The Growing Threat of Infectious Mortality in Chronic Kidney Disease: Epidemiology, Disparities and Policy Implications

Abstract Background: Infectious mortality in chronic kidney disease (CKD) is an underrecognized yet growing public health concern in the United States. As cardiovascular mortality among CKD patients declines, infection-related deaths are becoming increasingly prominent. However, limited epidemiological data exists on the trends, disparities, and policy implications associated with infectious mortality in CKD. Methods: We conducted a retrospective analysis using CDC WONDER data from 1999 to 2020. Deaths with an underlying cause classified as infectious or parasitic disease (ICD-10: A00–B99) and CKD (ICD-10: N18.0–N18.9) listed as a contributing cause were included for individuals aged 15–84 years. Age-adjusted mortality rates (AAMRs) were calculated and analyzed using Joinpoint regression to identify temporal trends and annual percent changes (APCs). Stratified analyses were conducted by age, sex, race/ethnicity, and geographic region. Results: From 1999 to 2020, a total of 239,078 infection-related deaths were recorded in individuals with CKD. AAMRs rose from 3.08 per 100,000 in 1999 to 4.24 in 2020, with a significant inflection in 2016 (95% CI: 2014–2017). Mortality increased modestly from 1999 to 2016 (APC: 0.50%; 95% CI: 0.30–0.71) and sharply from 2016 to 2020 (APC: 4.98%; 95% CI: 3.38–6.60). Disparities were pronounced, with males accounting for 53.3% of deaths and Black individuals bearing the highest burden, especially in the Southern U.S. Most deaths occurred in hospitals and leading causes included septicemia, pneumonia/influenza, and COVID-19. Conclusions: Infectious mortality in CKD is rising, particularly in vulnerable subgroups, driven by uremic immunosuppression, antimicrobial resistance, and systemic inequities. Strengthening preventive strategies such as targeted vaccination, infection control in dialysis units, and equitable healthcare delivery is essential. Reinforcing public health infrastructure and addressing structural disparities are essential to mitigate this growing threat to CKD patients.