impact of advanced chronic kidney disease stages on heart failure mortality: a nationwide analysis using CDC WONDER

Abstract Background Chronic kidney disease (CKD) is a well-established risk factor for cardiovascular complications, particularly heart failure (HF). Understanding the impact of advanced CKD stages on HF-related mortality is essential for identifying high-risk populations and guiding targeted interventions. Purpose This study utilizes CDC WONDER data to analyze HF mortality trends among individuals aged 45 and older with advanced CKD, assessing variations by age, sex, race/ethnicity, and geographic region. Identifying these disparities can inform clinical management strategies, improve healthcare resource allocation, and enhance prevention efforts to reduce HF mortality in patients with advanced CKD. Methods Using CDC WONDER data, we calculated AAMR per 1,000,000 individuals (≥45 years) who died from heart failure (HF) with advanced chronic kidney disease (CKD) between 1999 and 2020, using ICD-10 codes. HF-related deaths (I11.0, I13.0, I13.2, I50.0, I50.1, I50.9) and advanced CKD (N18.0, N18.4, N18.5) were identified from Multiple Causes of Death (MCD) records. Trends were analyzed across ten-year age groups. Joinpoint regression assessed annual and average annual percent change (AAPC) in mortality rates. Results From 1999 to 2020, AAMR for heart failure with advanced CKD rose from 27.99 to 87.88, with a steady increase after the early 2000s and a sharp surge post-2010, peaking in 2020 (APCC: 5.3, 95% CI: 4.1 to 6.6). Males had consistently higher AAMRs (71.5) than females (41.5). Racial disparities were evident, with non-Hispanic Black individuals having the highest AAMR (115.8), followed by American Indian/Alaskan Native (81.8), Hispanic/Latino (66.1), non-Hispanic Asian/Pacific Islander (49.1), and non-Hispanic White (45). Mortality rates were slightly higher in metropolitan areas (53.9) than in non-metropolitan areas (52.4). Age-specific trends showed significant increases across all groups, with the highest CMR observed in individuals aged 65 and older (123.8). Regional variations in AAMR were notable, with the highest rates in the South (57.6), followed by the Midwest (52.9), West (51.1), and Northeast (49.26). The majority of deaths occurred in inpatient medical facilities (68,875), with California reporting the highest number of cases (16,887). Conclusion Heart failure mortality among individuals with advanced CKD has risen significantly over the past two decades, with a sharp increase after 2010. Disparities persist across sex, race/ethnicity, and geographic regions, with non-Hispanic Black populations experiencing the highest mortality rates. The concentration of deaths in metro areas and medical facilities underscores the healthcare burden of managing HF in advanced CKD. Rising mortality necessitates early HF management in high-risk CKD patients through optimized care, risk reduction, and policy reforms.Central Illustration Deaths and Age-adjusted Mortality Rates