Temporal trends and disparities in mortality involving chronic kidney disease and malnutrition among U.S. adults, 1999–2024: a nationwide population-based study

BackgroundChronic kidney disease (CKD) and malnutrition frequently coexist and are associated with adverse outcomes, yet long-term population-level mortality trends involving both conditions remain poorly characterized. This study examined temporal trends, demographic disparities, and future mortality patterns among U.S. adults with CKD and malnutrition.MethodsWe conducted a nationwide population-based analysis using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause of Death database from 1999 to 2024. Adults aged ≥45 years were included when both CKD and malnutrition were documented on the same death certificate, with each condition recorded as either the underlying or a contributing cause of death. Joinpoint regression was used to estimate annual percent changes (APCs) and average annual percent changes (AAPCs). Autoregressive integrated moving average (ARIMA) models were used to project mortality through 2048.ResultsA total of 46,343 deaths involving both CKD and malnutrition were identified. Annual deaths increased from 847 in 1999 to 4,887 in 2024, while the overall AAMR increased from 0.89 to 3.22 per 100,000 population (AAPC, 5.01%; 95% CI, 2.85–7.20). Joinpoint analysis showed an initial decline followed by a marked increase during 2008–2011 and sustained acceleration after 2014. Males had higher AAMRs than females in 2024 (3.57 vs. 2.96 per 100,000). NH Black adults had the highest absolute AAMR (4.75 per 100,000), whereas NH White adults experienced the fastest long-term increase (AAPC, 6.55%; 95% CI, 4.06–9.09). Mortality rose sharply with advancing age, reaching 34.30 per 100,000 among adults aged ≥85 years in 2024. Nonmetropolitan populations had persistently higher mortality than metropolitan populations through 2020. ARIMA projections suggested continued increases in both AAMRs and annual deaths through 2048.ConclusionMortality involving both CKD and malnutrition increased substantially among U.S. adults aged ≥45 years over the past 26 years, with marked disparities by sex, race and ethnicity, age, and urbanization. Earlier nutritional risk identification, strengthened multidisciplinary CKD care, and targeted strategies for high-risk and underserved populations may help mitigate the future mortality burden.