Chronic Kidney Disease in the U.S. Appears to be Increasing

The estimated prevalence of chronic kidney disease among adults in the U.S. has increased to 13 percent, in part because of the increase in diabetes and hypertension, according to a study in the November 7 issue of JAMA.

Chronic kidney disease (CKD) is now recognized as a common condition that elevates the risk of cardiovascular disease as well as kidney failure and other complications. The number of patients with kidney failure treated by dialysis and transplantation (the end-stage of CKD) has increased dramatically in the United States, as has the incidence of end-stage renal disease, according to background information in the article. “Estimation of the prevalence of earlier stages of CKD in the U.S. population and ascertainment of trends over time is central to disease management and prevention planning, particularly given the increase in the prevalence of obesity, diabetes, and hypertension, the leading risk factors for CKD,” the authors write. Whether there have been changes in the prevalence of earlier stages of CKD is uncertain.

Josef Coresh, M.D., Ph.D., of Johns Hopkins University, Baltimore, and colleagues compared the prevalence, stages and severity of CKD in National Health and Nutrition Examination Surveys (NHANES 1988-1994 [n = 15,488] and NHANES 1999-2004 [n = 13,233]), a nationally representative sample of adults age 20 years or older. Chronic kidney disease prevalence was determined based on persistent albuminuria (the presence of excessive protein in the urine) and decreased estimated glomerular filtration rate (GFR; a measurement of fluid filtered by the kidney).

The researchers found that the prevalence of both albuminuria and decreased GFR increased from 1988-1994 to 1999-2004. The prevalence of CKD stages 1 to 4 increased from 10.0 percent in 1988-1994 to 13.1 percent in 1999-2004. A higher prevalence of diagnosed diabetes and hypertension and higher body mass index explained the entire increase in prevalence of albuminuria but only part of the increase in the prevalence of decreased GFR. Change in average serum creatinine (a product of protein metabolism) accounted for some of the increased prevalence of CKD.

“In conclusion, survey data suggest that the prevalence of CKD in the United States is high and has increased between 1988-1994 and 1999-2004, from 10 percent to 13 percent, while awareness of kidney disease among the general public remains very low. The increasing prevalence of diagnosed diabetes and hypertension has contributed to this increase, which may propagate to higher rates of complications and kidney failure requiring dialysis or transplantation.

Earlier stages accounted for most of the individuals with CKD. Because individuals with early stages of CKD have a higher risk of cardiovascular disease morbidity and mortality than their risk of progression to kidney failure, cardiovascular risk factor management in this group is critical. The high prevalence of CKD overall, and particularly among older individuals and persons with hypertension and diabetes, suggests that CKD needs to be a central part of future public health planning,” the authors write.

JAMA. 2007; 298(17):2038-2047.