenced by multiple factors. High SDI regions showed relatively clustered values but still exhibited annual fluctuations, reflecting instability in prevalence over time (Fig. 4A). For incidence, rates slightly increased with SDI and also fluctuated annually (Fig. 4C). In 2021, high SDI countries like the United Arab Emirates and Saudi Arabia had higher-than-expected prevalence and should learn from peers within the same SDI bracket. Low SDI countries such as Somalia and Burundi, which were closer to the frontier (optimal performance line) (Fig. 4B), served as benchmarks for similarly resourced regions. Regarding incidence, Somalia and the United Republic of Tanzania (low SDI) approached the frontier, whereas Nepal and Nicaragua (low SDI) lagged behind (Fig. 4C). The frontier analysis of mortality and DALYs can be found in Supplemental Fig. 44.

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

Results of the predictive analysis for CKD due to hypertension

Predictive analysis charts ASR of CKD due to hypertension from 2021 to 2036 (Fig. 5). Both sex prevalence (Fig. 5A) and incidence (Fig. 5B) remained stable over the period, with forecasts indicating continued stability. Male prevalence (Fig. 5C) showed slight variability followed by projected increases, while male incidence (Fig. 5D) rose consistently. Female prevalence (Fig. 5E) declined gradually, with forecasts extending this trend, whereas female incidence (Fig. 5F) demonstrated steady growth.

AS for the ASRs of deaths and DALYs for CKD due to hypertension from 1990 to 2021 with subsequent forecasts. For deaths, the both sex ASR (Supplemental Fig. 45A) rose from 1990 to 2021, with forecasts indicating a continued upward trend. Male (Supplemental Fig. 45B) and female (Supplemental Fig. 45C) death ASRs also increased during 1990–2021, and predictions show persistence of this growth. Regarding DALYs, the both sex ASR (Supplemental Fig. 45D) exhibited an upward trend, with forecasts suggesting further increases. Male (Supplemental Fig. 45E) and female (Supplemental Fig. 45F) DALYs ASR followed similar patterns, rising in the actual period (1990–2021) and projected to continue.

Results of the risk factors for CKD due to hypertension

Regarding the level 3 risk factors of CKD due to hypertension, there were a total of 10 risk factors in the GBD database in 2021. Among them, 7 were dietary risk factors: Diet high in processed meat, Diet high in red meat, Diet high in sodium, Diet high in sugar-sweetened beverages, Diet low in fruits, Diet low in vegetables, and Diet low in whole grains. There were 2 climate risk factors: High temperature and Low temperature, and 1 environmental risk factor: Lead exposure. Supplemental Fig. 46 and Supplemental Fig. 47 describe the contributions of the level 3 risk factors to mortality and DALYs respectively. It can be seen that, whether in terms of mortality or DALYs, dietary risk factors play a dominant role. The main one is Diet low in fruits, followed by Diet low in vegetables and Diet high in sodium, while the contributions of other dietary risk factors are minimal. Among the climate risk factors, the contribution of Low temperature is relatively high, and the contribution of High temperature is negligible in comparison. The contribution of Lead exposure also accounts for a certain proportion among the level 3 risk factors. There are no obvious gender differences in these characteristics.

Discussion

This study reveals that the global burden of CKD due to hypertension exhibited complex dynamics from 1990 to 2021. Despite a 6.27% decrease in the ASPR, the absolute number of prevalent cases increased significantly from over 11 million in 1990 to over 24 million in 2021, representing a RC of 108.9%. This divergence between absolute numbers and standardized rates highlights the dual impact of population growth and aging on disease burden. While advancements in medical technology and increased health education awareness may have reduced individual disease risk, population structural changes have significantly amplified the absolute scale of disease burden. This finding aligns with previous research emphasizing the profound influence of demographic shifts on public health systems [2, 27].

Additionally, the ASIR and ASMR both showed upward trends, increasing by 22.3% and 29.21%, respectively. This suggests that although medical interventions may have improved outcomes for some patients, the overall threat of the disease persists. The rise in mortality may be attributed to the complex pathophysiology of CKD due to hypertension, particularly in low- and middle-income countries, where limited healthcare resources exacerbate the challenge [2].

