Dataset Information

Trends in Prevalence of Chronic Kidney Disease in the United States.

ABSTRACT: 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.

SUBMITTER: Murphy D

PROVIDER: S-EPMC5552458 | biostudies-literature | 2016 Oct

REPOSITORIES: biostudies-literature

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Trends in Prevalence of Chronic Kidney Disease in the United States.

Murphy Daniel D McCulloch Charles E CE Lin Feng F Banerjee Tanushree T Bragg-Gresham Jennifer L JL Eberhardt Mark S MS Morgenstern Hal H Pavkov Meda E ME Saran Rajiv R Powe Neil R NR Hsu Chi-Yuan CY

Annals of internal medicine 20160802 7

<h4>Background</h4>Trends in the prevalence of chronic kidney disease (CKD) are important for health care policy and planning.<h4>Objective</h4>To update trends in CKD prevalence.<h4>Design</h4>Repeated cross-sectional study.<h4>Setting</h4>NHANES (National Health and Nutrition Examination Survey) for 1988 to 1994 and every 2 years from 1999 to 2012.<h4>Participants</h4>Adults aged 20 years or older.<h4>Measurements</h4>Chronic kidney disease (stages 3 and 4) was defined as an estimated glomerul ...[more]

PMID: 27479614

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Project description:ImportanceIncome disparity between persons with the most resources (the top 20% of earners) and the remainder of the population in the United States has dramatically widened over the past few decades. Given the well-established association between income and health, this increasing income gap may provide insights into the dynamics of cardiovascular disease (CVD) burden among adults in the US.ObjectiveTo quantify the contribution of people in the highest-resources group and the remainder of the population to the burden of CVD, and to estimate the trends in the prevalence of CVD for the 2 groups in the United States from 1999 to 2016.Design, setting, and participantsThis serial cross-sectional analysis used nationally representative data from 9 cycles of the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2016. Survey participants were adults 20 years or older. Statistical analysis of the data was conducted in December 2019.Main outcomes and measuresAge-standardized prevalence of CVD was calculated using the 2010 census estimates. Participants were stratified by income group using the NHANES income to poverty ratio, which was converted into a binary variable: a ratio of 5 or greater for the highest-resources group and a ratio of less than 5 for the remainder of the population.ResultsThis analysis included 44 986 participants. Among the 7926 participants in the highest-resources group, 3290 (50.3%) were in the 40- to 59-year age group and 4094 (51.9%) were men. Among the 37 060 participants in the remainder of the population, 10 840 (34.1%) were in the 40- to 59-year age group and 19 470 (53.2%) were women. The age-standardized prevalence of CVD decreased in the highest-resources group during the study period (1999-2016): angina from 3.4% (n = 24) to 0.3% (n = 5), heart attack from 3.2% (n = 24) to 1.4% (n = 19), congestive heart failure (CHF) from 1.2% (n = 11) to 0.5% (n = 7), and stroke from 1.1% to 1.0% (n = 8). In the remainder of the population, the prevalence of angina decreased from 3.3% (n = 131) in 1999 to 2.6% (n = 118) in 2016 and heart attack from 4.0% (n = 160) in 1999 to 3.6% (n = 201) in 2016. Conversely, an increase was observed in the prevalence of CHF from 2.6% (n = 123) in 1999 to 2.8% (n = 176) in 2016 and stroke from 2.9% (n = 152) in 1999 to 3.2% (n = 178) in 2016. Over time, the odds of reporting angina (odds ratio [OR], 0.80; 95% CI, 0.73-0.87; P < .001), heart attack (OR, 0.91; 95% CI, 0.86-0.97; P = .003), and CHF (OR, 0.90; 95% CI, 0.82-0.99; P = .03) decreased among those in the highest-resources group, while there was no significant change in the odds of reporting stroke (OR, 0.97; 95% CI, 0.90-1.05; P = .43). Among the remainder of the population, the odds of reporting angina (OR, 0.95; 95% CI, 0.92-0.99; P < .05) and heart attack (OR, 0.99; 95% CI, 0.97-1.02; P = .06) decreased over time. Conversely, there was no statistically significant change in the odds of reporting CHF (OR, 1.02; 95% CI, 1.00-1.05; P = .08) and stroke (OR, 1.02; 95% CI, 0.99-1.04; P = .21).Conclusions and relevanceThis study found substantial and increasing disparities in CVD prevalence between the richest and poorest participants in the NHANES from 1999 to 2016, with lower CVD rate reported among the highest-resources group. Additional research into the dynamics of income inequality and health outcomes as well as policy and public health efforts to mitigate this inequality are needed.

