Key takeaways:

• Between 1999 and 2024, 2020 and 2021 had the most respiratory failure and chronic kidney disease-related deaths.
• Men, non-Hispanic Black individuals and western region residents had high mortality rates.

ORLANDO — Among older U.S. adults, there has been an increase in respiratory failure and chronic kidney disease mortality rates from 1999 to 2021, according to a poster presented at the American Thoracic Society International Conference.

“People with kidney disease frequently develop significant respiratory complications,” Filza Rahat Khan, MBBS, emergency medicine registrar at Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust in the U.K., told Healio. “The interaction between these two conditions is clinically important and often underappreciated.”

Data derived from Sherwani M, et al. P1928: Temporal trends in mortality due to chronic kidney disease and respiratory failure among U.S. adults: A 25-year analysis using the CDC WONDER database (1999-2024). Presented at: American Thoracic Society International Conference; May 15-20, 2026; Orlando.

Using 1999 to 2024 data from the CDC WONDER Multiple Cause of Death database, Khan and colleagues analyzed 242,282 U.S. adults aged 65 years and older with respiratory failure and chronic kidney disease (CKD) as underlying or contributing causes of death to determine how mortality from these conditions has changed over the years.

“The goal of this research is to shed light on high-risk populations particularly those who are older or more frail and to address racial and regional inequities through improved public health education,” Khan said.

Most of the studied deaths occurred in medical facilities (71.6%), with fewer taking place in nursing homes (11.8%) and private homes (10%).

In 1999, the national age-adjusted mortality rate (AAMR) per 100,000 population — calculated using the U.S. 2000 standard population — was 7. By 2024, researchers found a higher national AAMR of 34.1 (annual percent change [APC], 7.6; 95% CI, 6.67-10.42).

Khan highlighted that 2020 and 2021 were the years with the most deaths and believes this can be “attributed in part to the compounding effects of the COVID-19 pandemic on patients with pre-existing cardiopulmonary and renal disease.”

Notably, in more recent years (2021 to 2024), the national AAMR fell, with an APC of –3.4 (95% CI, –15.48 to 6.3).

When divided by sex, the overall AAMR was greater in men vs. women (25.99 vs. 15.82).

Based on race/ethnicity, researchers observed the highest AAMR of 31.1 in the set of non-Hispanic Black individuals. The next highest AAMR was 21.5 in Hispanic/Latino individuals, followed by 18.7 in non-Hispanic “other” individuals and 15.1 in non-Hispanic white individuals.

By region, the highest AAMR was found in the West (22.3), followed by the South (19.77), the Midwest (19.18) and the Northeast (18.19).

Researchers noted that the state with highest AAMR was California (26). Other states in the 90th percentile included Indiana, Mississippi, South Carolina and Texas.

In contrast, the state with lowest AAMR was Alaska (10.4), and other states in the 10th percentile included Maine, New Mexico, Oregon and Wyoming.

The final subgroup researchers examined was metropolitan vs. non-metropolitan areas, which revealed a greater AAMR in metropolitan areas (17.15 vs. 16.32). Both area types had positive APCs from 1999 to 2020 (metropolitan, 7.32; non-metropolitan, 9.29), according to the poster.

“Clinicians and public health professionals working in high-burden regions need to proactively identify patients at risk for both CKD and respiratory failure, rather than waiting until these conditions present simultaneously in acute settings,” Khan said. “We also know that pulmonary disease places considerable hemodynamic stress on the heart, which compounds the overall clinical burden.”

When asked about future research, Khan told Healio it will focus on forecast modeling.

“This forecast analysis will help us understand where these trends are heading and, more importantly, what we can do to change that trajectory,” Khan said.

For more information:

Filza Rahat Khan, MBBS, can be reached at pulmonology@healio.com.