Kidney disease and cardiovascular death: a comparative analysis of chronic kidney disease vs. acute renal failure outcomes using CDC WONDER

Abstract Introduction Chronic Kidney Disease (CKD), formerly Chronic Renal Failure (CRF), is a progressive decline in kidney function, ranging from early damage to severe impairment. Cardiovascular Disease (CVD) is the leading cause of death in CKD, responsible for 40–50% of fatalities in advanced stages. Whereas, Acute Renal Failure (ARF) is a sudden loss of kidney function, affecting waste excretion, urine concentration, and fluid balance. It is common in intensive care units, with a mortality rate of 50–80%. Cardiovascular causes account for 40–60% of AKI deaths, rising to 60% when AKI coexists with CKD. Objective This study compares the Cardiovascular mortality trends in patients with CKD vs ARF over a period of two decades Method The study uses CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) to perform a retrospective analysis of cardiovascular disease-related deaths in CKD and ARF patients in the United States from 1999 to 2020. The analysis uses ICD codes I10-I64 for underlying cardiovascular related causes, N18 for CKD and N17. Age-adjusted mortality rates (AAMRs) and annual percentage change (APC), along with 95% confidence intervals, were examined over time and across sex, racial/ethnic groups, and geographical regions using joinpoint analysis. Result Due to Cardiovascular diseases, a total of 565,190 and 248,946 deaths occurred in patients with CKD and ARF from 1999-2020, with an overall decrease in mortality trends for both groups. Age category 85+ years showed a higher mortality rate in both groups with a crude rate of 173.99 in CKD and 81.31 in ARF patients. While, our analysis shows higher mortality trends among males in both CKD and ARF in 2020, males demonstrated higher deaths in CKD as compared to ARF (CKD males AAMR = 20.22 , ARF males AAMR = 8.48). Overall, The NH Whites demonstrated the highest mortality trends in CKD (AAMR = 13.49; 95% Cl: 13.45 - 13.53) as well as in ARF patients (AAMR = 6.49; 95% Cl: 6.46 - 6.52). The Midwest region exhibited the highest mortality trends in CKD patients (APC: 0.02; 95%Cl: -1.50 to 1.67) whereas, South showed increased mortality in ARF patients (APC: 2.19; 95% Cl: -1.27 to 6.18). In terms of state-wise trends, California had a high overall mortality rate from CVD in both CKD and ARF. In contrast, Alaska exhibited a lower mortality rate for both the conditions. Conclusion From 1999 to 2020, mortality in CKD and ARF with underlying CVD declined but remained highest in adults 85+, males, and NH Whites. CKD mortality was highest in the Midwest, while ARF mortality increased in the South. California had the highest state-wise mortality, while Alaska had the lowest. These findings highlight significant demographic and geographic disparities, emphasizing the need for targeted interventions.Illustration Table 1