This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (381)  • Contact me when this article is cited  Related Content  • Related letter  • Similar articles in JAMA  Topic Collections  • Renal Diseases  • Renal Diseases, Other  • Hypertension  • Alert me on articles by topic  Social Bookmarking   What's this?

Josef Coresh, MD, PhD; Elizabeth Selvin, PhD, MPH; Lesley A. Stevens, MD, MS; Jane Manzi, PhD; John W. Kusek, PhD; Paul Eggers, PhD; Frederick Van Lente, PhD; Andrew S. Levey, MD

JAMA. 2007;298(17):2038-2047.

Context  The prevalence and incidence of kidney failure treated by dialysis and transplantation in the United States have increased from 1988 to 2004. Whether there have been changes in the prevalence of earlier stages of chronic kidney disease (CKD) during this period is uncertain.

Objective  To update the estimated prevalence of CKD in the United States.

Design, Setting, and Participants  Cross-sectional analysis of the most recent National Health and Nutrition Examination Surveys (NHANES 1988-1994 and NHANES 1999-2004), a nationally representative sample of noninstitutionalized adults aged 20 years or older in 1988-1994 (n = 15 488) and 1999-2004 (n = 13 233).

Main Outcome Measures  Chronic kidney disease prevalence was determined based on persistent albuminuria and decreased estimated glomerular filtration rate (GFR). Persistence of microalbuminuria (>30 mg/g) was estimated from repeat visit data in NHANES 1988-1994. The GFR was estimated using the abbreviated Modification of Diet in Renal Disease Study equation reexpressed to standard serum creatinine.

Results  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% (95% confidence interval [CI], 9.2%-10.9%) in 1988-1994 to 13.1% (95% CI, 12.0%-14.1%) in 1999-2004 with a prevalence ratio of 1.3 (95% CI, 1.2-1.4). The prevalence estimates of CKD stages in 1988-1994 and 1999-2004, respectively, were 1.7% (95% CI, 1.3%-2.2%) and 1.8% (95% CI, 1.4%-2.3%) for stage 1; 2.7% (95% CI, 2.2%-3.2%) and 3.2% (95% CI, 2.6%-3.9%) for stage 2; 5.4% (95% CI, 4.9%-6.0%) and 7.7% (95% CI, 7.0%-8.4%) for stage 3; and 0.21% (95% CI, 0.15%-0.27%) and 0.35% (0.25%-0.45%) for stage 4. 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. Estimation of GFR from serum creatinine has limited precision and a change in mean serum creatinine accounted for some of the increased prevalence of CKD.

Conclusions  The prevalence of CKD in the United States in 1999-2004 is higher than it was in 1988-1994. This increase is partly explained by the increasing prevalence of diabetes and hypertension and raises concerns about future increased incidence of kidney failure and other complications of CKD.

Author Affiliations: Department of Epidemiology, Bloomberg School of Public Health, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland (Drs Coresh, Selvin, and Manzi); Division of Nephrology, Tufts-New England Medical Center, Boston, Massachusetts (Drs Stevens and Levey); National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland (Drs Kusek and Eggers); and Department of Clinical Pathology, Cleveland Clinic Foundation, Cleveland, Ohio (Dr Van Lente).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTER

Determining Prevalence of Chronic Kidney Disease Using Estimated Glomerular Filtration Rate
Pierre Delanaye, Etienne Cavalier, and Jean Marie Krzesinski
JAMA. 2008;299(6):631.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Protein Acetylation in the Cardiorenal Axis: The Promise of Histone Deacetylase Inhibitors
Bush and McKinsey
Circ. Res. 2010;106:272-284.
ABSTRACT | FULL TEXT  

Relation Between Kidney Function, Proteinuria, and Adverse Outcomes
Hemmelgarn et al.
JAMA 2010;303:423-429.
ABSTRACT | FULL TEXT  

Incidence and outcomes of acute kidney injury in a referred chronic kidney disease cohort
Lafrance et al.
Nephrol Dial Transplant 2010;:gfq011v1-gfq011.
ABSTRACT | FULL TEXT  

Establishing Reference Intervals for Clinical Laboratory Test Results: Is There a Better Way?
Katayev et al.
Am J Clin Pathol 2010;133:180-186.
ABSTRACT | FULL TEXT  

