Global burden and trends of stroke attributable to kidney dysfunction from 1990 to 2021.

Background: Accumulating evidence suggests that kidney dysfunction (KD) is a risk factor for stroke and stroke subtypes (SSS). However, comprehensive studies on the global burden of SSS attributable to KD are lacking. This study aimed to compare the long-term trends of KD-related SSS from 1990 to 2021 at the global, regional and national levels, and predict the disease burden until 2045.

Methods: The dataset was collected from the 2021 Global Burden of Disease Study (GBD). The study estimated mortality and disability-adjusted life years (DALYs) counts, while also calculating estimated annual percentage changes (EAPCs) to evaluate long-term trends in age-standardized rates of mortality and DALYs. The analyses were stratified based on sex, 14 age categories, 5 socio-demographic index (SDI) quintiles, 21 GBD regions, and 204 nations and territories. Statistical analyses and visualizations were conducted using R version 4.4.2.

Results: Between 1990 and 2021, KD-related stroke mortality rose by 40.4%, and DALYs were increased by 36.7%, with EAPCs of -1.8 and -1.7, respectively. KD-related ischaemic stroke mortality and DALYs grew by 45.9% and 47.4%, with EAPCs of -1.9 and -1.7. KD-related intracerebral haemorrhage mortality and DALYs increased by 35.3% and 28.7%, with EAPCs of -1.7 and -1.7. There was notable variation by sex and age. The major burden was located in the middle SDI region and East Asia (especially in China). Decomposition analyses revealed an increase burden in total KD-related SSS, with a positive contribution from population growth and aging. The burden of KD-related SSS has steadily risen and is expected to keep growing until 2045.

Conclusion: Despite a slight decrease in long-term trends, this study highlights a significant rise in the global burden of KD-related SSS, with notable variations across SDI areas, GBD regions, countries, sexes and age groups. This increasing challenge necessitates specific therapies and public health initiatives for KD-related SSS.