The global burden of CKD due to hypertension, as measured by DALYs, also exhibited a significant increase from 1990 to 2021. The total DALYs rose from over 4.34 million in 1990 to over 10.85 million in 2021, an increase of 149.74%. ASDR increased from approximately 107.77 per 100,000 to 128.41 per 100,000, with an EAPC of 0.63%. This increase in DALYs underscores the growing impact of CKD due to hypertension on both morbidity and mortality, reflecting not only the rise in disease prevalence but also the associated disability and premature death. The rise in DALYs is particularly concerning as it indicates a substantial loss of healthy life years, necessitating urgent public health action to mitigate this burden. These results may be attributed to the low rate of hypertension control (with only approximately 20% of patients achieving target blood pressure globally) and insufficient management of complications [28]. For instance, patients with CKD due to hypertension who do not receive timely treatment may progress to renal failure, which substantially elevates the risk of mortality [29]. The rising absolute burden and suboptimal control of ASR of CKD due to hypertension globally necessitate comprehensive interventions across the prevention-screening-treatment-surveillance continuum [30], with particular focus on high-risk populations (older adults, individuals with hypertension) and high-burden regions. Policy design should balance short-term enhancements in screening capacity with long-term control of risk factors, ultimately aiming to slow the growth of incidence, reduce mortality, and alleviate DALYs burden.

The similar burdens of CKD due to hypertension and CKD due to T2DM in deaths and DALYs, despite lower prevalence and incidence of the former, and the results are consistent with previous studies [4, 31]. indicate that CKD due to hypertension has a higher fatality and disability rate. Thus, CKD due to hypertension merits more attention in medical research and practice.

Male predominance in CKD due to hypertension burden before 75 years is attributed to biological factors (accelerated age-related decline in glomerular filtration rate and androgen-mediated renal fibrosis) [2] and lifestyle risks (threefold higher smoking prevalence and increased occupational exposure to heavy metals/organic solvents) [32]. Conversely, female reversal in ASRs after 80 years is linked to estrogen depletion (promoting arteriosclerosis and renal injury) [29] and higher comorbidity burdens of diabetes/obesity. Age-specific peaks demonstrate that 65–74 years old face compounded risks from age-related renal vascular sclerosis, prolonged hypertension exposure, and suboptimal antihypertensive adherence [2], while 80-89-year-olds experience mortality surges due to multi-organ failure and poor dialysis tolerance [29]. The DALY peak in 60–74 years old reflects dual impacts of lost productivity in working-age populations and protracted treatment demands for end-stage renal disease [28].

In order to effectively prevent and control CKD due to hypertension, two major strategies have been formulated: gender-differentiated precision prevention and control, and age-stratified key interventions. In the strategy of gender-differentiated precision prevention and control, for young and middle-aged men aged 18 to 64, interventions should integrate occupational protection, lifestyle adjustments, and targeted management of metabolic factors. Occupational risks remain non-negligible—reducing exposure to nephrotoxic substances (e.g., heavy metals, organic solvents) through improved workplace safety protocols and personal protective equipment is crucial [33]. However, given the significant role of metabolic factors (a higher prevalence of obesity in men, which exacerbates hypertension and renal damage) [34, 35], priority should also be given to interventions addressing metabolic dysregulation. These include promoting a diet low in added sugars, saturated fats, and processed foods (aligned with our identified dietary risk factors); encouraging regular physical activity (at least 150 min of moderate-intensity exercise weekly) to improve insulin sensitivity and reduce visceral adiposity; and implementing weight management programs for overweight/obese individuals (BMI ≥ 25 kg/m²) [36]. Additionally, screening for metabolic syndrome components (hypertension, hyperglycemia, dyslipidemia) during routine health checks can facilitate early intervention, thereby mitigating the synergistic effects of metabolic dysfunction and hypertension on renal injury [37]. For elderly women, hormone and comorbidity management is implemented to delay the renal injury related to estrogen deficiency after menopause and optimize the safety of multiple medications. In terms of age-stratified key interventions, early screening and enhanced management are implemented for the high-risk population aged 65 to 74, and efforts are made to improve the dialysis tolerance of elderly women aged 80 to 89 with ESRD [38].

