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. 2024 Apr 1;35(4):456-465.
doi: 10.1681/ASN.0000000000000310. Epub 2024 Jan 30.

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

Chyng-Wen Fwu  1 , Paul W Eggers  2 , Jenna M Norton  2 , Debbie S Gipson  2 , Paul L Kimmel  2 , Ivonne H Schulman  2 , Kevin E Chan  2 , Kara Bennett  1 , Susan R Mendley  2
Affiliations

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

Chyng-Wen Fwu et al. J Am Soc Nephrol. .

Abstract

Significance statement: ESKD incidence has changed substantially in the past four decades, but differences by age and race have been unexplored. Using data from the United States Renal Data System, we found that ESKD incidence rose for Black and White teenagers, adults, and older adults for two decades beginning in 1980. Growth in incidence slowed for most groups by 1993, and by 2006, the annual percent change (APC) in ESKD incidence had declined for all groups, except White adults, for whom rates continued to rise. 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 rate among Black American patients exceeds that of White patients in every age group. 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 health care, incidence of diabetes mellitus, implementation of evidence-based guidelines for treatment of CKD, or other unrecognized factors. There may be population-specific opportunities to change the growth of the US ESKD population and address current racial disparities.

Background: Substantial changes in 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 to 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 (APC) in ESKD incidence and to define points in time where a statistically significant change in APC slope occurred for each group.

Results: ESKD incidence rose after 1980 for all groups, although the trends differed ( P < 0.001). Growth in incidence slowed for most by 1993, and by 2006, the APC 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 American patients 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 health care, incidence of diabetes mellitus, implementation of evidence-based guidelines for treatment of CKD, or other unrecognized factors.

Podcast: This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/JASN/2024_03_13_ASN0000000000000310.mp3.

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Conflict of interest statement

K. Bennett is employed by and owns equity in Target RWE, which has received fees from Amgen, Baxter International, Gilead Sciences, Janssen Research & Development (Janssen R&D), and Merck (outside the submitted work). K. Bennett reports previous employment by DLH, Corp. K.E. Chan reports employment with the National Institute of Diabetes and Digestive Kidney. P.W. Eggers reports consultancy for the National Institute of Diabetes and Digestive and Kidney Diseases. D.S. Gipson reports employment with NIH/NIDDK/KUH; past consultancy between AstraZeneca, Boehringer-Ingelheim, Genentech, Goldfinch Bio, Roche, University of Michigan, and Vertex, but no individual consultancy agreements; past funding to University of Michigan from Goldfinch Bio and Travere; research funding from Boehringer-Ingelheim (self), Novartis, and Reata; advisory or leadership role on past advisory board/steering committee for AstraZeneca, Goldfinch Bio, Roche/Genentech, and Vertex; and other interests or relationships with (past) Nephrotic Syndrome Patient Reported Outcome Consortium (public–private partnership, with Goldfinch Bio, GSK, NephCure Kidney International), Pfizer, and as Co-chair for National Kidney Foundation Improving Vaccinations in Kidney Disease Workshop. P.L. Kimmel reports employment with National Institute of Diabetes and Digestive Kidney Diseases (NIDDK). As a Federal Employee at NIDDK, P.L. Kimmel's holdings are reviewed each year for potential conflict of interest. At this time, P.L. Kimmel's only stock holding related in any fashion to health care is CVS and GE Healthcare. P.L. Kimmel reports royalties for co-editing Chronic Renal Disease and Psychosocial Aspects of Chronic Kidney Disease and royalties from Mayo Clinic Press for The Body's Keepers; advisory or leadership role as an unpaid member of Board of Directors of the Academy of Medicine of Washington, DC; and other interests or relationships as a Co-Editor of Chronic Renal Disease (Academic Press) and a Co-Editor of Psychosocial Aspects of Chronic Kidney Disease (Academic Press). S.R. Mendley reports employment with NIDDK/NIH. J.M. Norton reports employment with NIH/NIDDK. J.M. Norton's spouse reports employment with AstraZeneca. I.H. Schulman reports employment with the National Institutes of Health (NIH). The remaining author has nothing to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Trends in crude incidence of ESKD by race and age group: United States, 1980–2019. (A) Trends in incidence of ESKD in Black patients, by age group. (B) Trends in incidence of ESKD in White patients, by age group. Different y axis scales are used to view the trends in different age groups on the same graphs.
Figure 2
Figure 2
Joinpoint analysis of the incidence of ESKD in Black and White patients by age group from 1980 to 2019 expressed as APC for different periods. (A) The trends for White and Black patients age 18–64 are significantly different (P < 0.001). Age standardized to 2000 US population. (B) The trends for White and Black patients age 65+ are significantly different (P < 0.001). Age standardized to 2000 US population. (C) The trends for White and Black patients age 13–17 are significantly different (P < 0.001). APC, annual percent change.
Figure 3
Figure 3
Joinpoint analysis of the age-standardized incidence of ESKD in Black male and female patients by age group from 1980 to 2019 expressed as APC for different periods. (A) The trends for Black male and female patients age 18–64 are significantly different (P < 0.001). (B) The trends for White male and female patients age 18–64 are significantly different (P < 0.001). (C) The trends for Black male and female patients age 65+ are significantly different (P < 0.001). (D) The trends for White male and female patients age 65+ are significantly different (P < 0.001). All analyses age-standardized to 2000 US population.
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