Age and cystatin C in healthy adults: a collaborative study
Odden et al.
Nephrol Dial Transplant 2010;25:463-469.
ABSTRACT | FULL TEXT  

The effect of the World Kidney Day campaign on the awareness of chronic kidney disease and the status of risk factors for cardiovascular disease and renal progression
Chin et al.
Nephrol Dial Transplant 2010;25:413-419.
ABSTRACT | FULL TEXT  

The EVEREST study: an international collaboration
Caskey et al.
NDT Plus 2010;3:28-36.
ABSTRACT | FULL TEXT  

Human Recombinant ACE2 Reduces the Progression of Diabetic Nephropathy
Oudit et al.
Diabetes 2010;59:529-538.
ABSTRACT | FULL TEXT  

Uromodulin Levels Associate with a Common UMOD Variant and Risk for Incident CKD
Kottgen et al.
J. Am. Soc. Nephrol. 2010;21:337-344.
ABSTRACT | FULL TEXT  

Is Longitudinal Pulse Pressure a Better Predictor of 24-Hour Urinary Albumin Excretion Than Other Indices of Blood Pressure?
Farasat et al.
Hypertension 2010;55:415-421.
ABSTRACT | FULL TEXT  

Use of Evidence-Based Therapies in Short-Term Outcomes of ST-Segment Elevation Myocardial Infarction and Non-ST-Segment Elevation Myocardial Infarction in Patients With Chronic Kidney Disease: A Report From the National Cardiovascular Data Acute Coronary Treatment and Intervention Outcomes Network Registry
Fox et al.
Circulation 2010;121:357-365.
ABSTRACT | FULL TEXT  

Prevalence and risk factors of chronic kidney disease in the Thai adult population: Thai SEEK study
Ingsathit et al.
Nephrol Dial Transplant 2010;:gfp669v2-gfp669.
ABSTRACT | FULL TEXT  

Blood Lead Level and Kidney Function in US Adolescents: The Third National Health and Nutrition Examination Survey
Fadrowski et al.
Arch Intern Med 2010;170:75-82.
ABSTRACT | FULL TEXT  

Stage IV Chronic Kidney Disease
Abboud and Henrich
NEJM 2010;362:56-65.
FULL TEXT  

Peritoneal dialysis in elderly patients: report from the French Peritoneal Dialysis Registry (RDPLF)
Castrale et al.
Nephrol Dial Transplant 2010;25:255-262.
ABSTRACT | FULL TEXT  

p-Cresyl sulfate serum concentrations in haemodialysis patients are reduced by the prebiotic oligofructose-enriched inulin
Meijers et al.
Nephrol Dial Transplant 2010;25:219-224.
ABSTRACT | FULL TEXT  

Incidence of Treatment for End-Stage Renal Disease Among Individuals With Diabetes in the U.S. Continues to Decline
Burrows et al.
Diabetes Care 2010;33:73-77.
ABSTRACT | FULL TEXT  

Adverse Safety Events in Chronic Kidney Disease: The Frequency of "Multiple Hits"
Chapin et al.
CJASN 2010;5:95-101.
ABSTRACT | FULL TEXT  

Establishing a National Chronic Kidney Disease Surveillance System for the United States
Saran et al.
CJASN 2010;5:152-161.
ABSTRACT | FULL TEXT  

Carotid Endarterectomy Benefits Patients with CKD and Symptomatic High-Grade Stenosis
Mathew et al.
J. Am. Soc. Nephrol. 2010;21:145-152.
ABSTRACT | FULL TEXT  

Cyclosporine Versus Tacrolimus in Immunosuppressive Maintenance Regimens in Renal Transplants in Brazil: Survival Analysis from 2000 to 2004
Guerra et al.
The Annals of Pharmacotherapy 2010;44:192-201.
ABSTRACT | FULL TEXT  

Albuminuria, impaired kidney function and cardiovascular outcomes or mortality in the elderly
Rifkin et al.
Nephrol Dial Transplant 2009;0:gfp646v1-gfp646.
ABSTRACT | FULL TEXT  

The CKD-EPI Equation and MDRD Study Equation Find Similar Prevalence of Chronic Kidney Disease in Asian Populations
Levey et al.
ANN INTERN MED 2009;151:893-893.
FULL TEXT  

