National adult mortality trends due to chronic kidney disease-related atrial fibrillation in the United States from year 2011-2020.

Background: Atrial fibrillation (AF) associated with chronic kidney disease (CKD) is a prevalent condition in the United States, significantly impacting global morbidity and mortality. Understanding temporal patterns in AF-related mortality among CKD patients is crucial for effective clinical and public health strategies.

Aim: To investigate AF-CKD comorbidity and mortality on the national level.

Methods: Death certificates from the Centers for Disease Control Wide-Ranging Online Data for Epidemiologic Research database spanning 2011-2020 were analyzed to investigate AF-related CKD mortality in adults aged 35 to 85 or more years. Age-adjusted mortality rates (AAMRs) per 100000 persons and annual percent change (APC) were calculated, stratified by year, sex, race/ethnicity, and geographic region.

Results: A total of 110733 deaths occurred among adults (aged 35-85 or more years) related to AF associated with CKD in the United States. Overall AAMR declined from 8.1 in 2011 to 5.5 in 2014 (APC: -14.89; 95% confidence interval (CI): -30.44 to -4.06), followed by an increase to 10.3 in 2020 (APC: 9.91; 95%CI: 6.1-19.62). Men had higher AAMRs than women (men: 7.6, 95%CI: 7.6-7.7). Non-Hispanic White adults had the highest AAMR (7.8), followed by non-Hispanic Black (5). States in the top 90^th percentile had approximately four times higher AAMRs than those in the lower 10^th percentile. AAMR also varied by region (Midwest: 7.6, West: 6.7, Northeast: 6.3, South: 5.6), with nonmetropolitan areas exhibiting higher AF-associated CKD mortality.

Conclusion: Temporal trends in AF-related mortality among CKD patients showed fluctuations over the study period, with notable disparities across demographic and geographic factors. Targeted interventions are warranted to mitigate the burden of AF associated with CKD and reduce mortality rates in the United States.