Projecting ESRD Incidence and Prevalence in the United States through 2030

Abstract

Background: Population rates of obesity, hypertension, diabetes, age, and race can be used in simulation models to develop projections of ESRD incidence and prevalence. Such projections can inform long-range planning for ESRD resources needs.

Methods: We used an open compartmental simulation model to estimate the incidence and prevalence of ESRD in the United States through 2030 on the basis of wide-ranging projections of population obesity and ESRD death rates. Population trends in age, race, hypertension, and diabetes were on the basis of data from the Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey and the US Census.

Results: The increase in ESRD incidence rates within age and race groups has leveled off and/or declined in recent years, but our model indicates that population changes in age and race distribution, obesity and diabetes prevalence, and ESRD survival will result in a 11%-18% increase in the crude incidence rate from 2015 to 2030. This incidence trend along with reductions in ESRD mortality will increase the number of patients with ESRD by 29%-68% during the same period to between 971,000 and 1,259,000 in 2030.

Conclusions: The burden of ESRD will increase in the United States population through 2030 due to demographic, clinical, and lifestyle shifts in the population and improvements in RRT. Planning for ESRD resource allocation should allow for substantial continued growth in the population of patients with ESRD. Future interventions should be directed to preventing the progression of CKD to kidney failure.

Keywords: United States Renal Data System; computer simulation; demographic trends; end stage kidney disease.

Graphical abstract

Figure 1.

Obesity has risen, but the models cover a wide range of possible future trends. Estimated and projected trends in the prevalence of obesity (body mass index of 30+ kg/m²; percentage) between 1960 and 2030 in the general United States population. Estimated obesity prevalence from Ljungvalla et al. and Ogden et al. using the National Health and Nutrition Examination Survey data.

Figure 2.

Death rates among ESRD patients have fallen. Age-specific ESRD death rates (per 1000/year) by year (1980–2030), with two projections after 2012 (proportional decrease and constant death rate). The 1980–2013 data from the US Renal Data System RenDER with extrapolations after 2012 on the basis of proportional decrease in death rates and constant death rates.

Figure 3.

Age-specific incidence rates have leveled off. Annual ESRD incidence rate (per million per year) from 1980 to 2030 by age, with two assumptions about the projected trend in obesity prevalence after 2012. Dashed lines represent reported data, and solid lines represent simulated data. Incident counts are from the US Renal Data System RenDER system (accessed January 2016). Population counts are from smoothed Centers for Disease Control and Prevention–bridged US Census data. Simulation results are on the basis of increasing obesity trend versus decreasing obesity projections.

Figure 4.

ESRD prevalence is increasing. (A–D) ESRD prevalence proportion (per million) by assumptions of obesity and ESRD death rate trends after 2012, age group (color coded), and year (observed [dashed curves] and simulated through 2012; projected after 2012 [solid curves]). The 1980–2012 ESRD prevalent counts are from the US Renal Data System RenDER. Population data are from smoothed Centers for Disease Control and Prevention–bridged US Census data. Simulation results are on the basis of increasing obesity trend versus decreasing obesity projections and constant ESRD death rate versus continued proportional decrease.

Figure 5.

ESRD incidence and prevalence should rise by 2030. Ranges of projected increases in incidence/prevalence. Each bar represents the range of results across four sets of simulations, each with a different set of assumptions. The range of projected incidence and incidence rates are shown on the basis of the increasing obesity versus decreasing obesity assumptions. Separate bars are shown for the prevalence under differing assumptions about the ESRD death rates (constant versus decreasing death rates); the obesity assumptions made smaller differences in ESRD prevalence.

Figure 6.

Visual abstract of factors incorporated into the simulation as influencing ESRD incidence and prevalence. Causal relationships between obesity and hypertension or other ESRD causes and additional losses (e.g., lost to follow-up) were handled as described in Supplemental Appendix 1.