Keywords
Chronic Kidney Disease
Trends
Disparities
Categories
How to Cite
Abstract
Background: Multiple Myeloma (MM) is the second most common hematological cancer, with chronic kidney disease (CKD) representing a major complication. This study aims to analyze national mortality trends, demographic differences, and geographic variation related to MM and CKD.
Methods: Nationwide mortality records were obtained from the CDC-WONDER database from 1999 to 2023 among U.S. adults aged ≥45 with MM (C90.0) and CKD (N18); Deaths recorded anywhere on the death certificate (multiple-cause). Age-adjusted mortality rates (AAMRs) per 100,000 populations were calculated for variables. Joinpoint regression analysis was utilized to evaluate annual percent changes (APCs).
Results: From 1999 to 2023, a total of 24,606 deaths occurred among adults with MM and CKD in the U.S. The overall AAMR increased from (0.65) in 1999 to (0.86) in 2023 (AAPC: 1.22; 95% CI: 0.54 to 2.00; p<0.001). Males had a higher overall AAMR (1.09) and a more rapid increase (AAPC: 1.40; p<0.001) compared to females (AAMR: 0.60; AAPC: 0.71; p=0.027). Racially, NH Blacks had the highest AAMR (2.14). Regionally, the highest AAMRs were in the South (0.83). Metropolitan areas had a higher overall AAMR 0.81 than Non-metropolitan areas 0.77 (available 1999–2020 only). Most deaths occurred in inpatient medical facilities (46.27%). Among adults aged ≥65 years, overall CMR was 1.80 per 100,000.
Conclusion: Mortality from MM and CKD is increasing in the U.S from 1999 to 2023. NH Blacks, males, urban areas and the South region face high burden of death, underscoring the need for targeted strategies to reduce these substantial disparities.
References
1. Smith L, McCourt O, Henrich M, Paton B, Yong K, Wardle J, Fisher A. Multiple myeloma and physical activity: a scoping review. BMJ Open. 2015: e009576 [PMID: 26614625, https://doi.org/10.1136/bmjopen-2015-009576]
2. Doddi S, Rashid MH. Disparities in Multiple Myeloma Mortality Rate Trends by Demographic Status in the USA. Cancer Diagn Progn. 2024: 288 [PMID: 38707728, https://doi.org/10.21873/cdp.10322]
3. Katagiri D, Noiri E, Hinoshita F. Multiple myeloma and kidney disease. ScientificWorldJournal. 2013: 487285 [PMID: 24288486, https://doi.org/10.1155/2013/487285]
4. Chakraborty R, Majhail NS. Treatment and disease-related complications in multiple myeloma: Implications for survivorship. Am J Hematol. 2020: 672 [PMID: 32086970, https://doi.org/10.1002/ajh.25764]
5. Gozzetti A, Candi V, Papini G, Bocchia M. Therapeutic advancements in multiple myeloma. Front Oncol. 2014: 241 [PMID: 25237651, https://doi.org/10.3389/fonc.2014.00241]
6. Touzeau C, Raguideau F, Denis H, Lamarsalle L, Guilmet C, Javelot M, Pierres M, Perrot A. Epidemiology of patients treated for multiple myeloma using a new algorithm in the French national health insurance database (SNDS): Results from the MYLORD study. PLoS One. 2025: e0322474 [PMID: 40338880, https://doi.org/10.1371/journal.pone.0322474]
7. Zhou L, Yu Q, Wei G, Wang L, Huang Y, Hu K, Hu Y, Huang H. Measuring the global, regional, and national burden of multiple myeloma from 1990 to 2019. BMC Cancer. 2021: 606 [PMID: 34034700, https://doi.org/10.1186/s12885-021-08280-y]
