TOPLINE: 

Age-adjusted rates of stroke-related mortality among adults with chronic kidney disease (CKD) in the United States declined from 1.08 to 0.71 per 100,000 people from 1999 to 2020. However, men, non-Hispanic Black individuals, residents of certain regions and states, and individuals living in small metropolitan areas continued to experience disproportionately high mortality, revealing persistent sociodemographic and geographic disparities.

METHODOLOGY:

• CKD is a major independent risk factor for stroke, but stroke mortality trends across racial, geographic, and socioeconomic groups remain poorly characterized despite CKD disproportionately affecting marginalized communities.
• This study analyzed 37,308 stroke-related deaths among US-based adults aged 25 years or older with CKD from 1999 to 2020; both stroke- and CKD-related deaths were identified using standard diagnostic codes.
• Variables extracted for decedents with CKD included year of death, sex, race/ethnicity (non-Hispanic Asian or Pacific Islander, non-Hispanic White, non-Hispanic Black, and Hispanic or Latino), geographic region and state (Northeast, Midwest, South, and West), place of death (hospital, home, hospice, and nursing home/long‑term care facility), and urbanization level (large central metro, large fringe metro, medium metro, small metro, micropolitan, and noncore).
• Crude annual mortality rates per 100,000 people were calculated, and age‑adjusted mortality rates (standardized to the 2000 US standard population) were used to enable valid comparisons across time and demographic groups.

TAKEAWAY:

• From 1999 to 2020, the age-adjusted stroke-related mortality rate among patients with CKD fell from 1.08 to 0.71 per 100,000 people; however, it fluctuated over this period. It declined between 1999 and 2009, rose between 2009 and 2012, declined sharply between 2012 and 2015, and rose again between 2015 and 2020.
• Mortality rates were higher among men than among women (0.79 vs 0.71 per 100,000 people), with significant declines in both groups over the study period.
• When stratified by race and ethnicity, Black or African American individuals had the highest age-adjusted mortality rate for stroke with CKD, followed by Hispanic or Latino, Asian or Pacific Islander, and White individuals.
• Regionally, the West had the highest age-adjusted stroke-related mortality rate; at the state level, mortality varied more than threefold, from 1.27 in the District of Columbia to 0.38 in Arizona; by urbanization status, small metropolitan areas had the highest mortality rate.

IN PRACTICE:

"The findings highlight the need for targeted public health efforts to address these persistent disparities. Future research should focus on identifying the underlying biological, structural, and systemic factors contributing to these differences and evaluating interventions aimed at reducing stroke mortality among CKD populations, " the authors wrote.

SOURCE:

The study was led by Muhammad Ibrahim, MD, Department of Nephrology, Faisalabad Medical University in Faisalabad, Pakistan. It was published online on December 25, 2025, in the World Journal of Nephrology.

LIMITATIONS: 

The study's retrospective nature limited control over data accuracy and may have introduced bias associated with administrative records. The dependence on coding for identifying stroke and CKD could have resulted in misclassification or underreporting, while temporal changes in coding practices may have affected trend consistency. The lack of granular clinical information, such as CKD stage, duration, or treatment modalities, limited the depth of clinical interpretation. 

DISCLOSURES:

The authors report no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.