Global Burden of Severe Heart Failure Attributable to Chronic Kidney Disease in Diabetes Populations: A Systematic Analysis of the Global Burden of Disease Study 2021.

Severe heart failure (SHF) secondary to chronic kidney disease (CKD) in type 1/2 diabetes mellitus (T1/T2DM) patients presents a critical global health challenge. Leveraging data from the Global Burden of Disease (GBD) 2021, we analyse epidemiological trends (1990-2021) and project disease trajectories to 2040, focusing on sociodemographic disparities and metabolic determinants. Utilising GBD 2021 data, the estimated prevalence and years lived with disability (YLDs) values were extracted for SHF-CKD-T1/T2DM, along with their corresponding 95% uncertainty intervals (UIs). The trend in SHF-CKD-T1/T2DM burden between 1990 and 2021 was evaluated from both a global and local perspective. Subgroup analysis was employed to examine the burden of SHF-CKD-T1/T2DM across various subpopulations. Additionally, decomposition analysis was used to assess the contributions of population size, age structure, and epidemiological changes to SHF-CKD-T1/T2DM burden. The Bayesian Age-Period-Cohort (BAPC) model and the Nordpred model projected the burden through 2040. In 2021, the prevalence of SHF-CKD-T1DM was 5723 (95% UI: 4397 to 7284) and SHF-CKD-T2DM was 122,404 (95% UI: 89,920 to 169,580). The age-standardised years lived with disability (YLDs) rates for SHF-CKD-T1DM in 2021 exhibited a significant increase to 0.012 (95% UI: 0.008 to 0.019), while YLDs rates for SHF-CKD-T2DM also showed a notable rise to 0.249 (95% UI: 0.146 to 0.394). The global burden of SHF-CKD-T1/T2DM showed variability across different sociodemographic index (SDI) regions. In 2021, the overall burden of SHF-CKD-T1/T2DM continued to increase, with age being a significant contributor. Similarly, SHF-CKD-T1/T2DM burden exhibited gender-specific variability. Decomposition analysis indicated that epidemiological changes were the primary contributors to the global burden of prevalence and YLDs associated with SHF-CKD-T1/T2DM. It is projected that by 2040, the trends in prevalence and YLDs will stabilise; however, they are expected to continue rising. The increasing burden of SHF-CKD-T1/T2DM is driven by epidemiological transitions, population growth, and regional disparities. Although growth rates have decelerated, the rising number of cases highlights the urgent need for targeted prevention and early intervention strategies in high-risk populations. To alleviate this burden, it is essential to address metabolic determinants, improve healthcare access in regions with high prevalence, expand diabetes treatment coverage in low-SDI regions, and incorporate cardiorenal risk stratification into diabetes management frameworks.