8. Zhu DT, Park A, Lai A, Zhang L, Attar H, Rebbeck TR. Multiple myeloma incidence and mortality trends in the United States, 1999-2020. Sci Rep. 2024: 14564 [PMID: 38914692, https://doi.org/10.1038/s41598-024-65590-4]
9. Lazana I, Floro L, Christmas T, Shah S, Bramham K, Cuthill K, Bassett P, Schey S, Kazmi M, Potter V, Pagliuca A, Streetly M, Benjamin R. Autologous stem cell transplantation for multiple myeloma patients with chronic kidney disease: a safe and effective option. Bone Marrow Transplant. 2022: 959 [PMID: 35413986, https://doi.org/10.1038/s41409-022-01657-y]
10. Sandsmark DK, Messe SR, Zhang X, Roy J, Nessel L, Lee Hamm L, He J, Horwitz EJ, Jaar BG, Kallem RR, Kusek JW, Mohler ER, 3rd, Porter A, Seliger SL, Sozio SM, Townsend RR, Feldman HI, Kasner SE, Investigators CS. Proteinuria, but Not eGFR, Predicts Stroke Risk in Chronic Kidney Disease: Chronic Renal Insufficiency Cohort Study. Stroke. 2015: 2075 [PMID: 26130097, https://doi.org/10.1161/STROKEAHA.115.009861]
11. Molina-Andujar A, Robles P, Cibeira MT, Montagud-Marrahi E, Guillen E, Xipell M, Blasco M, Poch E, Rosinol L, Blade J, Quintana LF. The renal range of the kappa/lambda sFLC ratio: best strategy to evaluate multiple myeloma in patients with chronic kidney disease. BMC Nephrol. 2020: 111 [PMID: 32234026, https://doi.org/10.1186/s12882-020-01771-3]
12. Qian Y, Bhowmik D, Bond C, Wang S, Colman S, Hernandez RK, Cheng P, Intorcia M. Renal impairment and use of nephrotoxic agents in patients with multiple myeloma in the clinical practice setting in the United States. Cancer Med. 2017: 1523 [PMID: 28612485, https://doi.org/10.1002/cam4.1075]
13. Shahid H, Haseeb A, Iftikhar A, Sial F. Trends in mortality of renal failure in adult multiple myeloma patients: a CDC data analysis (1999-2020). Int Urol Nephrol. 2025: [PMID: 40936059, https://doi.org/10.1007/s11255-025-04788-5]
14. Ibrahim AA, Hemida MF, Hussein M, Saghir M, Faisal MR, Kritika FNU, Patel K, Ali A, Saghir E, Tablawy M, Mohamed AH, Arafa A. Disparities and Trends in Polycythemia Vera–Related Mortality in U.S. Adults Aged ≥45 Years from 1999 to 2023. ASIDE Internal Medicine. 2025: 24 https://doi.org/10.71079/aside.Im.092725233]
15. Ibrahim AA, Hemida MF, Sharma B, Patel K, Qadri M, Alsaadi M, Arafa AO. MM-1180: Persistent Disparities in Multiple Myeloma and Renal Disease Mortality Across US Demographics and Regions (1999–2020): A CDC WONDER Database Analysis. Clinical Lymphoma Myeloma and Leukemia. 2025: S971 https://doi.org/10.1016/s2152-2650(25)02697-7]
16. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008: 344 [PMID: 18313558, https://doi.org/10.1016/j.jclinepi.2007.11.008]
17. CDC. Race and Ethnicity Measurement Methods - NCHS Rapid Surveys System 2023 [cited 2025 11/10/2025]. Available from: https://www.cdc.gov/nchs/rss/round1/omb.html.
18. Aggarwal R, Chiu N, Loccoh EC, Kazi DS, Yeh RW, Wadhera RK. Rural-Urban Disparities: Diabetes, Hypertension, Heart Disease, and Stroke Mortality Among Black and White Adults, 1999-2018. J Am Coll Cardiol. 2021: 1480 [PMID: 33736831, https://doi.org/10.1016/j.jacc.2021.01.032]
19. Ingram DD, Franco SJ. 2013 NCHS urban-rural classification scheme for counties: US Department of Health and Human Services, Centers for Disease Control and …; 2014.