Reduction of Circulating Soluble Fms-Like Tyrosine Kinase-1 Plays a Significant Role in Renal Dysfunction-Associated Aggravation of Atherosclerosis
Onoue et al.
Circulation 2009;120:2470-2477.
ABSTRACT | FULL TEXT  

Physical Activity and Rapid Decline in Kidney Function Among Older Adults
Robinson-Cohen et al.
Arch Intern Med 2009;169:2116-2123.
ABSTRACT | FULL TEXT  

Kidney function and future risk for adverse pregnancy outcomes: a population-based study from HUNT II, Norway
Munkhaugen et al.
Nephrol Dial Transplant 2009;24:3744-3750.
ABSTRACT | FULL TEXT  

Prevalence and risk factors of albuminuria and chronic kidney disease in Chinese population with type 2 diabetes and impaired glucose regulation: Shanghai diabetic complications study (SHDCS)
Jia et al.
Nephrol Dial Transplant 2009;24:3724-3731.
ABSTRACT | FULL TEXT  

Prevalence of ambulatory hypotension in elderly patients with CKD stages 3 and 4
Tomlinson et al.
Nephrol Dial Transplant 2009;24:3751-3755.
ABSTRACT | FULL TEXT  

Nocturnal versus conventional haemodialysis: some current issues
Bayliss and Danziger
Nephrol Dial Transplant 2009;24:3612-3617.
FULL TEXT  

Physical Activity and Mortality in Chronic Kidney Disease (NHANES III)
Beddhu et al.
CJASN 2009;4:1901-1906.
ABSTRACT | FULL TEXT  

Change in Estimated GFR Associates with Coronary Heart Disease and Mortality
Matsushita et al.
J. Am. Soc. Nephrol. 2009;20:2617-2624.
ABSTRACT | FULL TEXT  

The Databases: Renal Replacement Therapy Since 1989--The European Renal Association and European Dialysis and Transplant Association (ERA-EDTA)
Zoccali et al.
CJASN 2009;4:S18-S22.
ABSTRACT | FULL TEXT  

Hypertension Goals in Advanced-Stage Kidney Disease
Hopkins and Bakris
CJASN 2009;4:S92-S94.
ABSTRACT | FULL TEXT  

Is Lipid Control Necessary in Hemodialysis Patients?
Cheung
CJASN 2009;4:S95-S101.
ABSTRACT | FULL TEXT  

In-hospital outcomes with thrombolytic therapy in patients with renal dysfunction presenting with acute ischaemic stroke
Agrawal et al.
Nephrol Dial Transplant 2009;0:gfp619v1-gfp619.
ABSTRACT | FULL TEXT  

Incident chronic kidney disease and the rate of kidney function decline in individuals with hypertension
Hanratty et al.
Nephrol Dial Transplant 2009;0:gfp534v1-gfp534.
ABSTRACT | FULL TEXT  

Low levels of IgM antibodies against phosphorylcholine-A increase mortality risk in patients undergoing haemodialysis
Carrero et al.
Nephrol Dial Transplant 2009;24:3454-3460.
ABSTRACT | FULL TEXT  

71-Year-Old Man With Chronic Kidney Failure and Sudden Change of Mental Status
Mansfield and Qian
Mayo Clin Proc. 2009;84:e5-e8.
FULL TEXT  

Blood Cadmium and Lead and Chronic Kidney Disease in US Adults: A Joint Analysis
Navas-Acien et al.
Am J Epidemiol 2009;170:1156-1164.
ABSTRACT | FULL TEXT  

Is lowering phosphate exposure the key to preventing arterial stiffening with age?
Ferro et al.
Heart 2009;95:1770-1772.
ABSTRACT | FULL TEXT  

Cystatin C and Cardiovascular Risk
Taglieri et al.
Clin. Chem. 2009;55:1932-1943.
ABSTRACT | FULL TEXT  

Use of erythropoietins in patients with renal transplants
Treleaven and Clase
BMJ 2009;339:b3825-b3825.
FULL TEXT  

The economic benefits of preventing end-stage renal disease in patients with type 2 diabetes mellitus
Postma and de Zeeuw
Nephrol Dial Transplant 2009;24:2975-2983.
FULL TEXT  

Weight Loss Interventions in Chronic Kidney Disease: A Systematic Review and Meta-analysis
Navaneethan et al.
CJASN 2009;4:1565-1574.
ABSTRACT | FULL TEXT  

