 |
|
Prevalence of Chronic Kidney Disease in the United States
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).
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
|
Prevalence of chronic kidney disease in Kinshasa: results of a pilot study from the Democratic Republic of Congo
Sumaili et al.
Nephrol Dial Transplant 2008;0:gfn469v1-gfn469.
ABSTRACT
| FULL TEXT
FGF-23 and Outcomes Research -- When Physiology Meets Epidemiology
Hsu
NEJM 2008;359:640-642.
FULL TEXT
CKD--fiction not fact
Glassock and Winearls
Nephrol Dial Transplant 2008;23:2695-2696.
FULL TEXT
Lithium and eGFR: a new routinely available tool for the prevention of chronic kidney disease
Morriss and Benjamin
Br. J. Psychiatry 2008;193:93-95.
ABSTRACT
| FULL TEXT
Do we need another equation to estimate GFR from serum creatinine in renal allograft recipients?
Rule and Larson
Nephrol Dial Transplant 2008;23:2427-2428.
FULL TEXT
Death in Heart Failure: A Community Perspective
Henkel et al.
Circ Heart Fail 2008;1:91-97.
ABSTRACT
| FULL TEXT
Burden and Rates of Treatment and Control of Cardiovascular Disease Risk Factors in Obesity: The Framingham Heart Study
Molenaar et al.
Diabetes Care 2008;31:1367-1372.
ABSTRACT
| FULL TEXT
Trends in Diabetes, High Cholesterol, and Hypertension in Chronic Kidney Disease Among U.S. Adults: 1988-1994 to 1999-2004
Fox and Muntner
Diabetes Care 2008;31:1337-1342.
ABSTRACT
| FULL TEXT
Impact of Activated Vitamin D and Race on Survival among Hemodialysis Patients
Wolf et al.
J. Am. Soc. Nephrol. 2008;19:1379-1388.
ABSTRACT
| FULL TEXT
Race, Gender, and Socioeconomic Disparities in CKD in the United States
Norris and Nissenson
J. Am. Soc. Nephrol. 2008;19:1261-1270.
ABSTRACT
| FULL TEXT
Is the Ethnic Disparity in CKD a Symptom of Dysfunctional Primary Care in the US?
Wesson
J. Am. Soc. Nephrol. 2008;19:1249-1251.
FULL TEXT
Glomerular filtration rate <45 ml/min/1.73 m2 with microalbuminuria was associated with increased CV death
Rifkin and Sarnak
Evid. Based Med. 2008;13:89-89.
FULL TEXT
Current Approaches in the Treatment of Chronic Kidney Disease Mineral and Bone Disorder
How et al.
Journal of Pharmacy Practice 2008;21:196-213.
ABSTRACT
Hospitalization Discharge Diagnoses for Kidney Disease--United States, 1980-2005
JAMA 2008;299:2144-2145.
FULL TEXT
Staging of Chronic Kidney Disease: Time for a Course Correction
Bauer et al.
J. Am. Soc. Nephrol. 2008;19:844-846.
ABSTRACT
| FULL TEXT
Fact or fiction of the epidemic of chronic kidney disease--let us not squabble about estimated GFR only, but also focus on albuminuria
de Jong and Gansevoort
Nephrol Dial Transplant 2008;23:1092-1095.
FULL TEXT
Kidney disease in diabetology: lessons from 2007
Schernthaner
Nephrol Dial Transplant 2008;23:1112-1115.
FULL TEXT
An epidemic of chronic kidney disease: fact or fiction?
Glassock and Winearls
Nephrol Dial Transplant 2008;23:1117-1121.
FULL TEXT
Effects of statins in patients with chronic kidney disease: meta-analysis and meta-regression of randomised controlled trials
Strippoli et al.
BMJ 2008;336:645-651.
ABSTRACT
| FULL TEXT
Metabolic Syndrome and Risk of Development of Atrial Fibrillation: The Niigata Preventive Medicine Study
Watanabe et al.
Circulation 2008;117:1255-1260.
ABSTRACT
| FULL TEXT
Screening for Chronic Kidney Disease: Where Does Europe Go?
de Jong et al.
CJASN 2008;3:616-623.
ABSTRACT
| FULL TEXT
World Kidney Day 2008: Think Globally, Speak Locally
Davis et al.
J. Am. Soc. Nephrol. 2008;19:413-416.
FULL TEXT
Determining Prevalence of Chronic Kidney Disease Using Estimated Glomerular Filtration Rate
Delanaye et al.
JAMA 2008;299:631-631.
FULL TEXT
An Ounce of Prevention
Austin
Diabetes Spectr. 2008;21:5-6.
FULL TEXT
Management of Hypertension in Diabetic Patients With Chronic Kidney Disease
Steigerwalt
Diabetes Spectr. 2008;21:30-36.
ABSTRACT
| FULL TEXT
|
