Global Burden of Stroke Attributable to Kidney Dysfunction, 1992-2021: Age-Period-Cohort Analysis and Projected Trends

BACKGROUNDKidney dysfunction is an important modifiable risk factor for stroke, yet its attributable global burden remains understudied. This analysis quantifies its impact across demographics and projects future trends. METHODS AND RESULTSUsing Global Burden of Disease 2021 data, we analyzed stroke-related deaths and disability-adjusted life years (DALYs) attributable to kidney dysfunction globally, regionally, and nationally, stratified by age, sex, and socio-demographic index (SDI). Trends (1992-2021) were assessed via age-period-cohort (APC) modeling and estimated annual percentage change (EAPC). Contributions of aging, population growth, and epidemiological shifts were quantified through decomposition analysis. Bayesian models projected trends to 2040. Globally, age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life year rate (ASDR) declined (EAPC: -1.85% (95% CI -1.95 to -1.74) and -1.73% (95% CI -1.82 to -1.63)), yet absolute deaths and DALYs rose to 676,000 and 15.009 million in 2021. The burden surged after age 80, disproportionately affecting males and low-SDI regions. Middle-SDI regions showed the steepest declines, while Southern Sub-Saharan Africa experienced rising ASMR and ASDR. Projections suggest continued declines, particularly in females, though disparities persist. CONCLUSIONSDespite global declines, stroke burden attributable to kidney dysfunction remains elevated in older males and low-SDI regions. Targeted interventions addressing kidney health and equitable healthcare access are critical to mitigating disparities and reducing future burden.