Prevalence of Chronic Kidney Disease Final Paper

Prevalence of Chronic Kidney Disease in the United States
Public Health Surveillance Methods – EPBI 6333
July 27th, 2022
Olga Bivol
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Introduction
Kidneys serve to filter all blood in the human body, to remove toxins, waste, and excess fluid.
They also control blood pressure, regulate essential blood chemicals, and stimulate the production of red
blood cells. Proper kidney function is essential for maintaining optimal health, however, according to the
CDC, more than one in seven American adults are estimated to have chronic kidney disease (CKD).
Statistically, an estimated 15 % of US adults have CKD, which is approximately 37 million people
(cdc.gov, 2022). CKD is a condition that leads to damaged kidneys that do not properly filter blood. This
in turn leads to excess fluid in the body which can cause high blood pressure, shortness of breath, as well
as an increased the risk of anemia, heart disease or strokes (cdc.gov, 2022).
If detected early, proper treatment for CKD can slow the decline in kidney function and delay
failure. Kidney failure occurs when damage is severe, and function deteriorates. When CKD progression
is severe, dialysis or a kidney transplant is required to ensure survival. This stage is termed end-stage
renal disease (ESRD) (cdc.gov, 2022).
According to the Chronic Kidney Disease Surveillance System, the prevalence and incidence of
kidney failure treated by dialysis and transplantation in the United States have increased from 1988 to
2004. The overall unadjusted prevalence of CKD stages 1-4 was 20 % higher in 2015-2016 compared to
1988-1994 (CDC surveillance system: Prevalence ratio of CKD stages among U.S. adults, 1988-1994 vs.
2007-2016). According to the US Renal Data systems (USDRS), the number of patients needing dialysis,
or a kidney transplant has increased dramatically from 209,000 in 1991 to 472,000 in 2004 (USRDS
Annual Data Report, 2006). The increase is partly explained by the significant increase in prevalence of
diabetes and hypertension. The estimation of prevalence during the early stages of CKD over time is
central to disease management and prevention planning.
CKD prevalence is determined based on persistent albuminuria and decreased estimated
glomerular filtration rate (GFR) obtained from the serum creatinine concentration (Coresh J et al., 2007).
The main concern is that the potential increased incidence of kidney failure can lead to other
complications such as risk of cardiovascular disease, strokes, anemia, a weakened immune system.
The objective of this research analysis is to obtain a recent estimated prevalence of CKD in the
United States.
Methods
Population data was obtained from the National Health and Nutrition Examination Surveys
(NHANES 1988-1994 and NHANES 1999-2004) and the Chronic Kidney Disease Surveillance System.
The participants were noninstitutionalized U.S. residents age 20 years or older. This secondary research
analysis looked at results obtained from standardized surveys of in-home interviews and physical
examinations with collected blood and urine at a mobile examination center (MEC) (Coresh J, et al.
2007).
Earlier stages of CKD are defined based on kidney damage using albuminuria, and decreased
kidney function – quantified using glomerular filtration rate (GFR) from creatinine serum concentration
(Levey et al. 2005). Albuminuria represents a ratio of urinary albumin-to-creatinine ratio ≥ 30 mg/g.
Moderate albuminuria ranges between 30 and 299 mg/g and severe albuminuria is ≥ 300 mg/g. CKD
stages range from 1-5, however for this analysis, stage 5 is excluded. The eGFR classifications for each
stage are: stage 1, eGFR ≥ 90 ml/min/1.73 m² and presence of single albuminuria; stage 2, eGFR 60-89
ml/min/1.73 m² and presence of single albuminuria; Stage 3, eGFR 30-59 ml/min/1.73 m²; Stage 4, 15-29
ml/min/1.73 m² (nccd.cdc.gov).
The increasing prevalence of Chronic Kidney Disease (CKD) in the United States was
documented and noted due highly in part due to the increasing prevalence of hypertension and diabetes.
IBM SPSS Statistical software was used to plot histograms and line charts depicting the Prevalence Ratio
of CKD stages of US adults in 1988-1944 vs 2015-2016, along with Data comparing the prevalence of
CKD in patients with diagnosed Diabetes and Hypertension.
Results
Figure 1 depicts a histogram of the prevalence of CKD stages 1-4 during 1988-1994; 1999-2006;
2007-2014; 2015-2016 was plotted. This data was unadjusted for age and shows a prevalence of CKD at
approximately 14.2% during 2015-2016. Similarly, during the 2007-2014 period, the CKD prevalence is
approximately 14.0%. No significant increasing or decreasing pattern is noted in the unadjusted
prevalence of CKD stages 1-4over time. (“CDC surveillance system: Prevalence ratio of CKD stages
among U.S. adults, 1988-1994 vs. 2007-2016”, n.d.).
Figure 1. The Prevalence of CKD by Year and CKD
Figure 2 depicts the advanced stages 3 and 4 CKD Prevalence by Year and Diabetes status in the
