Mortality Burden and Life-Years Lost Across the Age Spectrum for Adults Living with Chronic Kidney Disease

Abstract

Background: 

Younger individuals living with CKD face a lifetime at risk for complications and mortality. Limited data exists to inform individual patients with CKD across the lifespan how their risk for mortality compares with equivalently aged individuals without CKD, particularly at younger ages. The objective of this study is to provide age specific contexts to the risk of mortality associated with a diagnosis of CKD.

Methods: 

We created a pooled study cohort using participants with CKD enrolled in the Chronic Renal Insufficiency Cohort along with participants aged 21-75 years included in the 1999-2008 NHANES surveys. Age-stratified mortality rates, along with unadjusted and adjusted hazard ratios (HR) for mortality were generated to compare differences between those with and without CKD. Mean life-years-lost (LYL) relating to CKD were calculated using CDC life tables.

Results: 

A total of 16,725 participants were included. Mortality rates were higher in those with CKD at all ages. The adjusted age stratified hazard ratio (HR) for mortality in those with CKD versus without was highest in the 21-35yr strata (HR [95% CI]: 4.9 [2.8, 8.]) )and lowest in the 65-75yr strata (HR [95% CI]: 2.0 [1.7, 2.3]). Mean LYL secondary to CKD was inversely related with increasing age.

Conclusions: 

Compared to age-matched peers without CKD, the age-stratified risk for mortality and LYL associated with a diagnosis of CKD is highest in younger individuals. Further research is needed to elucidate the societal and personal costs of premature mortality associated with CKD in young adults.