ESRD Impairs Nonrenal Clearance of Fexofenadine but not Midazolam
Nolin et al.
J. Am. Soc. Nephrol. 2009;20:2269-2276.
ABSTRACT | FULL TEXT  

Podocin Inactivation in Mature Kidneys Causes Focal Segmental Glomerulosclerosis and Nephrotic Syndrome
Mollet et al.
J. Am. Soc. Nephrol. 2009;20:2181-2189.
ABSTRACT | FULL TEXT  

Association of chronic kidney disease with the spectrum of ankle brachial index the CHS (Cardiovascular Health Study).
Ix et al.
J Am Coll Cardiol 2009;54:1176-1184.
ABSTRACT | FULL TEXT  

Secondary Hyperparathyroidism: Pathophysiology and Treatment
Saliba and El-Haddad
J Am Board Fam Med 2009;22:574-581.
ABSTRACT | FULL TEXT  

Association between chronic obstructive pulmonary disease and chronic kidney disease in vascular surgery patients
van Gestel et al.
Nephrol Dial Transplant 2009;24:2763-2767.
ABSTRACT | FULL TEXT  

Glycaemic control in type 2 diabetic patients on chronic haemodialysis: use of a continuous glucose monitoring system
Riveline et al.
Nephrol Dial Transplant 2009;24:2866-2871.
ABSTRACT | FULL TEXT  

Arterial Stiffness in Mild-to-Moderate CKD
Upadhyay et al.
J. Am. Soc. Nephrol. 2009;20:2044-2053.
ABSTRACT | FULL TEXT  

Wnt/{beta}-Catenin Signaling Promotes Podocyte Dysfunction and Albuminuria
Dai et al.
J. Am. Soc. Nephrol. 2009;20:1997-2008.
ABSTRACT | FULL TEXT  

MicroRNA: a new frontier in kidney and blood pressure research
Liang et al.
Am. J. Physiol. Renal Physiol. 2009;297:F553-F558.
ABSTRACT | FULL TEXT  

Blood Pressure Is a Major Risk Factor for Renal Death: An Analysis of 560 352 Participants From the Asia-Pacific Region
O'Seaghdha et al.
Hypertension 2009;54:509-515.
ABSTRACT | FULL TEXT  

Invited Commentary: Defining Incident Chronic Kidney Disease in Epidemiologic Study Settings
Tonna
Am J Epidemiol 2009;170:425-427.
ABSTRACT | FULL TEXT  

Effect of spironolactone on left ventricular mass and aortic stiffness in early-stage chronic kidney disease: a randomized controlled trial.
Edwards et al.
J Am Coll Cardiol 2009;54:505-512.
ABSTRACT | FULL TEXT  

Screening renal angiography as a routine part of cardiac catheterization: a reappraisal
Slovut
Vasc Med 2009;14:271-275.
 

Body mass index modifies the risk of cardiovascular death in proteinuric chronic kidney disease
Obermayr et al.
Nephrol Dial Transplant 2009;24:2421-2428.
ABSTRACT | FULL TEXT  

Chronic kidney disease, creatinine and cognitive functioning
Elias et al.
Nephrol Dial Transplant 2009;24:2446-2452.
ABSTRACT | FULL TEXT  

Screening for kidney disease in vascular patients: SCreening for Occult REnal Disease (SCORED) experience
Bang et al.
Nephrol Dial Transplant 2009;24:2452-2457.
ABSTRACT | FULL TEXT  

Chronic Renal Insufficiency Cohort (CRIC) Study: Baseline Characteristics and Associations with Kidney Function
Lash et al.
CJASN 2009;4:1302-1311.
ABSTRACT | FULL TEXT  

Association of kidney function and uncarboxylated matrix Gla protein: Data from the Heart and Soul Study
Parker et al.
Nephrol Dial Transplant 2009;24:2095-2101.
ABSTRACT | FULL TEXT  

Assessing Glycemic Control in Maintenance Hemodialysis Patients With Type 2 Diabetes
Kazempour-Ardebili et al.
Diabetes Care 2009;32:1137-1142.
ABSTRACT | FULL TEXT  

Effectiveness of a Multidisciplinary Clinic in Managing Children with Chronic Kidney Disease
Menon et al.
CJASN 2009;4:1170-1175.
ABSTRACT | FULL TEXT  