US. While some minor increases and decreases are noted, the prevalence of CKD in adults with
diagnosed diabetes remained the same (20%) during the periods 1999-2004 to 2011-2018. A similar trend
is noted when looking at the prevalence among adults with prediabetes (13% in 1999-2004 and 10% in
2011-2018) and in adults with undiagnosed diabetes (10% and 9%, respectively) (CDC surveillance
system: CKD prevalence by diabetes mellitus status, n.d.).
Figure 2. Advanced Level CKD (Stage 3 and 4) by Year and Diabetes Status in US Adults
The prevalence of CKD in adults with diagnosed hypertension during 1999-2004, 2005-2010 and
2011-2018 was compared in figure 3. According to the data analyzed, the prevalence during the period
1999-2004 to 2011-2018 varied based on hypertension status. Among adults with diagnosed
hypertension, prevalence decreased from 29.1% in 1999-2004 to 27.6% in 2011-2018. Among the
undiagnosed hypertensive adults, the prevalence decreased from 23.1% to 14.6%. Among the adults
diagnosed with Pre-hypertension, a slight decrease was recorded – from 8.7% in 1999-2004 to 8.0% in
2011-2018 (“CDC surveillance system: CKD prevalence by hypertension status”, n.d).
Figure 3. CKD Prevalence By Hypertension Status and Year
Conclusion
CKD has varying levels of seriousness. While it typically progresses slowly with proper
treatment, if left untreated, can progress into kidney failure and early cardiovascular disease. (Chronic
kidney disease basics, 2022). In the U.S, hypertension and diabetes represent the leading causes of kidney
failure. While a great majority of US patients that suffer from CKD are diagnosed with diabetes (nearly
25%), a large amount of the population continues to remain undiagnosed (from 9% in 1999-2004 to 7-8%
in 2011-2018). While one is tempted to report that a similar situation occurs when referring to
hypertension, according to figure 3, 26-29% have been diagnosed with Hypertension, and the number of
undiagnosed continues to decrease from 23-24 % in 1999-2004 to 14-15% in 2011-2018. In order to help
prevent CKD and lower the risk of kidney failure, patients must see their health care providers regularly,
make lifestyle changes and get tested annually.
References
Centers for Disease Control and Prevention. (2022, February 28). Chronic kidney disease basics. Centers
for Disease Control and Prevention. Retrieved July 26, 2022, from
https://www.cdc.gov/kidneydisease/basics.html
Centers for Disease Control and Prevention. (n.d.). CDC surveillance system: Prevalence ratio of CKD
stages among U.S. adults, 1988-1994 vs. 2007-2016. Centers for Disease Control and Prevention.
Retrieved July 27, 2022, from https://nccd.cdc.gov/CKD/detail.aspx?Qnum=Q440#refreshPosition
Centers for Disease Control and Prevention. (n.d.). CDC surveillance system: CKD prevalence by
hypertension status. Centers for Disease Control and Prevention. Retrieved July 24, 2022, from
https://nccd.cdc.gov/CKD/detail.aspx?Qnum=Q687#refreshPosition
Centers for Disease Control and Prevention. (n.d.). CDC surveillance system: CKD prevalence by
diabetes mellitus status. Centers for Disease Control and Prevention. Retrieved July 24, 2022, from
https://nccd.cdc.gov/CKD/detail.aspx?Qnum=Q702#refreshPosition
Coresh, J., Selvin, E., Stevens, L. A., Manzi, J., Kusek, J. W., Eggers, P., Van Lente, F., & Levey, A. S.
(2007). Prevalence of chronic kidney disease in the United States. JAMA, 298(17), 2038–2047.
https://doi.org/10.1001/jama.298.17.2038
Levey AS, Eckardt KU, Tsukamoto Y. et al. Definition and classification of chronic kidney disease: a
position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney
Int. 2005;67(6):2089-210015882252
US Renal Data Systems. USRDS 2006 Annual Data Report: Atlas of End-Stage Renal Disease in the
United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and
Digestive and Kidney Diseases; 2007
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Prevalence of Chronic Kidney Disease in the United States

Public Health Surveillance Methods – EPBI 6333

July 27th, 2022

Statistically, an estimated 15 % of US adults have CKD, which is approximately 37 million people

as an increased the risk of anemia, heart disease or strokes (cdc.gov, 2022).

renal disease (ESRD) (cdc.gov, 2022).

central to disease management and prevention planning.

CKD prevalence is determined based on persistent albuminuria and decreased estimated

CKD in patients with diagnosed Diabetes and Hypertension.

approximately 14.0%. No significant increasing or decreasing pattern is noted in the unadjusted

among U.S. adults, 1988-1994 vs. 2007-2016”, n.d.).

Figure 1. The Prevalence of CKD by Year and CKD

system: CKD prevalence by diabetes mellitus status, n.d.).

2011-2018 (“CDC surveillance system: CKD prevalence by hypertension status”, n.d).

make lifestyle changes and get tested annually.

Retrieved July 27, 2022, from https://nccd.cdc.gov/CKD/detail.aspx?Qnum=Q440#refreshPosition

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