Recent Trends in the Prevalence of Chronic Kidney Disease

Not the Same Old Song

Raymond K. Hsu; Neil R. Powe

Disclosures

Curr Opin Nephrol Hypertens. 2017;26(3):187-196. 

In This Article

Abstract and Introduction

Abstract

Purpose of review We aim to review recent updates on the epidemiology of chronic kidney disease (CKD).

Recent findings Recent analyses from the National Health and Nutritional Examination survey describe the temporal trend in CKD prevalence in US adults. The overall prevalence of estimated glomerular filtration rate less than 60 ml/min/1.73 m2 increased from 4.8% in 1988–1994 to 6.9% in 2003–2004, but has since stabilized at 6.4–6.9% up to 2011–2012. Prevalence of CKD stages 1–4 has also stabilized at ~14% of adults since 2003–2004. The prevalence of diabetic kidney disease – defined as estimated glomerular filtration rate less than 60 ml/min/1.73 m2 and/or microalbuminuria among adults with diabetes – has similarly plateaued since the early to mid-2000s at ~26–27%. There is continued rise in CKD and diabetic kidney disease prevalence among blacks and Mexican-Americans, however, in the last decade. Worldwide, a similar pattern of stable prevalence of CKD since the early 2000s is seen in England, Norway, and Korea. Despite these optimistic findings, there are several emerging at-risk populations. Rapid increases in diabetes and hypertension in China may signal an impending growth in CKD. In parts of Central America, there is emergence of very high CKD prevalence among agricultural workers – suspected to be due to occupational and environmental exposures.

Summary Collective efforts to undermine risk factors, such as better control of hypertension and diabetes, have likely helped to abate the growth in CKD in several developed countries within the last decade. More worldwide high-quality and geographically granular data collection on CKD would help to monitor the epidemiology of CKD and potentially assist in identifying impactful interventions.

Introduction

Chronic kidney disease (CKD) is associated with major adverse outcomes, including progression toward end-stage renal disease (ESRD), acute kidney injury, cardiovascular events, reduced quality of life, death, and increased healthcare costs.[1,2] Since the advent of consensus definitions for CKD in 2002 by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative classification system,[3] there has been tremendous advances in the research and understanding of the epidemiology of CKD. One of the most highlighted data sources to estimate the prevalence of CKD on a population level has been the National Health and Nutrition Examination Survey (NHANES)[4] in the United States. Analyses of NHANES data[5–7] showing a rise in CKD prevalence in the past few decades have led to CKD being characterized as an 'epidemic'.[8] A recent study projecting the future burden of CKD in the United States estimates that the prevalence of CKD (here defined as CKD stages 1–4) among those aged 30 years or older will increase from 13.2% in 2010 to 16.7% in 2030.[9] However, there are more recent emerging data from both the United States and other developed countries that the CKD prevalence may have stabilized. We review two recent publications in 2016 with the most updated trends in overall CKD prevalence and diabetic kidney disease prevalence in the United States, along with several updates in the temporal trend in CKD prevalence in other developed countries. We will also point out emerging threats in the global burden of CKD.

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