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National All-Cause Mortality Trends Among Adults With and Without CKD in the United States, 1999-2019
Daesung Choi1, Fang Xu1, Ibrahim Zaganjor1
1Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia.
Insights
All-cause mortality remained stable for US adults with chronic kidney disease (CKD) but was double that of those without CKD. Mortality increased in women with CKD, highlighting disparities in public health strategies.
Area of Science:
- Nephrology
- Public Health
- Epidemiology
Background:
- Chronic kidney disease (CKD) is a prevalent condition in the US, linked to increased risk of premature death, especially from cardiovascular disease.
- National trends in all-cause mortality for US adults with CKD require contemporary examination.
Purpose of the Study:
- To examine national trends in all-cause mortality among US adults diagnosed with chronic kidney disease (CKD) between 1999 and 2019.
Main Methods:
- An observational cohort study utilizing data from the National Health and Nutrition Examination Survey (1999-2016) with mortality follow-up through 2019.
- CKD defined by estimated glomerular filtration rate <60 ml/min/1.73 m² or urine albumin-to-creatinine ratio ≥30 mg/g.
- Age-standardized mortality rates were analyzed across three periods (1999-2004, 2005-2010, 2011-2016), calculating average percent change and relative risk.
Main Results:
- Overall age-standardized mortality rates for adults with CKD showed minimal change from 1999-2004 to 2011-2016 (APC: -0.4%).
- Mortality rates declined among men with CKD (APC: -3.0%) but increased among women with CKD (APC: 2.3%).
- Adults with CKD consistently had approximately double the adjusted relative risk of all-cause mortality compared to those without CKD across all study periods.
Conclusions:
- All-cause mortality among US adults with CKD has remained stable overall but is significantly higher than in the general population.
- Increasing mortality trends observed in specific subpopulations, such as women with CKD, underscore the need for targeted public health interventions.
- Further research is warranted to understand and address disparities in mortality risk among diverse CKD patient groups.
Rationale & Objective:
Chronic kidney disease (CKD) is one of the most highly prevalent chronic conditions in the United States and associated with a high risk of premature death, particularly from cardiovascular disease. However, contemporary national trends in all-cause mortality among adults with CKD in the United States remain unclear. This study examined trends in all-cause mortality among US adults with CKD from 1999 to 2019.
Study Design:
Observational cohort study.
Setting & Participants:
Adults aged ≥20 years who participated in the 1999-2016 National Health and Nutrition Examination Survey (NHANES), with mortality follow-up through December 2019.
Exposure:
CKD defined by an estimated glomerular filtration rate < 60 mL/min/1.73 m2 or a urinary albumin-creatinine ratio ≥ 30 mg/g.
Outcome:
All-cause mortality.
Analytical Approach:
Age-standardized all-cause mortality rates were estimated for 3 survey periods: 1999-2004, 2005-2010, and 2011-2016. Average percent change (APC) in age-standardized mortality and adjusted relative risk (RR) of CKD-associated mortality for each survey period were estimated.
Results:
Age-standardized mortality rate was 23.0 deaths/1,000 person-years (95% CI, 19.8-26.2) among adults with CKD surveyed 1999-2004 and 21.8 deaths/1,000 person-years (95% CI, 18.8-24.9) for those surveyed 2011-2016 (APC, -0.4% [95% CI, -1.4 to 0.5]). In contrast to men whose mortality declined (APC, -3.0 [95% CI, -3.5 to -2.6]), mortality rates increased among women with CKD (APC, 2.3 [95% CI, 1.7-3.0]). Adjusted RRs for CKD-associated mortality remained approximately 2-fold higher compared with adults without CKD across all time periods.
Limitations:
The cross-sectional design of NHANES precludes analysis of CKD progression or incident CKD during follow-up.
Conclusions:
All-cause mortality remained stable among adults with CKD and was about 2 times higher than for those without CKD. However, increasing mortality trends in specific demographic subpopulations may indicate the need for focused public health strategies and further research to address and reduce mortality disparities.
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