20. Hemida MF, Khan A, Ibrahim AA, Goel A, Patel K, Shahriar Z, Hageen AW, Alsaadi M, Rahman SU, Arafa A, Kholeif Z, Bahnasy A. Trends in Mortality from Leukemia and Ischemic Heart Disease: A 22-Year Analysis in the U.S. (1999-2020). ASIDE Internal Medicine. 2025: 21 https://doi.org/10.71079/aside.Im.091425163]
21. Anderson RN, Rosenberg HM. Age standardization of death rates: implementation of the year 2000 standard. Natl Vital Stat Rep. 1998: 1 [PMID: 9796247,
22. SR P. Joinpoint Regression Program. Joinpoint Trend Analysis Software 2025. Available from: https://surveillance.cancer.gov/joinpoint/.
23. Grant SJ, Wildes TM, Rosko AE, Silberstein J, Giri S. A real-world data analysis of predictors of early mortality after a diagnosis of multiple myeloma. Cancer. 2023: 2023 [PMID: 36989073, https://doi.org/10.1002/cncr.34760]
24. Urban VS, Cegledi A, Mikala G. Multiple myeloma, a quintessential malignant disease of aging: a geroscience perspective on pathogenesis and treatment. Geroscience. 2023: 727 [PMID: 36508077, https://doi.org/10.1007/s11357-022-00698-x]
25. Hommos MS, Glassock RJ, Rule AD. Structural and Functional Changes in Human Kidneys with Healthy Aging. J Am Soc Nephrol. 2017: 2838 [PMID: 28790143, https://doi.org/10.1681/ASN.2017040421]
26. Fraz MA, Warraich FH, Warraich SU, Tariq MJ, Warraich Z, Khan AY, Usman M, Ijaz A, Tenneti P, Mushtaq A, Akbar F, Shahid Z, Ali Z, Fazeel HM, Rodriguez C, Nasar A, McBride A, Anwer F. Special considerations for the treatment of multiple myeloma according to advanced age, comorbidities, frailty and organ dysfunction. Crit Rev Oncol Hematol. 2019: 18 [PMID: 31014512, https://doi.org/10.1016/j.critrevonc.2019.02.011]
27. Shpitzer D, Cohen YC, Shragai T, Grossberger O, Amsterdam D, Reiner-Benaim A, Avivi I. Clinical outcomes in older adults treated outside clinical studies: highlighting the octogenarian experience. Blood Adv. 2025: 2677 [PMID: 40048737, https://doi.org/10.1182/bloodadvances.2025015968]
28. Blimark C, Holmberg E, Mellqvist UH, Landgren O, Bjorkholm M, Hultcrantz M, Kjellander C, Turesson I, Kristinsson SY. Multiple myeloma and infections: a population-based study on 9253 multiple myeloma patients. Haematologica. 2015: 107 [PMID: 25344526, https://doi.org/10.3324/haematol.2014.107714]
29. Belotti A, Ribolla R, Cancelli V, Crippa C, Bianchetti N, Ferrari S, Bottelli C, Cattaneo C, Tucci A, De La Fuente Barrigon C, Rossi G. Transplant eligibility in elderly multiple myeloma patients: Prospective external validation of the international myeloma working group frailty score and comparison with clinical judgment and other comorbidity scores in unselected patients aged 65-75 years. Am J Hematol. 2020: 759 [PMID: 32242970, https://doi.org/10.1002/ajh.25797]
30. Branco C, Silva M, Rodrigues N, Vieira J, Forjaz Lacerda J, Lopes JA. The Role of High-Risk Cytogenetics in Acute Kidney Injury of Newly Diagnosed Multiple Myeloma: A Cohort Study. Int J Mol Sci. 2025: [PMID: 40649884, https://doi.org/10.3390/ijms26136108]
31. Swartling O, Rydell H, Stendahl M, Segelmark M, Trolle Lagerros Y, Evans M. CKD Progression and Mortality Among Men and Women: A Nationwide Study in Sweden. Am J Kidney Dis. 2021: 190 [PMID: 33434591, https://doi.org/10.1053/j.ajkd.2020.11.026]
