Concerning demographic and geographic disparities are present among certain patients with chronic kidney disease (CKD) and acute renal failure with underlying cardiovascular disease, according to an abstract presented at the European Society of Cardiology (ESC) 2025 Congress.1 Additionally, another abstract demonstrated that heart failure mortality among patients with advanced CKD has risen significantly over the past 2 decades.2 Of note, both ESC Congress abstracts utilized data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER).1,2
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Kidney Disease and Cardiovascular Death
The first abstract utilized the data to perform a retrospective analysis of cardiovascular disease-related deaths in US patients with CKD and acute renal failure from 1999 to 2020. The investigators utilized ICD codes I10-I64 for underlying cardiovascular-related causes, N18 for CKD, and N17. Additionally, age-adjusted mortality rates (AAMRs) and annual percentage change (APC), along with 95% confidence intervals, were examined over time and across sex, racial and ethnic groups, and geographical regions using a joinpoint analysis.1
Findings
From 1999 to 2020, the investigators observed a total of 565,190 and 248,946 deaths that occurred in patients with CKD and acute renal failure, respectively. Interestingly, there was an overall decrease in mortality trends for both groups. The 85-years-and-older age group demonstrated a higher mortality rate in both groups, with a crude rate of about 173.99 in CKD and 81.31 in acute renal failure, respectively. In 2020, the analysis showed higher mortality trends among male patients in both kidney disease groups; however, males demonstrated higher deaths in CKD (AAMR: 20.22) compared with acute renal failure (AAMR: 8.48).1
Further, the non-Hispanic White patients demonstrated the highest mortality trends in CKD (AAMR: 13.49; 95% Cl, 13.45–13.53) as well as in acute renal failure (AAMR: 6.49; 95% Cl, 6.46–6.52). In addition, the Midwest region exhibited the highest mortality trends in patients with CKD (APC: 0.02; 95% Cl, –1.50 to 1.67), whereas the Southern region showed increased mortality in patients with acute renal failure (APC: 2.19; 95% Cl, –1.27 to 6.18). Regarding state-specific trends, California had a high overall mortality rate from cardiovascular disease in both CKD and ARF. Conversely, Alaska was observed to have a lower mortality rate for both of the kidney diseases.1
Advanced CKD and Heart Failure Mortality
Similar to the previous abstract, this nationwide analysis also utilized data from the CDC WONDER database to calculate AAMR per 1 million individuals with advanced CKD aged 45 years and older who died from heart failure between 1999 and 2020. Heart failure-related deaths (ICD codes I11.0, I13.0, I13.2, I50.0, I50.1, and I50.9) and advanced CKD (N18.0, N18.4, N18.5) were identified from Multiple Causes of Death (MCD) records. Trends were analyzed across 10-year age groups, and joinpoint regression assessed AAPC in mortality rates.2
Findings
From 1999 to 2020, AAMR for heart failure with advanced CKD rose from about 27.99 to 87.88, with a steady increase after the early 2000s and a sharp surge following 2010, which peaked in 2020 (APCC: 5.3; 95% CI 4.1–6.6). Notably, male patients had higher AAMRs (71.5) compared with females (41.5). Crucially, racial disparities were evident, with non-Hispanic Black individuals having the highest AAMR (115.8), followed by American Indian or Alaskan Native (81.8), Hispanic or Latino (66.1), non-Hispanic Asian or Pacific Islander (49.1), and non-Hispanic White (45). Mortality rates were also slightly higher in metropolitan areas (53.9) than in nonmetropolitan areas (52.4).2
Additionally, age-specific trends demonstrated significant increases across all groups, with the highest CMR observed in patients aged 65 and older (123.8). Regional variations in AAMR were notable, with the highest rates in the South (57.6), followed by the Midwest (52.9), West (51.1), and Northeast (49.26). Further, most deaths occurred in inpatient medical facilities (n = 68,875), with California reporting the highest number of cases (n = 16,887).2
The findings from both abstracts show how having CKD—as well as other kidney diseases—is correlated with cardiovascular-related mortality. Depending on patients’ geographical location or demographics, there are notable disparities that present a higher incidence of death. The authors of both abstracts emphasized a need for optimized care, risk reduction, and policy reforms to address the disparities among underrepresented populations with kidney disease.1,2