CKD due to hypertension burden demonstrates non-linear relationships with the SDI across 21 GBD regions, characterized by dual inflection points at SDI 0.6 and 0.8. Low-SDI regions face rising prevalence due to limited healthcare access, high sodium intake (e.g., > 10 g/day in sub-Saharan Africa) [39], and poor hypertension awareness [40]. Medium-SDI countries achieve reductions through expanded health insurance coverage [41] and widespread use of low-cost antihypertensives (e.g., thiazide diuretics) [42], may resulting in prevalence decline. High-SDI regions, however, experience prevalence resurgence due to obesity and diabetes, which offset gains from medical advancements [2]. Incidence rates rise consistently with SDI, may drive by aging populations [43], metabolic syndrome [44], and improved early detection [45]. Mortality and DALYs initially decline at SDI 0.5–0.6 due to expanded dialysis access but rebound at SDI 0.8–0.9, likely due to polypharmacy-related renal injury in elderly patients (e.g., 2.5-fold risk increase in Japan) [46].

Central Asia’s uniformly elevated prevalence requires prioritizing environmental regulation (e.g., closing unregulated lead-zinc mines) and genetic screening for APOL1 variants, which confer increased nephropathy risk [47, 48]. Low-SDI African countries must address critical gaps in dialysis accessibility (low coverage in sub-Saharan Africa) [49] and healthcare workforce shortages (5 nephrologists per 100,000 population) [50] by expanding health insurance and training primary health workers. High-SDI nations should focus on obesity prevention (e.g., sugar-sweetened beverage taxes) and optimizing medication management in elderly populations to reduce polypharmacy-related nephropathy [51]. These strategies align with the Global Kidney Health Atlas (2024) and Sustainable Development Goal 3, emphasizing tailored interventions to address SDI-dependent drivers of CKD due to hypertension [52].

The decomposition analysis of CKD due to hypertension indicates that, in terms of prevalence, aging, due to the decline of renal function and the increase of comorbidities in the elderly, and population growth, which leads to an enlarged patient base and strain on medical resources, jointly exacerbate the disease burden. In contrast, epidemiological changes, such as improvements in public health and the promotion of a healthy lifestyle, play a role in alleviating it. Regarding the incidence, aging may reduce the risk of onset as some elderly people die prematurely due to other diseases and timely medical diagnosis and treatment are available. Population growth increases the number of potential patients, while epidemiological changes lead to an increase in incidence due to the prevalence of unhealthy lifestyles and the emergence of new risk factors. In terms of mortality, aging, because of the weak resistance and complex treatment requirements of the elderly, population growth, which results in an increase in the number of patients and uneven distribution of medical resources, and epidemiological changes, due to new pathogenic factors and limitations in treatment, all contribute to aggravating the burden. For DALYs, aging, which leads to a long disease duration and high risk of disability, population growth, which increases the overall burden, and epidemiological changes, which cause alterations in the severity and duration of the disease, jointly intensify the loss of healthy life years. In view of this, health policies that include strengthening health management and medical services for the elderly, rationally allocating medical resources, and enhancing disease surveillance and scientific research innovation should be formulated to address the disease burden of CKD due to hypertension:

The frontier analysis shows that the SDI affects the ASR of CKD due to hypertension. In low-to-medium SDI regions, the prevalence generally decreases with the increase of SDI, but the data fluctuates due to the interference of economic, policy and other factors. In high SDI regions, the values are relatively concentrated, and there are still annual fluctuations due to lifestyle and medical factors. The incidence rate increases with SDI and fluctuates due to various factors. For example, countries with high SDI such as the UAE have a high prevalence rate due to unhealthy lifestyles, etc. Countries with low SDI such as Somalia have achieved good prevention and control effects through public health education, while countries like Nepal have a high incidence rate due to the lack of medical resources. In response to this, universal and targeted policies should be formulated. Countries should also actively communicate with frontier countries with the same SDI, learn advanced prevention and control strategies, and optimize and apply them in combination with national conditions to improve the prevention and control effectiveness of CKD due to hypertension.

