Abstract Body (Do not enter title and authors here): Background:Chronic kidney disease(CKD) is a growing global health challenge, with hypertension being a leading cause of renal dysfunction across populations. A major yet underrecognized complication of hypertensive CKD (HTN-CKD) is anemia, which not only worsens renal outcomes but also amplifies cardiovascular risk through mechanisms like left ventricular hypertrophy and myocardial strain. Understanding its burden is critical, as anemia in this setting accelerates disease progression and contributes significantly to cardiovascular morbidity and mortality.

Method:We estimated the global and regional burden of anemia attributable to HTN-CKD in 204 countries and its terriotories from 1990-2021 using standardized Global Burden of Disease Study 2021. Estimates of prevalence and years lived with disability(YLDs) were generated using DisMod-MR 2.1, a Bayesian meta-regression tool that integrates data from population-based surveys, cohort studies, hospital records, and vital registration systems. Age-standardized rates were calculated to facilitate comparisons across time and regions, and annualized percentage changes(APCs) were computed using log-linear regression.

Results:Between 1990 and 2021, the global prevalence of anemia attributable to HTN-CKD more than doubled, rising from 2.6 million(95% UI: 2.4–2.9 million) to 5.6 million(5.2–6.1 million), with an APC of +2.46%. Correspondingly, YLDs increased from 74,819 (49,512–106,554) to 138,672 (92,028–198,889), reflecting an APC of +2.01%. The highest regional increase in prevalence was observed in South Asia (APC: +3.16%), followed by Latin America and the Caribbean (+2.94%), Sub-Saharan Africa (+2.80%), and North Africa and the Middle East (+2.71%). The greatest rise in age-standardized prevalence rate was seen in Fiji (APC: +0.80%), followed by the United States (APC: +0.74%), signaling a growing concern even in high-resource settings like the USA. Among adults aged 70 years and above in middle and low-middle SDI regions, both prevalence and YLDs showed annualized increases exceeding 2%, whereas younger age groups in high SDI regions exhibited stable or declining trends.

Conclusion:The global burden of anemia due to HTN-CKD has escalated, with the sharpest increases concentrated in low- and middle-income regions where hypertension detection and management remain suboptimal. The burden is especially pronounced among older adults and men, accentuating widening disparities by age, sex, and socioeconomic status.