Mortality trends involving chronic kidney disease and electrolyte and acid–base disorders in the United States, 1999–2023: a CDC WONDER analysis
Zemichael Getu Alemayehu, Abenezer Shiferaw Keraga, Fikir Kibret, Yeabsra Tewdrose Tsegaye, Beamlak Getachew Woldeselassie, Bona Degefu Zerfu, Yonatan Abbawa Zewdie, Yared Mezemir Tiruneh, Yonathan Belay Kebede, Brook Lelisa Sime, Frealem Wechefo AmenuBackground:
Chronic kidney disease (CKD) is a growing global health burden, often complicated by electrolyte and acid–base disorders that exacerbate morbidity and mortality. Despite recognition of CKD-related cardiovascular outcomes, mortality patterns involving metabolic complications remain underexplored.
Methods:
Using CDC WONDER Multiple Cause-of-Death data (1999–2023), we identified adult deaths (≥25 years) involving CKD (ICD-10 code N18) and electrolyte and acid–base disorders (ICD-10 codes E87.0–E87.8). Age-adjusted mortality rates (AAMRs) were calculated per 100 000 population, stratified by sex, race/ethnicity, census region, and urbanization. Temporal trends were assessed using Joinpoint regression.
Results:
Between 1999 and 2023, 75 149 deaths occurred among individuals with both CKD and electrolyte/acid–base disorders (overall AAMR, 1.35). Mortality remained relatively stable, with a non-significant downward trend until 2008, and then rose sharply (APC, 6.54%; 95% CI, 5.33–7.77), peaking during the COVID-19 pandemic. Men had consistently higher AAMRs than women (1.63 vs 1.14). Non-Hispanic Black individuals had the highest burden (AAMR, 3.01), nearly threefold higher than that of non-Hispanic Whites. Geographic disparities were also evident, with the South and rural counties experiencing higher and progressively increasing mortality rates.
Conclusions:
Mortality co-involving CKD and electrolyte and acid–base disorders has more than doubled in the U.S. since 2008, with widening disparities by sex, race/ethnicity, and geography. These findings highlight the growing contribution of metabolic complications to CKD-related mortality and underscore the need for earlier detection and management of electrolyte and acid–base disturbances alongside equity-focused interventions for high-risk populations.