The predictive analysis of CKD due to hypertension shows the trends of ASR from 2021 to 2036, during which the overall prevalence and incidence remained stable yet with significant gender differences: the prevalence among men first fluctuated and then increased while the incidence kept rising, and the prevalence among women gradually decreased with the incidence steadily increasing. The ASRs of mortality and DALYs also trended upward. Thus, targeted policies should be formulated, including conducting dietary guidance, health promotion, and occupational protection for men, helping women with menopause health management and stress response, improving the elderly health security system, strengthening primary medical care capabilities, and promoting universal disease prevention to enhance the prevention and control of CKD due to hypertension.

Analysis of the risk factors for CKD due to hypertension indicates that in 2021, there were a total of 10 level-3 risk factors in the GBD database. Dietary risk factors were dominant. This was due to long-term nutritional imbalance, with high intake of processed meat, high-sodium, and high-sugar foods, and low intake of fruits, vegetables, and whole grains [53]. Also, the modern fast-paced lifestyle led to reliance on convenience foods and poor eating habits due to work pressure [54]. The low-temperature climate risk factor contributed significantly. Low temperature causes blood vessels to constrict, increasing blood pressure and affecting the kidneys. Moreover, during low-temperature periods, people are less active and have a poorer diet [5]. Lead exposure also accounted for a certain proportion. Widespread lead pollution in the environment, such as from industrial production, vehicle exhausts, and lead-containing coatings in old buildings, and in occupations like battery manufacturing where practitioners may be exposed due to insufficient protection, are the main reasons [55]. Therefore, targeted policies are needed. For dietary risks, conduct nutrition education and publicity, implement food policy interventions, and promote healthy eating in schools and workplaces. For climate risks, provide low-temperature protection and health guidance, and improve environmental temperature control and public facilities. For lead exposure risks, strengthen environmental lead pollution control and occupational protection and health monitoring to reduce the risk of CKD due to hypertension.

To address the growing burden of CKD due to hypertension, targeted public health interventions should be tailored to gender- and age-specific patterns, modifiable risk factors, and socio-demographic disparities, with strategies implemented at local, national, and global levels. For gender and age stratification, interventions include integrating occupational protection, lifestyle adjustments, and metabolic factor management (e.g., obesity control through diet and exercise) for young and middle-aged men (18–64 years); prioritizing integrated care for hypertension and CKD with safe medication regimens for older women (≥ 80 years); and enhancing regular monitoring of renal function and antihypertensive adherence for adults aged 65–74 years. Incorporate renal ultrasonography and urine sediment analysis into the essential tests for hypertension patients [56]. Dietary interventions should involve global advocacy for standardized food labeling and sodium reduction targets, national policies such as subsidizing fresh produce and taxing sugary beverages, and local culturally tailored nutrition education. Environmental policies need to address low-temperature exposure (e.g., expanding public heating in cold regions) [57, 58] and lead contamination (e.g., stricter industrial regulations, local screening in high-risk areas). Healthcare resource allocation should target low-SDI regions with investments in renal care infrastructure and training, focus high-SDI regions on preventive care and telemedicine, and facilitate cross-country learning through global platforms based on frontier analysis findings.

This study has several limitations. First, the data from the GBD 2021 database may be affected by inconsistent data collection across regions; specifically, in resource-limited areas, under-reporting, misclassification, or incomplete data could lead to inaccurate disease burden estimates [59]. Second, some potential risk factors might have been overlooked, such as emerging environmental factors, genetic-environmental interactions, and population-specific lifestyle factors. Third, the predictive models assume future trends will follow historical patterns, which may deviate from the actual situation considering rapid changes in medical technology, policies, and social-economic conditions. Finally, cultural, social, and economic contexts, which can influence diet, healthcare-seeking behavior, and health determinants, were not fully considered, potentially limiting the generalizability of the findings effectiveness.

