Trends, underlying-cause structure, and penetration of end-stage kidney disease involvement in U.S. mortality, 1999–2023: a multiple-cause-of-death analysis

Background End-stage kidney disease (ESKD) is often listed as a contributing rather than underlying cause of death, potentially understating its burden in underlying-cause surveillance. Using U.S. multiple-cause-of-death data, we evaluated trends, underlying-cause pathways, ESKD “penetration” into cause-specific mortality, and drivers of change in ESKD-involved deaths. Methods Using CDC WONDER Multiple Cause of Death data (1999–2023), we identified ESKD-involved deaths among adults aged ≥25 year