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Trends in Prevalence of Chronic Kidney Disease in the United StatesTrends in Prevalence of Chronic Kidney Disease in the United States ONLINE FIRST

Daniel Murphy, MD; Charles E. McCulloch, PhD; Feng Lin; Tanushree Banerjee, PhD; Jennifer L. Bragg-Gresham, PhD; Mark S. Eberhardt, PhD; Hal Morgenstern, PhD; Meda E. Pavkov, MD, PhD; Rajiv Saran, MBBS, MD, MS; Neil R. Powe, MD, MPH, MBA*; Chi-yuan Hsu, MD, MSc*, for the Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team
[+] Article, Author, and Disclosure Information

This article was published at www.annals.org on 2 August 2016.

* Drs. Powe and Hsu contributed equally to this work.

† For a list of members of the Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team, see the Appendix.


From the University of Minnesota, Minneapolis, Minnesota; University of California, San Francisco, San Francisco, California; University of Michigan, Ann Arbor, Michigan; National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland; and Centers for Disease Control and Prevention, Atlanta, Georgia.

Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Acknowledgment: The authors thank the participants and staff of NHANES.

Financial Support: By a Centers for Disease Control and Prevention cooperative agreement (1U58DP003839), the American Society of Nephrology Foundation for Kidney Research Student Scholar Grant Program, and the National Institutes of Health (K24DK92291).

Disclosures: Dr. Murphy reports a grant from the American Society of Nephrology Foundation for Kidney Research during the conduct of the study. Dr. Hsu reports grants from the National Institutes of Health during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-0273.

Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.

Reproducible Research Statement:Study protocol: Not available. Statistical code: Available to approved persons through written agreement with the authors from Dr. Powe (e-mail, Neil.Powe@ucsf.edu) or Dr. Hsu (e-mail, hsuchi@medicine.ucsf.edu). Data set: Available at www.cdc.gov/nchs/nhanes.htm.

Requests for Single Reprints: Chi-yuan Hsu, MD, MSc, Division of Nephrology, University of California, San Francisco, 533 Parnassus Avenue, U-400, Box 0532, San Francisco, CA 94143-0532; e-mail, hsuchi@medicine.ucsf.edu.

Current Author Addresses: Dr. Murphy: Department of Medicine, University of Minnesota, MMC 284 Mayo, 8284A (Campus Delivery Code), 420 Delaware Street SE, Minneapolis, MN 55455.

Dr. McCulloch and Ms. Lin: UCSF School of Medicine, Epidemiology & Biostatistics, 550 16th Street, Box 0560, San Francisco, CA 94158.

Drs. Banerjee and Powe: Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, ZFGH 10, Box 1364, San Francisco, CA 94110.

Dr. Bragg-Gresham: University of Michigan, Internal Medicine-Nephrology, 1455 Washington Heights, Suite 3645, Ann Arbor, MI 48109-2029.

Dr. Eberhardt: Centers for Disease Control and Prevention, National Center for Health Statistics, 3311 Toledo Road, Hyattsville, MD 20782-2064.

Dr. Morgenstern: University of Michigan, School of Public Health, M5164 SPH II, 1415 Washington Heights, Ann Arbor, MI 48109-2029.

Dr. Pavkov: Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329-4027.

Dr. Saran: University of Michigan, Internal Medicine - Nephrology, Kidney Epidemiology and Cost Center, 1415 Washington Heights, SPH I, Suite 3645, Ann Arbor, MI 48109-2029.

Dr. Hsu: UCSF School of Medicine, 533 Parnassus Avenue, UC Hall 404, Box 0532, San Francisco, CA 94143.

Author Contributions: Conception and design: D. Murphy, C.E. McCulloch, R. Saran, N.R. Powe, C.Y. Hsu.

Analysis and interpretation of the data: D. Murphy, C.E. McCulloch, F. Lin, H. Morgenstern, M.E. Pavkov, R. Saran, N.R. Powe, C.Y. Hsu.

Drafting of the article: D. Murphy, M.E. Pavkov, C.Y. Hsu.

Critical revision of the article for important intellectual content: D. Murphy, C.E. McCulloch, T. Banerjee, J.L. Bragg-Gresham, H. Morgenstern, M.E. Pavkov, R. Saran, N.R. Powe, C.Y. Hsu.

Final approval of the article: D. Murphy, C.E. McCulloch, F. Lin, T. Banerjee, J.L. Bragg-Gresham, M.S. Eberhardt, H. Morgenstern, M.E. Pavkov, R. Saran, N.R. Powe, C.Y. Hsu.

