Global burden and trends of hypertension-related chronic kidney disease attributable to high body mass index or low physical activity: an analysis of data from the Global Burden of Disease Study 2021

Xiaohua LinKaiyi MiaoKaiqi HuangYanfang XuYujia Wang^*

• First Affiliated Hospital of Fujian Medical University, Fuzhou, China

Background: Hypertension-related chronic kidney disease (HT-CKD) is a global health threat exacerbated by modifiable metabolic risks. High BMI and low physical activity contribute to the development of hypertension and subsequent HT-CKD. This study quantified the global burden of HT-CKD attributable to high BMI or low physical activity from 1990 to 2021 and projected future trends to 2050. Methods: Using Global Burden of Disease (GBD) 2021 data, we analyzed deaths, disability-adjusted life years (DALYs), and age-standardized rates (ASRs) of HT-CKD attributable to high BMI or physical inactivity. The temporal trend of the disease burden was explored by the linear regression model from 1990 to 2021. The autoregressive integrated moving average (ARIMA) model and exponential smoothing (ES) model forecasted burden to 2050. Results: In 2021, HT-CKD attributable to high BMI caused 179,788 deaths and 4.26 million DALYs globally, representing 392.9% and 322.2% increases since 1990. HT-CKD attributable to low physical activity contributed 4,479 deaths and 77,879 DALYs, with similar growth. ASRs for deaths and DALYs showed significant global upward trends from 1990–2021 for both risk. North Africa had the highest ASR of death and DALYs for HT-CKD attributable to high BMI. For HT-CKD attributable to low physical activity, North Africa and South Africa showed the highest ASR of death and DALYs, respectively. Burden increased with age, peaking in populations ≥80 years and reaching maximal ASRs in the ≥95-year age group for both metrics and risks. Gender disparities revealed higher absolute deaths/DALYs in males for high BMI, but females exhibited faster ASR growth for low physical activity. All Socio-demographic Index (SDI) quintiles showed significant burden increases, with High-SDI regions experiencing the steepest ASR growth for HT-CKD attributable to high BMI and HT-CKD attributable to low physical activity, while Low-SDI regions had the slowest growth. ARIMA and ES models projected continued increases in absolute deaths and DALYs attributable to both risks from 2022–2050, particularly for high BMI. Conclusion: High BMI is the dominant metabolic driver of HT-CKD burden, with physical inactivity contributing significantly. This burden demonstrates pronounced demographic and geographic disparities, demanding urgent, targeted public health interventions to address obesity and promote physical activity.