Disparities in CKD-Associated Cardiac Arrest Across Demographics

Rates of chronic kidney disease (CKD)–associated cardiac arrest appear to be stable over time, but certain subsets of the patient population are at a higher risk of death, a new study found.¹

The study, which was based on data from the United States, found that men, Hispanic and non-Hispanic Black people, and people living in urban areas and the West had higher risk of mortality. Patients with higher Social Vulnerability Index (SVI) scores also had a higher mortality rate, they found. The study was published in the Journal of Arrhythmia.

The investigators concluded that epidemiological inequity in CKD and cardiovascular disease remains an important issue that requires further study of potential interventions. | Image credit: filins - stock.adobe.com

It has long been known that CKD increases the risk of cardiac arrest, noted corresponding author Hoang Nhat Pham, MD, of the University of Arizona, and colleagues. The reasons, they noted, are multifactorial, including electrolyte imbalances, inflammation, iron deposition, and structural heart changes, among others. Pham and colleagues said the innate risk of cardiac arrest in patients with CKD can also be exacerbated by a patient’s socioeconomic status. They noted that the CDC developed the SVI as a tool to measure the burden of social determinants of health on a patient. Previous research has suggested that high SVI scores, indicative of greater levels of social vulnerability, are associated with a higher risk of premature cardiovascular disease, heart failure, and other complications.²

Pham and colleagues searched the CDC’s Wide-ranging Online Data for Epidemiological Research (WONDER) database to identify people with CKD-related cardiac arrest listed as a cause of death. They found a total of 336,494 deaths between the years 1999 and 2020.

Those data showed that the age-adjusted mortality rates (AAMR) remained steady over time, with a rate of 4.64 deaths per 100,000 in 1999 (95% CI, 4.56-4.72) and 4.79 per 100,000 in 2020 (95% CI, 4.72-4.86).

When investigators broke down the data demographically, they found males had a higher mortality rate than females (AAMR, 5.95 vs 3.60). Non-Hispanic Black populations had an AAMR of 11.03 (95% CI, 10.95-11.11), compared with 3.38 for non-Hispanic White patients (95% CI, 3.36-3.39). Non-Hispanic American Indian/Alaska Native and Asian/Pacific Islander populations also had an elevated risk of death compared with non-Hispanic White patients.

Pham and colleagues further found that patients who lived in urban areas had higher mortality rates (AAMR, 4.76; 95% CI, 4.74-4.77) than those that lived in rural regions (AAMR, 3.70; 95% CI, 3.67-3.73). Those living in the Western US had the highest mortality rate of any region (AAMR, 6.70; 95% CI, 6.66-6.74). This finding contrasts with numerous earlier studies suggesting people living in the South have the greatest risk of cardiovascular disease and mortality.

The investigators also calculated that higher SVI was associated with an additional 4.09 excess deaths per 100,000 person-years. “This may reflect insufficient adoption of risk-factor management and low utility of standardized CKD management in vulnerable populations, despite advancements in guidelines over the last two decades,” Pham et al wrote.

The authors noted their findings align with previous research showing poverty is independently associated with kidney disease and that patients in racial or ethnic minority groups are at an increased risk of delayed diagnosis and treatment of cardiovascular disease.

The finding that patients in urban areas face greater risk may be due to environmental stressors and “urban infrastructure that fails to promote physical activity,” the authors suggested. They added that while many patients in rural areas face longer travel to get to health care facilities, certain pockets within urban areas are also “health care deserts.”

The investigators concluded that epidemiological inequity in CKD and cardiovascular disease remains an important issue that requires further study of potential interventions.

References

1. Shahid M, Pham HN, Ibrahim R, et al. Disparities in cardiac arrest mortality among patients with chronic kidney disease: A US-based epidemiological analysis. J Arrhythm. 2025;41(1):e13217. Published 2025 Jan 10. doi:10.1002/joa3.13217
2. Ibrahim R, Sainbayar E, Pham HN, et al. Social Vulnerability Index and cardiovascular disease care continuum: a scoping review. JACC Adv. 2024;3(7):100858. doi:10.1016/j.jacadv.2024.100858