32. Antlanger M, Noordzij M, van de Luijtgaarden M, Carrero JJ, Palsson R, Finne P, Hemmelder MH, Areste-Fosalba N, Reisaeter AV, Cases A, Traynor JP, Kramar R, Massy Z, Jager KJ, Hecking M, Registry E-E. Sex Differences in Kidney Replacement Therapy Initiation and Maintenance. Clin J Am Soc Nephrol. 2019: 1616 [PMID: 31649071, https://doi.org/10.2215/CJN.04400419]
33. Vadakedath S, Kandi V. Dialysis: A Review of the Mechanisms Underlying Complications in the Management of Chronic Renal Failure. Cureus. 2017: e1603 [PMID: 29067226, https://doi.org/10.7759/cureus.1603]
34. Patwardhan V, Gil GF, Arrieta A, Cagney J, DeGraw E, Herbert ME, Khalil M, Mullany EC, O'Connell EM, Spencer CN, Stein C, Valikhanova A, Gakidou E, Flor LS. Differences across the lifespan between females and males in the top 20 causes of disease burden globally: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Public Health. 2024: e282 [PMID: 38702093, https://doi.org/10.1016/S2468-2667(24)00053-7]
35. Mouhieddine TH, Weeks LD, Ghobrial IM. Monoclonal gammopathy of undetermined significance. Blood. 2019: 2484 [PMID: 31010848, https://doi.org/10.1182/blood.2019846782]
36. Leung N, Bridoux F, Nasr SH. Monoclonal Gammopathy of Renal Significance. N Engl J Med. 2021: 1931 [PMID: 34010532, https://doi.org/10.1056/NEJMra1810907]
37. Wadhera RK, Rajkumar SV. Prevalence of monoclonal gammopathy of undetermined significance: a systematic review. Mayo Clin Proc. 2010: 933 [PMID: 20713974, https://doi.org/10.4065/mcp.2010.0337]
38. Viera AJ, Thorpe JM, Garrett JM. Effects of sex, age, and visits on receipt of preventive healthcare services: a secondary analysis of national data. BMC Health Serv Res. 2006: 15 [PMID: 16504097, https://doi.org/10.1186/1472-6963-6-15]
39. Buck T, Hartley-Brown MA, Efebera YA, Milner CP, Zonder JA, Richardson PG, Salinardi T, Rice MS. Real-world multiple myeloma risk factors and outcomes by non-Hispanic Black/African American and non- Hispanic White race/ethnicity in the United States. Haematologica. 2024: 1882 [PMID: 38031762, https://doi.org/10.3324/haematol.2023.282788]
40. Peres LC, Colin-Leitzinger CM, Teng M, Dutil J, Alugubelli RR, DeAvila G, Teer JK, Du D, Mo Q, Siegel EM, Hampton OA, Alsina M, Brayer J, Blue B, Baz R, Silva AS, Nishihori T, Shain KH, Gillis N. Racial and ethnic differences in clonal hematopoiesis, tumor markers, and outcomes of patients with multiple myeloma. Blood Adv. 2022: 3767 [PMID: 35500227, https://doi.org/10.1182/bloodadvances.2021006652]
41. Caraballo C, Ndumele CD, Roy B, Lu Y, Riley C, Herrin J, Krumholz HM. Trends in Racial and Ethnic Disparities in Barriers to Timely Medical Care Among Adults in the US, 1999 to 2018. JAMA Health Forum. 2022: e223856 [PMID: 36306118, https://doi.org/10.1001/jamahealthforum.2022.3856]
42. Moore JX, Chaudhary N, Akinyemiju T. Metabolic Syndrome Prevalence by Race/Ethnicity and Sex in the United States, National Health and Nutrition Examination Survey, 1988-2012. Prev Chronic Dis. 2017: E24 [PMID: 28301314, https://doi.org/10.5888/pcd14.160287]
43. Caraballo C, Massey D, Mahajan S, Lu Y, Annapureddy AR, Roy B, Riley C, Murugiah K, Valero-Elizondo J, Onuma O, Nunez-Smith M, Forman HP, Nasir K, Herrin J, Krumholz HM. Racial and Ethnic Disparities in Access to Health Care Among Adults in the United States: A 20-Year National Health Interview Survey Analysis, 1999-2018. medRxiv. 2020: [PMID: 33173905, https://doi.org/10.1101/2020.10.30.20223420]
