CKD-Associated Cardiovascular Mortality in the United States: Temporal Trends From 1999 to 2020

Ofer Kobo; Dmitry Abramov; Simon Davies; Sofia B Ahmed; Louise Y Sun; Jennifer H Mieres; Purvi Parwani; Zbigniew Siudak; Harriette G C Van Spall; Mamas A Mamas

doi:10.1016/j.xkme.2022.100597

CKD-Associated Cardiovascular Mortality in the United States: Temporal Trends From 1999 to 2020

Kidney Med. 2022 Dec 28;5(3):100597. doi: 10.1016/j.xkme.2022.100597. eCollection 2023 Mar.

Authors

Ofer Kobo^{1

2}, Dmitry Abramov³, Simon Davies⁴, Sofia B Ahmed^{5

6

7}, Louise Y Sun^{8

9}, Jennifer H Mieres¹⁰, Purvi Parwani³, Zbigniew Siudak¹¹, Harriette G C Van Spall^{12

13

14}, Mamas A Mamas²

Affiliations

¹ Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel.
² Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom.
³ Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, California.
⁴ Department of Renal Medicine, School of Medicine, Keele University, David Weatherall Building, Keele, United Kingdom.
⁵ Department of Medicine, University of Calgary, Alberta, Canada.
⁶ Libin Cardiovascular Institute of Alberta, Calgary, Canada.
⁷ Alberta Kidney Disease Network, Calgary, Canada.
⁸ Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
⁹ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
¹⁰ Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York.
¹¹ Collegium Medicum, Jan Kochanowski University, Kielce, Poland.
¹² Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
¹³ Population Health Research Institute, Hamilton, Ontario, Canada.
¹⁴ Research Institute of St. Joseph's, Hamilton, Ontario, Canada.

Abstract

Rationale & objective: Chronic kidney disease (CKD) is associated with an increased risk of cardiovascular (CV) mortality, but there are limited data on temporal trends disaggregated by sex, race, and urban/rural status in this population.

Study design: Retrospective observational study.

Setting & participants: The Centers for Disease Control and Prevention Wide-Ranging, Online Data for Epidemiologic Research database.

Exposure & predictors: Patients with CKD and end-stage kidney disease (ESKD) stratified according to key demographic groups.

Outcomes: Etiologies of CKD- and ESKD-associated mortality between 1999 and 2000.

Analytical approach: Presentation of age-adjusted mortality rates (per 100,000 people) characterized by CV categories, ethnicity, sex (male or female), age categories, state, and urban/rural status.

Results: Between 1999 and 2020, we identified 1,938,505 death certificates with CKD (and ESKD) as an associated cause of mortality. Of all CKD-associated mortality, the most common etiology was CV, with 31.2% of cases. Between 1999 and 2020, CKD-related age-adjusted mortality increased by 50.2%, which was attributed to an 86.6% increase in non-CV mortality but a 7.1% decrease in CV mortality. Black patients had a higher rate of CV mortality throughout the study period, although Black patients experienced a 38.6% reduction in mortality whereas White patients saw a 2.7% increase. Hispanic patients experienced a greater reduction in CV mortality over the study period (40% reduction) compared to non-Hispanic patients (3.6% reduction). CV mortality was higher in urban areas in 1999 but in rural areas in 2020.

Limitations: Reliance on accurate characterization of causes of mortality in a large dataset.

Conclusions: Among patients with CKD-related mortality in the United States between 1999 and 2020, there was an increase in all-cause mortality though a small decrease in CV-related mortality. Overall, temporal decreases in CV mortality were more prominent in Hispanic versus non-Hispanic patients and Black patients versus White patients.

Keywords: Cardiovascular mortality; chronic kidney disease; race differences.