Association of Preventive Health Care with Atherosclerotic Heart Disease and Mortality in CKD
Snyder and Collins
J. Am. Soc. Nephrol. 2009;20:1614-1622.
ABSTRACT | FULL TEXT  

The Frequency of Hyperkalemia and Its Significance in Chronic Kidney Disease
Einhorn et al.
Arch Intern Med 2009;169:1156-1162.
ABSTRACT | FULL TEXT  

The scope of coronary heart disease in patients with chronic kidney disease.
Hage et al.
J Am Coll Cardiol 2009;53:2129-2140.
ABSTRACT | FULL TEXT  

The Hazards of Dual Renin-Angiotensin Blockade in Chronic Kidney Disease
Ku et al.
Arch Intern Med 2009;169:1015-1018.
FULL TEXT  

Predicting mortality and uptake of renal replacement therapy in patients with stage 4 chronic kidney disease
Conway et al.
Nephrol Dial Transplant 2009;24:1930-1937.
ABSTRACT | FULL TEXT  

End-stage kidney disease patients in the intensive care unit
Bagshaw and Uchino
Nephrol Dial Transplant 2009;24:1714-1717.
FULL TEXT  

Predicting outcomes in CKD: the importance of perspectives, populations and practices
Levin
Nephrol Dial Transplant 2009;24:1724-1726.
FULL TEXT  

The Association of Active and Passive Smoking With Peripheral Arterial Disease: Results From NHANES 1999-2004
Agarwal
ANGIOLOGY 2009;60:335-345.
ABSTRACT  

Symptom Burden, Depression, and Quality of Life in Chronic and End-Stage Kidney Disease
Abdel-Kader et al.
CJASN 2009;4:1057-1064.
ABSTRACT | FULL TEXT  

Association of CKD and Cancer Risk in Older People
Wong et al.
J. Am. Soc. Nephrol. 2009;20:1341-1350.
ABSTRACT | FULL TEXT  

Prediction, Progression, and Outcomes of Chronic Kidney Disease in Older Adults
Anderson et al.
J. Am. Soc. Nephrol. 2009;20:1199-1209.
ABSTRACT | FULL TEXT  

Natriuretic peptides and heart failure in the patient with chronic kidney disease: a review of current evidence
Dhar et al.
Postgrad. Med. J. 2009;85:299-302.
ABSTRACT | FULL TEXT  

Effects of Renal Perfusion Pressure on Renal Medullary Hydrogen Peroxide and Nitric Oxide Production
Jin et al.
Hypertension 2009;53:1048-1053.
ABSTRACT | FULL TEXT  

Current Guidelines for Using Angiotensin-Converting Enzyme Inhibitors and Angiotensin II-Receptor Antagonists in Chronic Kidney Disease: Is the Evidence Base Relevant to Older Adults?
O'Hare et al.
ANN INTERN MED 2009;150:717-724.
ABSTRACT | FULL TEXT  

Does Evidence Support Renin-Angiotensin System Blockade for Slowing Nephropathy Progression in Elderly Persons?
Sarafidis and Bakris
ANN INTERN MED 2009;150:731-733.
FULL TEXT  

Fibroblast Growth Factor 23 and Left Ventricular Hypertrophy in Chronic Kidney Disease
Gutierrez et al.
Circulation 2009;119:2545-2552.
ABSTRACT | FULL TEXT  

A New Equation to Estimate Glomerular Filtration Rate
Levey et al.
ANN INTERN MED 2009;150:604-612.
ABSTRACT | FULL TEXT  

How should proteinuria be detected and measured?
Lamb et al.
Ann Clin Biochem 2009;46:205-217.
ABSTRACT | FULL TEXT  

Systematic review of the evidence underlying the association between mineral metabolism disturbances and risk of all-cause mortality, cardiovascular mortality and cardiovascular events in chronic kidney disease
Covic et al.
Nephrol Dial Transplant 2009;24:1506-1523.
ABSTRACT | FULL TEXT  

Cystatin C Levels in U.S. Adults, 1988-1994 Versus 1999-2002: NHANES
Foley et al.
CJASN 2009;4:965-972.
ABSTRACT | FULL TEXT  

Nonrecovery of Kidney Function and Death after Acute on Chronic Renal Failure
Hsu et al.
CJASN 2009;4:891-898.
ABSTRACT | FULL TEXT