Increased mortality in chronic kidney disease: a call to action.

The mortality rate among patients with chronic kidney disease is much higher than among those without. As glomerular filtration rate declines and patients approach end-stage renal disease, the mortality rate increases and patients at this stage are more likely to die than receive renal replacement therapy. The higher mortality and its underlying causes among chronic kidney disease patients is a serious issue. Lack of physician awareness of chronic kidney disease and its association with excess mortality remains a problem. In this review of current literature, we aim to increase this awareness among health care professionals and the general public and to call for action to improve survival in chronic kidney disease patients. The data strongly suggest that advancing kidney dysfunction leads to increased mortality risk. Contributing to the mortality associated with chronic kidney disease are the comorbidities that accompany this disease state. For instance, patients with chronic kidney disease and comorbidities are at 1.3 to 3.6 times more risk than patients without chronic kidney disease. Further, cardiovascular disease is the leading cause of death among chronic kidney disease patients. It appears that both traditional (such as diabetes mellitus, hypertension, and smoking) and nontraditional risk factors (C-reactive protein and interleukin-6 levels) present in the chronic kidney disease population promote the frequent development of cardiovascular disease. Therefore, therapies targeting both progression of chronic kidney disease and comorbidities such as cardiovascular disease are required to reduce mortality among these patients.