Hypertensive kidney disease with concurrent diabetes mellitus: national mortality trends from CDC WONDER 1999–2024

Background: Hypertension and diabetes are among the most prevalent conditions in the world, which can severely affect the kidneys, especially when they occur together. This study analyzes mortality trends among the American population with hypertensive kidney disease (HKD) and diabetes. Methods: We carried out a retrospective analysis from 1999 to 2024 of nationwide mortality data obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database. We included individuals with HKD diabetes (ICD-10 codes: I12, E10-E14) using a multiple cause of death approach (reporting any mention of the diagnosis as an underlying or contributing cause of death). We calculated the age-adjusted mortality rates (AAMR) per 100 000 population, and analysis based on year, gender, race/ethnicity, state, and urban/rural classification was performed. Joinpoint regression analysis was used to determine significant annual percent changes (APCs) in AAMR over the study period. Results: A total of 242 071 deaths among the patient population were reported, and analysis revealed a significant increase in the overall AAMR for mortality related to HKD and diabetes, rising from 1.1 per 100 000 in 1999 to 4.9 per 100 000 in 2024. Men consistently showed higher AAMRs (overall 2.4) compared to women (overall 2.0). Among racial and ethnic groups, the highest overall AAMR was observed in the non-Hispanic Black or African American population (6.9). States that showed the highest AAMR included California, South Carolina, Texas, Mississippi, and the District of Columbia. Additionally, nonmetropolitan areas demonstrated a generally higher AAMR (2.6) compared to metropolitan areas (2.5). Conclusions: HKD-related mortality among diabetic Americans surged between 1999 and 2024, with gender, race/ethnicity, and geographic location disparities, especially in nonmetropolitan areas. Targeted health strategies and interventions are vital to reducing mortality and addressing these disparities.