Trends in Prevalence of Chronic Kidney Disease in the United States

Abstract

Background Trends in the prevalence of chronic kidney disease (CKD) are important for health-care policy and planning. Objective To update trends in CKD prevalence. Design Repeated cross-sectional study. Setting National Health and Nutrition Examination Survey (NHANES) in 1988–94 and every two years from 1999 to 2012. Participants Adults 20 years or older. Measurements CKD (stages 3–4) was defined using glomerular filtration rate (GFR) estimated with the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation from calibrated serum creatinine measurements (eGFR 15–59 ml/min/1.73m2). An expanded definition of CKD also included persons with an eGFR ≥60 ml/min/1.73m2 and a one-time urine albumin-to-creatinine ratio ≥30 mg/g. Results An increase in the unadjusted prevalence of stages 3–4 CKD occurred from the late 1990s to the early 2000’s. Since 2003–04, however, the prevalence of stages 3–4 CKD overall has largely stabilized (e.g. 6.9% prevalence of stage 3–4 CKD in 2003–04 and 6.9% prevalence in 2011–12). There was little difference in adjusted prevalence of stage 3–4 CKD overall comparing 2003–04 and 2011–12 after controlling for age, sex, race/ethnicity, and diabetes mellitus status (p=0.26). Lack of increase in CKD prevalence since the early 2000’s was observed in most subgroups and with an expanded definition of CKD which included persons with higher eGFRs but with albuminuria. Limitations Serum creatinine and albuminuria were measured only once in each subject. Conclusions In a reversal of prior trends, there has been no appreciable increase in the prevalence of stages 3–4 CKD in the U.S. population overall during the most recent decade.

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“…Chronic kidney disease (CKD) is a public health problem of major significance with nearly 13% of the US population being affected during the recent years [1]. The average age of patients starting dialysis has been increasing [2].…”

“…The average age of patients starting dialysis has been increasing [2]. These patients often consider prognosis while making these decisions [1,3]. Experts in the field have called for more studies analyzing prognosis and risk fac-tors for early mortality in CKD patients [4].…”

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“…1,2 Persons with CKD are at high risk of cardiovascular disease (CVD), progression to end-stage renal disease (ESRD), and all-cause mortality. 3 Hypertension is a well-known risk factor for CVD; therefore, optimal blood pressure (BP) control is a major clinical and public health priority.…”

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