Cause-Specific Deaths in Non-Dialysis-Dependent CKD

Area of Science:

• Nephrology
• Public Health
• Epidemiology

Background:

• Chronic kidney disease (CKD) is linked to increased mortality risk.
• Specific causes of death in non-dialysis-dependent CKD patients require further elucidation.
• Understanding cause-specific mortality is crucial for targeted interventions in CKD management.

Purpose of the Study:

• To investigate the leading causes of death in a large, non-dialysis-dependent CKD population.
• To analyze the association between declining estimated glomerular filtration rate (eGFR) and cause-specific mortality.
• To examine racial differences in mortality causes among CKD patients.

Main Methods:

• Utilized an electronic medical record-based CKD registry and Ohio Department of Health mortality files.
• Included 33,478 white and 5042 Black patients with CKD (eGFR < 60 ml/min/1.73 m² on two occasions).
• Classified causes of death (before end-stage renal disease) into cardiovascular, malignancy, and other categories.

Main Results:

• Cardiovascular diseases (34.7%) and malignant neoplasms (31.8%) were the primary causes of death.
• Malignancy-related deaths were more prevalent in earlier stages of CKD.
• Each 5 ml/min/1.73 m² decline in eGFR correlated with increased risk of cardiovascular and non-cardiovascular/non-malignancy deaths, but not malignancy deaths. Black patients showed higher cardiovascular death risk compared to white patients.

Conclusions:

• Cardiovascular disease and cancer are the dominant causes of mortality in non-dialysis CKD.
• Declining kidney function significantly elevates the risk of cardiovascular and other non-malignancy deaths.
• Targeting cardiovascular risk factors and cancer risk factors is essential for improving survival in CKD populations, with attention to racial disparities.