Reported Cases of End-Stage Kidney Disease — United States, 2000–2019

Nilka Ríos Burrows, MPH; Alain Koyama, ScD; Meda E. Pavkov, MD, PhD

Disclosures

Morbidity and Mortality Weekly Report. 2022;71(11):412-415. 

In This Article

Abstract and Introduction

Introduction

End-stage kidney disease (ESKD) (kidney failure requiring dialysis or transplantation) is a costly and disabling condition that often results in premature death.[1] During 2019, Medicare fee-for-service expenditures for ESKD were $37.3 billion, accounting for approximately 7% of Medicare paid claims costs.[1] Diabetes and hypertension remain the leading causes of ESKD, accounting for 47% and 29%, respectively, of patients who began ESKD treatment in 2019.[1] Compared with White persons, Black, Hispanic, and American Indian or Alaska Native persons are more likely to develop ESKD[1,2] and to have diagnosed diabetes.[3] After declining for more than a decade, the incidence rate of ESKD with diabetes reported as the primary cause (ESKD from diabetes) has leveled off since 2010.[1,4] Further, after increasing for many years, the prevalence of diagnosed diabetes has also leveled off.[4] Although these flattening trends in rates are important from a population perspective, the trend in the number of ESKD cases is important from a health systems resources perspective. Using United States Renal Data System (USRDS) 2000–2019 data, CDC examined trends in the number of incident and prevalent ESKD cases by demographic characteristics and by primary cause of ESKD. During 2000–2019, the number of incident ESKD cases increased by 41.8%, and the number of prevalent ESKD cases increased by 118.7%. Higher percentage changes in both incident and prevalent ESKD cases were among Asian, Hispanic, and Native Hawaiian or other Pacific Islander persons and among cases with hypertension or diabetes as the primary cause. Interventions to improve care and better manage ESKD risk factors among persons with diabetes and hypertension, along with increased use of therapeutic agents such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARB), and sodium-glucose cotransporter 2 (SGLT2) inhibitors shown to have kidney-protective benefits[5,6] might slow the increase and eventually reverse the trend in incident ESKD cases.

USRDS collects, analyzes, and distributes ESKD clinical and claims data from the Centers for Medicare & Medicaid Services (CMS) Medical Evidence Report form (CMS 2728), which includes sociodemographic characteristics, the date patients were first treated for ESKD, and the primary cause of ESKD. The Medicare program covers 80% of the cost of ESKD treatment for beneficiaries in the United States regardless of age.[1] Kidney care providers are required to complete the CMS 2728 form for each new patient with ESKD, regardless of Medicare eligibility status. Using USRDS 2000–2019 data, CDC examined the number of incident and prevalent ESKD cases in the United States each year during 2000–2019 by demographic characteristics (i.e., age, sex, and race/ethnicity) and by primary cause (i.e., diabetes, hypertension, or other cause). This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.*

During 2000 and 2019, for both incident and prevalent ESKD cases, 34.9%–42.3% occurred among persons aged 45–64 years, 53.4%–-58.3% occurred among males, and 44.7%–55.2% occurred among White persons (Table). During 2000–2019, the number of incident ESKD cases increased 41.8%, from 92,660 to 131,422 (Table) (Figure 1), and the number of prevalent cases increased 118.7%, from 358,247 to 783,594 (Table) (Figure 2). Larger increases among incident cases occurred among Asian (149.5%), Native Hawaiian or other Pacific Islander (96.5%), and Hispanic (84.0%) persons (Table). Similarly, larger increases among prevalent cases were also observed among these populations. Smaller percentage increases in both incident and prevalent cases were observed among persons aged <45 years and among American Indian or Alaska Native persons. Although diabetes was the primary cause for a larger percentage of incident and prevalent ESKD cases, the largest increase in incident and prevalent cases was among patients with hypertension reported as the primary cause.

Figure 1.

Number of reported incident cases of end-stage kidney disease, by primary cause — United States, 2000–2019*
*Data from United States Renal Data System, 2021 Annual Data Report, Reference Tables. https://adr.usrds.org/2021/reference-tables

Figure 2.

Number of reported prevalent cases of end-stage kidney disease, by primary cause — United States, 2000–2019*
*Data from United States Renal Data System, 2021 Annual Data Report, Reference Tables. https://adr.usrds.org/2021/reference-tables

*45 C.F.R. part 46.102(l)(2); 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.

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