Abstract
<title>Abstract</title> <p>Chronic kidney disease due to type 2 diabetes (CKD-T2DM) is an increasing contributor to the global kidney disease burden, yet its country-level burden structure remains incompletely characterised. Using Global Burden of Disease 2021 estimates, we analysed adults aged 45 years or older in 203 countries and territories from 1990 to 2021. T2DM-related and non-diabetic CKD-related indicators were incorporated into an XGBoost model with CKD-T2DM disability-adjusted life-years as the outcome, and SHAP was used to quantify model-attributed feature contributions. We developed the relative driver structure ratio (RDSR) to compare these contributions across countries and over time. Global RDSR increased from 0.21 (95% credible interval 0.14–0.27) in 1990 to 0.43 (0.37–0.49) in 2021, with higher values at higher Socio-demographic Index. Pacific Island countries and territories showed the highest CKD-T2DM burden and elevated body-mass index exposure. These findings describe model-attributed burden patterns rather than causal effects and may inform integrated diabetes-kidney surveillance.</p>