Elevated BMI and Physical Inactivity Drive Rising Global Hypertension-CKD Burden

Elevated body mass index (BMI) and low physical activity may be major, modifiable contributors to the rising global burden of hypertension-related chronic kidney disease (HT-CKD), according to new research.1

New analysis quantified HT-CKD burden attributable to both risk factors from 1990 to 2021 and projected the possibility of increasing trends in disability-adjusted life years (DALYs) and deaths through 2050 for this patient population.1

“Elevated BMI is the dominant metabolic driver of hypertension-CKD burden, with physical inactivity playing a significant role,” wrote study investigators, Yujia Wang, MD, from the Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, and colleagues. “This burden demonstrates pronounced demographic and geographic disparities, highlighting the need for urgent, targeted public health interventions to combat obesity and promote physical activity.”1

Hypertension remains one of the leading modifiable contributors to adverse renal and cardiovascular outcomes in patients with CKD. The relationship between CKD and hypertension is synergistic: uncontrolled blood pressure accelerates intraglomerular hypertension, glomerulosclerosis, and tubulointerstitial injury, thereby promoting progression to end-stage renal disease (ESRD), while declining renal function further exacerbates hypertension.1,2

Elevated BMI and low physical activity can further increase hypertension-related renal injury through mechanisms including renin-angiotensin-aldosterone system activation, sodium retention, and chronic low-grade inflammation, collectively increasing the global burden of HT-CKD.1,2

To assess this, investigators conducted a retrospective analysis using data from the Global Burden of Disease (GBD) 2021 study. Outcomes included deaths, DALYs, and age-standardized rates (ASRs) of HT-CKD attributable to elevated BMI and low physical activity.1

“This study represented the first comprehensive global burden assessment of HT-CKD attributable to two pivotal modifiable metabolic risk factors—elevated BMI and low physical activity—from 1990 to 2021, with projections to 2050,” wrote Wang and colleagues.1

In 2021, investigators observed HT-CKD attributable to elevated BMI resulted in an estimated 179,788 deaths (95% uncertainty interval [UI], 91,323–260,251), accounting for 0.26% of global deaths. The corresponding age-standardized death rate was 2.19 (95% UI, 1.11–3.19) per 100,000 population. Investigators also reported 4,257,037 DALYs (95% UI, 2,119,854–6,136,203), representing 6.17% of global DALYs, with an age-standardized DALY rate of 50.11 (95% UI, 25.00–72.49) per 100,000 population.1

Globally, investigators noted substantial geographic heterogeneity in the burden of HT-CKD attributable to elevated BMI. Among all regions, the Americas recorded the highest absolute number of deaths, totaling 66,801 (95% UI, 36,624–90,568).1

From 1990 to 2021, investigators observed a marked rise in deaths from HT-CKD attributable to elevated BMI, increasing from 36,476 to 179,788 cases—a 392.89% increase. Over the same period, the age-standardized death rate increased by 100.92%. DALYs rose from 1,008,372 in 1990 to 4,257,037 in 2021, representing a 322.17% increase, while the age-standardized DALY rate increased from 26.04 to 50.11 (92.43%). Investigators reported significant upward trends in global age-standardized death rates and DALYs, with estimated annual percentage changes (EAPCs) of 3.38% (95% CI, 2.99–3.78) for death rates and 2.97% (95% CI, 2.7–3.23) for DALYs.1

In sex-specific analyses, investigators observed consistent annual increases in both deaths and DALYs attributable to elevated BMI among male and female individuals. Among males, deaths increased from 17,805 (95% UI, 8,034–30,806) in 1990 to 88,941 (95% UI, 44,216–131,308) in 2021. Among females, deaths increased from 18,671 (95% UI, 9,115–28,969) to 90,847 (95% UI, 47,294–131,912) over the same period.1

Upon age-stratified analyses, investigators observed progressively increasing deaths and DALYs attributable to elevated BMI beginning at age 40 years and peaking in older age groups in 2021. Mortality peaked in the 85–89 age group for both sexes. Male deaths exceeded female deaths through the 75–79 age group, after which females exhibited higher mortality rates in individuals aged ≥80 years.1

Using autoregressive integrated moving average (ARIMA) and exponential smoothing (ES) models, investigators projected future trends in HT-CKD attributable to elevated BMI from 2022 to 2050. The ARIMA model predicted continued increases in deaths and DALYs for both men (65.43% and 77.71%, respectively) and women (75.54% and 90.07%, respectively). Age-standardized rates were also projected to rise among men by 35.18% for deaths and 39.06% for DALYs.1

Investigators clarify current estimates and future projections should account for data limitations, regional uncertainty, and potential changes in risk exposure and healthcare trends.1

References

1. Lin X, Miao K, Huang K, Xu Y, Wang Y. Global burden and trends of hypertension-related chronic kidney disease attributable to high body mass index or low physical activity: an analysis based on global burden of disease study 2021 data. Frontiers in Nutrition. 2026;12. doi:https://doi.org/10.3389/fnut.2025.1701077

2. National Institute of Diabetes and Digestive and Kidney Diseases. High blood pressure & kidney disease. National Institute of Diabetes and Digestive and Kidney Diseases. Published March 2020. https://www.niddk.nih.gov/health-information/kidney-disease/high-blood-pressure