National All-Cause Mortality Trends Among Adults With and Without CKD in the United States, 1999-2019

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: 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.