Renal failure mortality, 1999-2022: exploring demographic and regional trends and the impact of the COVID-19 pandemic.

BACKGROUND

Renal failure, including acute kidney injury (AKI) and chronic kidney disease (CKD), represents a significant contributor to morbidity and mortality. Previous studies of CDC WONDER data related to renal diseases have not tracked mortality into the pandemic years, and have not analyzed disparities in deaths from renal failure specifically. Our study addresses these two gaps.

METHODS

Renal failure-related mortality data were extracted from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database and stratified into different demographic and geographic groups. Statistically significant trends in mortality over time were identified using Joinpoint regression.

RESULTS

Overall age-adjusted mortality rate from renal failure increased from 1999 to 2003 with annual percent change of 3.17 (95% CI 2.16 to 4.35), decreased from 2003 to 2012 with annual percent change − 1.11 (95% CI -2.01 to -0.83), remained stable from 2012 to 2020 with APC − 0.53 (95% CI -0.91 to 0.17), and increased from 2020 to 2022 with APC 4.11 (95% CI 2.06 to 5.28) during the years of the COVID-19 pandemic. Many demographic and regional groups followed similar trends. Males, Black or African Americans, and the elderly had significantly higher renal failure-related mortality rates than their demographic counterparts. The West census region had significantly lower renal failure-related mortality rates than the other census regions.

CONCLUSION

There were significant increases in renal failure mortality rates from 2020 to 2022, reversing nearly two decades of declining rates. While our study cannot provide causal analysis, this increase maps neatly onto the years of the COVID-19 pandemic. Several demographic and regional disparities were noted. Strength of conclusions are limited by the data source, which does not allow us to adjust for comorbidities or socioeconomic factors, and relies entirely on death certificates.