Cardiovascular mortality has decreased among patients in the United States with nondialysis-dependent chronic kidney disease (CKD), according to a study of data on nearly 2 million individuals from the Centers for Disease Control and Prevention.

From 1999 to 2020, age-adjusted all-cause mortality in the CKD population increased by 50.2% due to an 86.6% increase in noncardiovascular mortality and a 7.1% decrease in cardiovascular mortality, Mamas A. Mamas, MBBCh, of Keele University in the United Kingdom, and colleagues reported in Kidney Medicine. In the population with end-stage kidney disease (ESKD), age-adjusted all-cause mortality increased by 44.7% due to a 76.2% increase in noncardiovascular mortality that was offset by a 19.3% decrease in cardiovascular mortality.

Deaths from genitourinary (including renal) causes and malignancy increased for both the CKD and ESKD groups. Investigators also found a large increase in deaths from causes that could not be specified.

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With respect to cardiovascular mortality in the combined CKD/ESKD population, deaths from heart failure/cardiomyopathy and hypertensive diseases increased 66.7% and 50.0%, respectively, whereas deaths from ischemic heart diseases and cerebrovascular diseases decreased, Dr Mamas’ team reported. White patients were the only racial group to experience an increase in cardiovascular mortality (from 7.3% in 1999 to 7.5% in 2020). All other groups – Hispanic, Black, Asian/Pacific Islander, Native Americans – experienced decreases. Rural residents experienced an increase in their cardiovascular mortality rate, whereas urban residents had a decrease. Cardiovascular mortality improved similarly over time for both men and women.

The decreases in deaths due to ischemic heart diseases and cerebrovascular causes suggests that current strategies for cardiovascular disease have yielded benefit, according to Dr Mamas’ team. However, the increase in deaths from hypertension and heart failure warrant additional focus and strategies, such as use of sodium-glucose cotransporter 2 inhibitors and selective nonsteroidal mineralocorticoid receptor antagonists in patients with nondialysis CKD.


Kobo O, Abramov D, Davies S, Siudak Z, Van Spall HGC, Mamas MA. CKD-associated cardiovascular mortality in the United States: Temporal trends from 1999 to 2020. Kidney Med. Published online December 28, 2022. doi:10.1016/j.xkme.2022.100597