Kidney Week

Abstract: FR-PO0284

Sickle Cell Nephropathy Mortality in the United States, 1999-2024: Persistent Racial Inequity in the Disease-Modifying Therapy Era

Session Information

• CKD: Omics, Systemic Stressors, and Targeted Pharmacotherapy
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2201 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Kodali, Naga Anvesh, University of Central Florida/HCA Florida Ocala Hospital, Ocala, Florida, United States

Naga Anvesh Kodali, MD, MBBS

• Seth, Sukriti, University of Central Florida/HCA Florida Ocala Hospital, Ocala, Florida, United States

Sukriti Seth, MBBS

• Mitra, Chandan, University of Central Florida/HCA Florida Ocala Hospital, Ocala, Florida, United States

Chandan Mitra, MD, MPH

• Vaghela, Mahesh K., University of Central Florida/HCA Florida Ocala Hospital, Ocala, Florida, United States

Mahesh K. Vaghela, MD, FASN

Background

Sickle cell nephropathy (SCN) is a progressive complication of sickle cell disease (SCD) affecting up to 30% of patients and representing a leading cause of premature death in this population. The disease-modifying therapy era—marked by expanded hydroxyurea uptake, L-glutamine approval (2017), crizanlizumab and voxelotor (2019), and gene therapy breakthroughs (2023) has raised expectations for improved organ outcomes.

Methods

Using CDC WONDER Multiple Cause of Death data (1999–2024), we identified decedents with kidney failure (ICD-10: N17–N19) as the underlying cause and sickle cell disease (ICD-10: D57) as a contributing cause. Temporal trends were analyzed via Joinpoint Regression (NCI v5.0.2), reporting Annual Percent Change (APC) and Average Annual Percent Change (AAPC) with 95% confidence intervals. Pre- vs. post-hydroxyurea-expansion periods (1999–2011 vs. 2012–2024) were compared using rate ratios. Stratified analyses examined sex, race/ethnicity (Black vs. other), age group, urbanicity, and Census region.

Results

Over 25 years, 4,318 kidney failure deaths with co-occurring sickle cell disease were recorded nationally. The overall ASMR remained persistently elevated with an AAPC of +1.4% (95% CI: 0.6–2.2; p=0.002), indicating a modest but statistically significant upward trend despite the disease-modifying therapy era. Joinpoint regression identified a non-significant deceleration post-2017 (APC: −0.8%; 95% CI: −2.1–0.6; p=0.27), suggesting partial but incomplete attenuation. Black Americans constituted 93.7% of all SCN deaths, with an ASMR of 18.4 per 1,000,000 compared to 0.9 per 1,000,000 among White Americans (rate ratio: 20.4; 95% CI: 17.8–23.4). The South contributed 52.8% of all SCN deaths. Non-metropolitan counties showed a 28% higher ASMR than large urban centers, consistent with restricted specialist access. Young adults aged 25–44 years accounted for the largest share of premature SCN deaths (41.3%).

Conclusion

SCN mortality has not meaningfully declined over 25 years despite the introduction of multiple disease-modifying therapies, and the Black–White mortality ratio exceeds 20-fold—among the starkest racial disparities documented in organ-specific mortality literature. The failure of therapeutic advances to reach population-level mortality benefit likely reflects access barriers, underdiagnosis of early nephropathy.