Statistical expertise: C.E. McCulloch, F. Lin, H. Morgenstern, C.Y. Hsu.

Obtaining of funding: R. Saran, N.R. Powe.

Administrative, technical, or logistic support: M.S. Eberhardt, N.R. Powe, C.Y. Hsu.

Collection and assembly of data: D. Murphy.


Ann Intern Med. Published online 2 August 2016 doi:10.7326/M16-0273
© 2016 American College of Physicians
Text Size: A A A

Background: Trends in the prevalence of chronic kidney disease (CKD) are important for health care policy and planning.

Objective: To update trends in CKD prevalence.

Design: Repeated cross-sectional study.

Setting: NHANES (National Health and Nutrition Examination Survey) for 1988 to 1994 and every 2 years from 1999 to 2012.

Participants: Adults aged 20 years or older.

Measurements: Chronic kidney disease (stages 3 and 4) was defined as an estimated glomerular filtration rate (eGFR) of 15 to 59 mL/min/1.73 m2, estimated with the Chronic Kidney Disease Epidemiology Collaboration equation from calibrated serum creatinine measurements. An expanded definition of CKD also included persons with an eGFR of at least 60 mL/min/1.73 m2 and a 1-time urine albumin–creatinine ratio of at least 30 mg/g.

Results: The unadjusted prevalence of stage 3 and 4 CKD increased from the late 1990s to the early 2000s. Since 2003 to 2004, however, the overall prevalence has largely stabilized (for example, 6.9% prevalence in 2003 to 2004 and in 2011 to 2012). There was little difference in adjusted prevalence of stage 3 and 4 CKD overall in 2003 to 2004 versus 2011 to 2012 after age, sex, race/ethnicity, and diabetes mellitus status were controlled for (P = 0.26). Lack of increase in CKD prevalence since the early 2000s was observed in most subgroups and with an expanded definition of CKD that included persons with higher eGFRs and albuminuria.

Limitation: Serum creatinine and albuminuria were measured only once in each person.

Conclusion: In a reversal of prior trends, there has been no appreciable increase in the prevalence of stage 3 and 4 CKD in the U.S. population overall during the most recent decade.

Primary Funding Source: American Society of Nephrology Foundation for Kidney Research Student Scholar Grant Program, Centers for Disease Control and Prevention, and National Institutes of Health.

Figures

Grahic Jump Location
Figure.

Adjusted prevalence of stage 3 and 4 chronic kidney disease (estimated glomerular filtration rate of 15 to 59 mL/min/1.73 m2 calculated with Chronic Kidney Disease Epidemiology Collaboration equation) in U.S. adults by age (A), sex (B), race/ethnicity (C), and presence or absence of diabetes (D), NHANES 1988–1994 through 2011–2012.

Grahic Jump Location
Grahic Jump Location
Appendix Figure 1.

Adjusted prevalence of chronic kidney disease with use of expanded definition (which also included persons with estimated glomerular filtration rate ≥60 mL/min/1.73 m2 [calculated with Chronic Kidney Disease Epidemiology Collaboration equation] and urine albumin–creatinine ratio ≥30 mg/g), by age (A), sex (B), race/ethnicity (C), and presence or absence of diabetes (D), NHANES 1988–1994 through 2011–2012.

Each subgroup is adjusted for the other 3 subgroup variables (e.g., age-specific prevalence is adjusted for sex, race/ethnicity, and diabetes status). NHANES = National Health and Nutrition Examination Survey.

Grahic Jump Location
Grahic Jump Location
Appendix Figure 2.

Adjusted prevalence of stage 3 and 4 chronic kidney disease (estimated glomerular filtration rate of 15 to 59 mL/min/1.73 m2 calculated with Modification of Diet in Renal Disease Study equation) in U.S. adults, by age (A), sex (B), race/ethnicity (C), and presence or absence of diabetes (D).

Each subgroup is adjusted for the other 3 subgroup variables (e.g., age-specific prevalence is adjusted for sex, race/ethnicity, and diabetes status).

Grahic Jump Location
Grahic Jump Location
Appendix Figure 3.

Adjusted prevalence of chronic kidney disease with use of expanded definition (which also included persons with estimated glomerular filtration rate ≥60 mL/min/1. 73 m2 [calculated with Modification of Diet in Renal Disease Study equation] and urine albumin–creatinine ratio ≥30 mg/g), by age (A), sex (B), race/ethnicity (C), and presence or absence of diabetes (D).

Each subgroup is adjusted for the other 3 subgroup variables (e.g., age-specific prevalence is adjusted for sex, race/ethnicity, and diabetes status).

Grahic Jump Location

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