Abstract
BACKGROUND: Ischemic heart disease (IHD) remains a leading cause of global morbidity and mortality, with kidney dysfunction (KD) emerging as a critical independent risk factor. This study aimed to provide a comprehensive analysis of the global burden and trends of KD-attributed IHD from 1990 to 2021. METHODS: We analyzed data from the Global Burden of Disease (GBD) study 2021, covering 204 countries and territories from 1990 to 2021. We examined trends in mortality and disability-adjusted life years (DALYs) of KD-attributable IHD, with stratification by sex, age, and socio-demographic index (SDI). The association between burden and SDI was evaluated using Spearman's correlation coefficient, and a smoothed curve model was developed to analyze the stage of the association. RESULTS: From 1990 to 2021, global deaths and DALYs from KD-attributable IHD increased by 22.4% and 18.7%, respectively, despite a decline in age-standardized rates (ASRs). Low- and low-middle SDI regions experienced the highest burden, with increasing ASRs, while high-SDI regions showed significant reductions. Males exhibited a higher burden, with pronounced age-specific increases in IHD burden post-50 years. Significant threshold effects were observed, with substantial declines in ASRs only in regions with SDI values above 0.7. CONCLUSIONS: The global burden of KD-attributable IHD is increasing, especially in low- and middle-income countries. Socioeconomic development plays a crucial role in mitigating the disease burden, underscoring the need for targeted interventions, including chronic kidney disease screening, lifestyle modification, and integrated cardiovascular and renal care.