Conclusion

This study comprehensively analyzed the global, regional, and national burden of CKD due to hypertension from 1990 to 2021. Despite a decline in age-standardized prevalence in certain aspects, the overall disease burden has increased in terms of absolute numbers of prevalence, incidence, mortality, and DALYs. There are notable gender-and age-related differences, as well as variations across regions with different SDI levels. Dietary factors, along with low-temperature and lead exposure, are significant contributors to the disease burden. To address this public health challenge, targeted strategies including gender-and age-specific prevention, dietary improvements, environmental protection, and optimized medical resource allocation are essential. Continuous monitoring and adjustment of these strategies according to the changing disease trends are also necessary to safeguard global kidney health.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary Material 1^{(15.2MB, pdf)}

Acknowledgements

We express our gratitude to the Institute for Health Metrics and Evaluation (IHME) for facilitating open access.

Author contributions

HYJ: Writing-original draft, Writing-review & editing, Conceptualization, Methodology, Formal analysis, Data curation, Supervision. TWW: Writing-review & editing, Conceptualization, Visualization. CJY: Writing-review & editing, Investigation, Validation. TJ: Writing-review & editing, Formal analysis, Data curation. ZYL: Writing-review & editing, Investigation, Data curation, Validation. WXY: Writing-review & editing, Conceptualization, Methodology. XBW: Writing-review & editing, Data curation, Visualization. LXJ: Writing-review & editing, Project administration, Funding acquisition.XY: Writing-review & editing, Methodology, Data curation.WXY: Writing-review & editing, Investigation, Data curation.

Funding

This study is supported by 1.The third round of Taizhou Traditional Chinese Medicine (Integrated Traditional Chinese and Western Medicine) key (supported) disciplines (No: Tai Wei Fa [2020] 52)0.2. General Project of Scientific Research Program of Hunan Provincial Administration of Traditional Chinese Medicine: Evaluation of Clinical Efficacy and Research on Related Mechanisms of Xie’s Qizhen Acupuncture Therapy in Treating Diabetic Peripheral Neuropathy (No: B2024153).

Data availability

The datasets utilized in this investigation are accessible in open repositories. The repository names and accession numbers are provided below: All data may be accessed via the IHME website (https://vizhub.healthdata.org/gbd-results/).

Declarations

Ethics approval and consent to participate

Not applicable.

Patient and public involvement

Not applicable.

Consent to participate

Not applicable.

Competing interests

The authors declare no competing interests.

Footnotes

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Yujun He, Weiwei Tang, and Jianying Chen share the first authorship.

Contributor Information

Yi Xu, Email: xuy1065@enzemed.com.

Xiaoyi Wang, Email: 984437045@qq.com.

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Associated Data

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Supplementary Materials

Supplementary Material 1^{(15.2MB, pdf)}

Data Availability Statement

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PERMALINK

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

Yujun He

Weiwei Tang

Jianying Chen

Jie Tang

Yaling Zheng

Xinyuan Wang

Bowen Xing

Xiaojun Li

Yi Xu

Xiaoyi Wang

Abstract

Background

Objective

Method

Results

Conclusions

Supplementary Information

Introduction

Material and methods

Data source

Statistical analysis

Results

Overview of the global burden

Results of the trend analysis for CKD due to hypertension

Fig. 1.

Results of the trends by year, sex and age for CKD due to hypertension

Fig. 2.

Results of the relationship between CKD due to hypertension burden and SDI

Results of the decomposition analysis for CKD due to hypertension

Fig. 3.

Results of the frontier analysis for CKD due to hypertension

Fig. 4.

Results of the predictive analysis for CKD due to hypertension

Fig. 5.

Results of the risk factors for CKD due to hypertension

Discussion

Conclusion

Supplementary Information

Acknowledgements

Author contributions

Funding

Data availability

Declarations

Ethics approval and consent to participate

Patient and public involvement

Consent to participate

Competing interests

Footnotes

Contributor Information

References

Associated Data

Supplementary Materials

Data Availability Statement

ACTIONS

PERMALINK

RESOURCES

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