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. 2016 Oct 4;165(7):473-481.
doi: 10.7326/M16-0273. Epub 2016 Aug 2.

Trends in Prevalence of Chronic Kidney Disease in the United States

Daniel Murphy  1 , Charles E McCulloch  1 , Feng Lin  1 , Tanushree Banerjee  1 , Jennifer L Bragg-Gresham  1 , Mark S Eberhardt  1 , Hal Morgenstern  1 , Meda E Pavkov  1 , Rajiv Saran  1 , Neil R Powe  1 , Chi-Yuan Hsu  1 ; Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team
Collaborators, Affiliations

Trends in Prevalence of Chronic Kidney Disease in the United States

Daniel Murphy et al. Ann Intern Med. .

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: NHANES (National Health and Nutrition Examination Survey) for 1988 to 1994 and every 2 years from 1999 to 2012.

Participants: Adults aged 20 years or older.

Measurements: Chronic kidney disease (stages 3 and 4) was defined as an estimated glomerular filtration rate (eGFR) of 15 to 59 mL/min/1.73 m2, estimated with the Chronic Kidney Disease Epidemiology Collaboration equation from calibrated serum creatinine measurements. An expanded definition of CKD also included persons with an eGFR of at least 60 mL/min/1.73 m2 and a 1-time urine albumin-creatinine ratio of at least 30 mg/g.

Results: The unadjusted prevalence of stage 3 and 4 CKD increased from the late 1990s to the early 2000s. Since 2003 to 2004, however, the overall prevalence has largely stabilized (for example, 6.9% prevalence in 2003 to 2004 and in 2011 to 2012). There was little difference in adjusted prevalence of stage 3 and 4 CKD overall in 2003 to 2004 versus 2011 to 2012 after age, sex, race/ethnicity, and diabetes mellitus status were controlled for (P = 0.26). Lack of increase in CKD prevalence since the early 2000s was observed in most subgroups and with an expanded definition of CKD that included persons with higher eGFRs and albuminuria.

Limitation: Serum creatinine and albuminuria were measured only once in each person.

Conclusion: In a reversal of prior trends, there has been no appreciable increase in the prevalence of stage 3 and 4 CKD in the U.S. population overall during the most recent decade.

Primary funding source: American Society of Nephrology Foundation for Kidney Research Student Scholar Grant Program, Centers for Disease Control and Prevention, and National Institutes of Health.

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Figures

Figure 1
Figure 1. Adjusted prevalence (as percentage) of CKD stages 3–4 (eGFR 15–59 ml/min/1.73m2 by CKD-EPI equation) in U.S. adults by age (1A), sex (1B), race/ethnicity (1C) and presence or absence of diabetes mellitus (1D), NHANES 1988–1994 through 2011–2012
Each subgroup is adjusted for the other three subgroup variables (e.g. 1A is adjusted for sex, race/ethnicity, and diabetes status). CKD=chronic kidney disease CKD-EPI = Chronic Kidney Disease-Epidemiology Collaboration eGFR = estimated glomerular filtration rate NHANES = National Health and Nutritional Examination Survey
See this image and copyright information in PMC

Comment in

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