Incidence of End-Stage Renal Disease Attributed to Diabetes Among Persons with Diagnosed Diabetes - United States and Puerto Rico, 2000-2014

Abstract

During 2014, 120,000 persons in the United States and Puerto Rico began treatment for end-stage renal disease (ESRD) (i.e., kidney failure requiring dialysis or transplantation) (1). Among these persons, 44% (approximately 53,000 persons) had diabetes listed as the primary cause of ESRD (ESRD-D) (1). Although the number of persons initiating ESRD-D treatment each year has increased since 1980 (1,2), the ESRD-D incidence rate among persons with diagnosed diabetes has declined since the mid-1990s (2,3). To determine whether ESRD-D incidence has continued to decline in the United States overall and in each state, the District of Columbia (DC), and Puerto Rico, CDC analyzed 2000-2014 data from the U.S. Renal Data System and the Behavioral Risk Factor Surveillance System. During that period, the age-standardized ESRD-D incidence among persons with diagnosed diabetes declined from 260.2 to 173.9 per 100,000 diabetic population (33%), and declined significantly in most states, DC, and Puerto Rico. No state experienced an increase in ESRD-D incidence rates. Continued awareness of risk factors for kidney failure and interventions to improve diabetes care might sustain and improve these trends.

FIGURE 1

Number and rate of adults aged ≥18 years who began treatment for end-stage renal disease attributed to diabetes (ESRD-D), U.S. states, the District of Columbia, and Puerto Rico, 2000–2014^† * Rate per 100,000 persons with diabetes and age-standardized to the 2000 U.S. standard population, excluding Alaska, Vermont, and Wyoming because of the small annual number (<50) of new ESRD-D cases during the study period. ^† In 2011, the Behavioral Risk Factor Surveillance System (BRFSS) survey changed sampling and weighting methodology and added cell phone respondents; however, this change did not appear to affect overall estimates of self-reported diabetes. BRFSS estimates of the population with self-reported diabetes were used to calculate ESRD-D incidence rates.

FIGURE 2

Age-standardized incidence of end-stage renal disease attributed to diabetes (ESRD-D) among adults aged ≥18 years with diagnosed diabetes, by state^† — U.S. states, the District of Columbia, and Puerto Rico, 2000 and 2014^§ Abbreviations: DC = District of Columbia; PR = Puerto Rico. * Rate per 100,000 persons with diabetes and age-standardized based on the 2000 U.S. standard population. ^† Alaska, Vermont, and Wyoming were excluded because of the small annual number (<50) of new ESRD-D cases. ^§ Legend categories were created using ranks based on the combined 2000 and 2014 rates.