Age- and Race-Specific Changes in ESKD Incidence over Four Decades

Abstract

Introduction: Substantial changes in End Stage Kidney Disease (ESKD) incidence over four decades among Black and White Americans of different ages have been incompletely explored. Methods: We analyzed United States Renal Data System data from 1980-2019 to determine ESKD incidence trends among Black and White adolescent (13-17 years), adult (18-64 years), and older adult (≥65) populations. We used the National Cancer Institute Joinpoint Regression Program to estimate Annual Percent Change in ESKD incidence and to define points in time where a statistically significant change in Annual Percent Change slope occurred for each group. Results: ESKD incidence rose after 1980 for all groups, although the trends differed (p<.001). Growth in incidence slowed for most by 1993 and by 2006 the Annual Percent Change in ESKD incidence had declined for all groups except White adults, for whom rates continued to rise (p<0.05). By 2019 ESKD incidence among Black and White adolescents nearly returned to 1980 levels, but no other group achieved that degree of improvement. Nonetheless, the ESKD incidence among Black Americans exceeds that of White patients in every age group. Conclusions: Distinct patterns in ESKD incidence among patients of different age, sex, and racial groups are shown. These findings could reflect changes in dialysis acceptance rates, access to preventive healthcare, incidence of diabetes mellitus, implementation of evidence-based guidelines for treatment of chronic kidney disease, or other unrecognized factors. There may be population-specific opportunities to change the growth of the US ESKD population and address current racial disparities.