Twenty-six-year trends in U.S. mortality among older adults with coexisting chronic kidney disease and atrial fibrillation/flutter

Background: Chronic kidney disease (CKD) and atrial fibrillation/flutter (AF/AFL) frequently coexist in older adults, sharing common risk factors such as hypertension, diabetes, and coronary artery disease. However, long-term national mortality trends among patients with concurrent CKD and AF/AFL remain poorly defined. The primary research question of this study is to examine how the combined presence of CKD and AF/AFL has influenced mortality rates in older adults in the U.S. over the past 26 years. Methods: We analyzed mortality data from the CDC Wide-Ranging Online Data for Epidemiologic Research database for U.S. adults aged ≥65 years from 1999 to 2024. Deaths listing both CKD (ICD-10 N18.0–N18.9) and AF/AFL (I48) were identified. Age-adjusted mortality rates (AAMRs) per 100 000 population were calculated using the 2000 U.S. standard population and stratified by sex, race/ethnicity, census region, and urban–rural status. Temporal trends were assessed using Joinpoint regression to estimate annual percentage change (APC). Results: A total of 203 662 deaths were attributed to concurrent CKD and AF/AFL. The overall AAMR increased from 4.9 per 100 000 in 1999 to 30.0 per 100 000 in 2024. Mortality rose rapidly from 1999 to 2011 (APC: +12.3%, P = 0.0016), followed by a slower, non-significant increase from 2011 to 2024 (APC: +3.9%, P = 0.0767). Mortality was higher in men and in nonmetropolitan areas. Non-Hispanic White and Black populations showed the greatest increases, while Hispanic and Asian/Pacific Islander groups had the lowest rates. The Midwest and West exhibited the highest regional burdens, with notable state-level variation. Conclusions: Mortality linked to concurrent CKD and AF/AFL has risen sharply, with widening disparities by sex, race, and geography. Integrated, equitable care strategies are urgently needed.