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A long-term nationwide study on chronic kidney disease-related mortality in Italy: trends and associated comorbidity

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Abstract

Background

Chronic kidney diseases (CKDs) represent a major public health concern worldwide with increasing incidence and prevalence. However, the epidemiological dimension of CKD in Italy is still under evaluation. By analyzing all the conditions reported on death certificates (multiple causes of death), we aimed to investigate the real burden of CKD mortality in Italy over 15 years and identify the main conditions contributing to death in association with CKD.

Methods

Death certificates of all deaths occurring in Italy from 2003 to 2017 were analyzed. Certificates reporting CKD were identified as CKD-related deaths. CKD-related mortality was investigated through age-standardized mortality rates, by sex and age. Conditions associated with CKD were identified through an indicator (age-standardized proportion ratio) measuring the excess proportion (value > 1) of having such conditions mentioned in the death certificate with and without CKD.

Results

From 2003 to 2017, multiple-cause-based CKD mortality rates increased by 60% in males and by 54% in females. The overall increase was mostly attributable to people aged 80 years or more. Several conditions were associated with CKD, the most relevant being diabetes (age-standardized proportion ratio = 2.2), obesity (2.1), systemic connective tissue disorders (2.3), anemia (2.7), and genitourinary system diseases (2.6).

Conclusions

Multiple-cause-of-death data revealed a significant increase in CKD-related mortality in recent years, providing a measure of the burden of CKD on overall mortality in Italy. Moreover, multiple cause analysis allowed to identify the main conditions contributing to death in association with CKD, which should be aggressively targeted by clinicians to prevent CKD adverse outcomes.

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Availability of data and material

The datasets generated and/or analyzed during the current study are not publicly available as access to individual data is limited to Istat authorized personnel. Nevertheless, aggregated data, in compliance with the Italian privacy legislation, are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Authors and Affiliations

  1. Italian National Institute of Statistics, Integrated System for Health, Social Assistance and Welfare, Rome, Italy

    Simone Navarra, Luisa Frova & Enrico Grande

  2. Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy

    Anna Solini

  3. Department of Clinical Medicine, Public Health, Life and Environmental Sciences (MeSVA), University of L’Aquila, L’Aquila, Italy

    Marco Giorgio Baroni

  4. IRCCS Neuromed-Pozzilli (IS), Pozzilli, Italy

    Marco Giorgio Baroni

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  1. Simone Navarra
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Contributions

All authors devised the study concept and design. SN and EG completed the acquisition of data and the statistical analysis. SN and EG wrote the first draft of the manuscript. All authors contributed to the interpretation of the results and the critical revision of the manuscript. All authors approved the final version of the manuscript.

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Correspondence to Simone Navarra.

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This article does not contain any studies with human participants or animals performed by any of the authors. Mortality data are routinely collected by the National Institute of Statistics. All analyses were carried out on aggregated data without any possibility of identification of individuals; therefore, the study was exempt from institutional review board approval.

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Navarra, S., Solini, A., Baroni, M.G. et al. A long-term nationwide study on chronic kidney disease-related mortality in Italy: trends and associated comorbidity. J Nephrol 35, 505–515 (2022). https://doi.org/10.1007/s40620-021-01132-9

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