Global Burden and Health Inequalities of Heart Failure Attributable to Chronic Kidney Disease: A Comprehensive Analysis from 1990 to 2021.

BACKGROUND

Limited data are available regarding the global burden of heart failure attributable to chronic kidney disease (CKD-HF). The aim of this study was to estimate the disease burden and cross-national disparities in CKD-HF from 1990 to 2021.

METHODS

CKD-HF prevalence and years lived with disability (YLDs) were extracted from the Global Burden of Disease (GBD) database. The slope index of inequality (SII) and concentration index were adopted for analyzing absolute and relative health inequalities, and the autoregressive integrated moving average (ARIMA) model was applied to project trends in CKD-HF burden through 2040.

RESULTS

From 1990 to 2021, the CKD-HF age-standardized prevalence rate (ASPR) globally increased from 13.58 per 100,000 (95% uncertainty interval (UI): 11.16-16.22) to 24.21 (95% UI: 19.86-29.23), and the age-standardized years lived with disability (ASYR) increased from 1.73 (95% UI: 1.12-2.56) to 3.07 (95% UI: 1.95-4.44). By 2040, the global ASPR is projected to increase to 30.90 (95% confidence interval (CI): 29.62-32.18), with the ASYR expected to increase to 3.84 (95% CI: 3.59-4.08). In 2021, the highest ASPRs were observed in Western Sub-Saharan Africa, Andean Latin America and Central Latin America, whereas the highest ASYRs were observed in Australasia, Tropical Latin America, and Andean Latin America. Diabetic nephropathy and hypertensive nephropathy have emerged as increasingly significant drivers of the CKD-HF burden. The CKD-HF burden exhibited significant health inequities, with low-sociodemographic index (SDI) regions bearing a disproportionate share of the burden, a trend that is expected to persist through 2040.

CONCLUSION

Patients with CKD-HF exhibited a sustained increase in disease burden, a shift in the underlying cause distribution, and significant health disparities. There is an urgent need for more region-specific strategies to prevent the underlying causes and improve medical care for patients with CKD-HF to mitigate the future burden of this condition.