# Global burden, regional disparities, and future projections of hypertensive kidney disease in older adults: analysis of GBD 1990–2021 data

## TL;DR

This study analyzed global data to show how hypertensive kidney disease affects older adults, highlighting regional differences and predicting future trends.

## Contribution

The study provides new projections of hypertensive kidney disease burden and identifies key drivers of its increasing prevalence and mortality.

## Key findings

- High-SDI regions had higher HKD prevalence and incidence, while low-SDI regions had higher mortality and DALY rates.
- Males had higher HKD prevalence across all age groups, with the highest rates in those over 95 years.
- Population growth and aging were the main drivers of increased HKD burden from 1990 to 2021.

## Abstract

Hypertensive kidney disease (HKD) contributes significantly to global morbidity and mortality. This study evaluated the burden of HKD in older adults (≥60 years) across 204 countries from 1990 to 2021 and projected trends to 2045.

Data from the Global Burden of Disease Study 2021 were used to estimate HKD prevalence, incidence, mortality, and disability-adjusted life years (DALYs). Age-standardized rates (ASRs) were calculated with 95% uncertainty intervals (UIs). Temporal trends were analyzed using Joinpoint regression. Slope and concentration indices quantified health inequality. Decomposition and frontier analyses explored burden drivers. Future projections were made using Nordpred-based Bayesian age-period-cohort models. Sensitivity analyses assessed model robustness. Risk-attributable mortality was also estimated.

In 2021, global ASRs were 1674.9 (prevalence), 93.4 (incidence), 36.5 (mortality), and 631.1 (DALYs) per 100,000 older adults. High-SDI regions had higher prevalence (ASPR: 1857.8) and incidence (ASIR: 126.5), while low-SDI regions showed higher mortality (ASMR: 58.6) and DALY rates (ASDR: 972.7). Males across all age groups had higher prevalence (e.g. 95 plus: 9109.6 vs. 7031.5 per 100,000). Leading risk factors included low fruit intake (6.98 deaths per 100,000), high sodium, and lead exposure. From 1990-2021, ASIR (AAPC = 0.63%), ASMR (0.99%), and ASDR (0.77%) rose, while ASPR declined (-0.25%). Decomposition attributed burden increases mainly to population growth (72.3%) and aging (6.7%). Frontier analysis revealed substantial room for improvement in middle-SDI countries. Sensitivity analyses confirmed the stability of trend estimates and projections. Forecasts indicate that deaths in adults ≥90 will triple by 2045 (e.g. 95 plus: 75,271 vs. 20,242 in 2021).

HKD burden has grown substantially, with persistent geographic and socioeconomic disparities. Effective mitigation requires not only demographic- and region-specific interventions but also improved access to early detection and dietary risk reduction. Integration of kidney care into primary health systems and aging-focused strategies will be crucial to curb future disease escalation.