44. Saka AH, Giaquinto AN, McCullough LE, Tossas KY, Star J, Jemal A, Siegel RL. Cancer statistics for African American and Black people, 2025. CA Cancer J Clin. 2025: 111 [PMID: 39976243, https://doi.org/10.3322/caac.21874]
45. Gurka MJ, Filipp SL, DeBoer MD. Geographical variation in the prevalence of obesity, metabolic syndrome, and diabetes among US adults. Nutr Diabetes. 2018: 14 [PMID: 29549249, https://doi.org/10.1038/s41387-018-0024-2]
46. Serchen J, Johnson D, Cline K, Hilden D, Algase LF, Silberger JR, Watkins C, Jr., Health, Public Policy C, the Medical P, Quality Committee of the American College of P. Improving Health and Health Care in Rural Communities: A Position Paper From the American College of Physicians. Ann Intern Med. 2025: 701 [PMID: 40163886, https://doi.org/10.7326/ANNALS-24-03577]
47. Al-Hamadani M, Hashmi SK, Go RS. Use of autologous hematopoietic cell transplantation as initial therapy in multiple myeloma and the impact of socio-geo-demographic factors in the era of novel agents. Am J Hematol. 2014: 825 [PMID: 24799343, https://doi.org/10.1002/ajh.23753]
48. Terlizzi EP, Cohen RA. 2023: https://doi.org/10.15620/cdc:133320]
49. Daniel H, Bornstein SS, Kane GC, Health, Public Policy Committee of the American College of P, Carney JK, Gantzer HE, Henry TL, Lenchus JD, Li JM, McCandless BM, Nalitt BR, Viswanathan L, Murphy CJ, Azah AM, Marks L. Addressing Social Determinants to Improve Patient Care and Promote Health Equity: An American College of Physicians Position Paper. Ann Intern Med. 2018: 577 [PMID: 29677265, https://doi.org/10.7326/M17-2441]
50. Mettias S, ElSayed A, Moore J, Berenson JR. Multiple Myeloma: Improved Outcomes Resulting from a Rapidly Expanding Number of Therapeutic Options. Target Oncol. 2025: 247 [PMID: 39878864, https://doi.org/10.1007/s11523-024-01122-4]
51. Dimopoulos MA, Mikhael J, Terpos E, Leleu X, Moreau P, Blade J, Kim JS, Stockerl-Goldstein K, Richardson PG. An overview of treatment options for patients with relapsed/refractory multiple myeloma and renal impairment. Ther Adv Hematol. 2022: 20406207221088458 [PMID: 35392438, https://doi.org/10.1177/20406207221088458]
52. Dimopoulos MA, Merlini G, Bridoux F, Leung N, Mikhael J, Harrison SJ, Kastritis E, Garderet L, Gozzetti A, van de Donk N, Weisel KC, Badros AZ, Beksac M, Hillengass J, Mohty M, Ho PJ, Ntanasis-Stathopoulos I, Mateos MV, Richardson P, Blade J, Moreau P, San-Miguel J, Munshi N, Rajkumar SV, Durie BGM, Ludwig H, Terpos E, International Myeloma Working G. Management of multiple myeloma-related renal impairment: recommendations from the International Myeloma Working Group. Lancet Oncol. 2023: e293 [PMID: 37414019, https://doi.org/10.1016/S1470-2045(23)00223-1]
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2025 Alyaa Ahmed Ibrahim, Mohamed Fawzi Hemida, Amro Ali, Raveen Mujeeb, Mohammad Rayyan Faisal, Mahmoud Tablawy, Krish Patel, Maryam Saghir, Eshal Saghir, Sara Hasanin, Ahmed Atef Mohamed, Safeya Fawzi, Arwa Khaled Dessouky, Ahmed Khairy, Asmaa Mohamed, Abdelrhman H. Mohamed, Abdullah Farahat Elbanna