Project description:BackgroundThe objective of the study was to examine overall anemia management trends in non-dialysis patients with chronic kidney disease (CKD) from 2006 to 2015, and to evaluate the impact of Trial to Reduced Cardiovascular Events with Ananesp Therapy (TREAT)'s study results (October 2009) and the US Food and Drug Administration (FDA)'s (June 2011) safety warnings and guidelines on the use of ESA therapy in the current treatment of anemia.MethodsA retrospective cohort analysis of anemia management in CKD patients using Truven MarketScan Commercial and Medicare Supplemental databases was conducted. Monthly rates and types of anemia treatment for post-TREAT and post-FDA safety warning periods were compared to pre-TREAT period. Anemia management included ESA, intravenous iron, and blood transfusion. A time-series analysis using Autoregressive Integrated Moving Average (ARIMA) model and a Generalized Estimating Equation (GEE) model were used.ResultsBetween 2006 and 2015, CKD patients were increasingly less likely to be treated with ESAs, more likely to receive intravenous iron supplementation, and blood transfusions. The adjusted probabilities of prescribing ESAs were 31% (odds ratio (OR) = 0.69, 95% confidence interval (CI): 0.67-0.71) and 59% (OR = 0.41, 95% CI: 0.40, 0.42) lower in the post-TREAT and post-FDA warning periods compared to pre-TREAT period. The probability of prescribing intravenous iron was increased in the post-FDA warning period (OR = 1.11, 95% CI: 1.03-1.19) although the increase was not statistically significant in the post-TREAT period (OR = 1.03, 95% CI: 0.94-1.12). The probabilities of prescribing blood transfusion during the post-TREAT and post-FDA warning periods increased by 14% (OR = 1.14, 95% CI: 1.06-1.23) and 31% (OR = 1.31, 95% CI: 1.22-1.39), respectively. Similar trends of prescribing ESAs and iron supplementations were observed in commercially insured CKD patients but the use of blood transfusions did not increase.ConclusionsAfter the 2011 FDA safety warnings, the use of ESA continued to decrease while the use of iron supplementation continued to increase. The use of blood transfusions increased significantly in Medicare patients while it remained stable in commercially insured patients. Results suggest the TREAT publication had effected treatment of anemia prior to the FDA warning but the FDA warning solidified TREAT's recommendations for anemia treatment for non- dialysis dependent CKD patients.

Project description:BackgroundIt is well-known that patients with chronic kidney disease and end-stage renal disease are at increased risk of pulmonary embolism than patients with normal kidney function. However, the data on trends, outcomes, and predictors of mortality in pulmonary embolism patients with chronic kidney disease and end-stage renal disease in the United States are limited.MethodsWe queried the National Inpatient Sample database from 2010 to 2014. International Classification of Diseases-Ninth Revision-Clinical Modification codes were used to identify patients with normal kidney function, chronic kidney disease, and end-stage renal disease. The frequency of pulmonary embolism, complications, in-hospital mortality, and length of stay were calculated for each cohort. Multivariable logistic regression models were constructed to determine the predictors of mortality.ResultsIn the study population (2010-2014), there were 766,176 pulmonary embolism hospitalizations with normal kidney function, 79,824 with chronic kidney disease, and 9147 with end-stage renal disease. Among the study cohorts, the mortality rate was 2.7% in normal kidney function, 4.5% in chronic kidney disease, and 6.8% in end-stage renal disease hospitalizations. Median length of stay was highest in the end-stage renal disease cohort and lowest in the normal kidney function cohort. After adjusting for confounders, pulmonary embolism patients with chronic kidney disease died 1.15 times more often than those with normal kidney function and pulmonary embolism patients with end-stage renal disease died 4.2 times more often than those with normal kidney function.ConclusionThe mortality rate and length of stay in pulmonary embolism patients with chronic kidney disease and end-stage renal disease were significantly higher than those in pulmonary embolism patients with normal kidney function. Also, pulmonary embolism patients with chronic kidney disease and end-stage renal disease were at higher risk of in-hospital mortality than those with normal kidney function. There was statistically significant higher risk of mortality in elderly and Black patients with pulmonary embolism and concurrent chronic kidney disease or end-stage renal disease.

Project description:Background and objectivesLong wait times for deceased donor kidneys and low rates of preemptive wait-listing have limited preemptive transplantation in the United States. We aimed to assess trends in preemptive deceased donor transplantation with the introduction of the new Kidney Allocation System (KAS) in 2014 and identify whether key disparities in preemptive transplantation have changed.Design, setting, participants, & measurementsWe identified adult deceased donor kidney transplant recipients in the United States from 2000 to 2018 using the Scientific Registry of Transplant Recipients. Preemptive transplantation was defined as no dialysis before transplant. Associations between recipient, donor, transplant, and policy era characteristics and preemptive transplantation were calculated using logistic regression. To test for modification by KAS policy era, an interaction term between policy era and each characteristic of interest was introduced in bivariate and adjusted models.ResultsThe proportion of preemptive transplants increased after implementation of KAS from 9.0% to 9.8%, with 1.10 (95% confidence interval [95% CI], 1.06 to 1.14) times higher odds of preemptive transplantation post-KAS compared with pre-KAS. Preemptive recipients were more likely to be white, older, female, more educated, hold private insurance, and have ESKD cause other than diabetes or hypertension. Policy era significantly modified the association between preemptive transplantation and race, age, insurance status, and Human Leukocyte Antigen zero-mismatch (interaction P<0.05). Medicare patients had a significantly lower odds of preemptive transplantation relative to private insurance holders (pre-KAS adjusted OR, [aOR] 0.26; [95% CI, 0.25 to 0.27], to 0.20 [95% CI, 0.18 to 0.22] post-KAS). Black and Hispanic patients experienced a similar phenomenon (aOR 0.48 [95% CI, 0.45 to 0.51] to 0.41 [95% CI, 0.37 to 0.45] and 0.43 [95% CI, 0.40 to 0.47] to 0.40 [95% CI, 0.36 to 0.46] respectively) compared with white patients.ConclusionsAlthough the proportion of deceased donor kidney transplants performed preemptively increased slightly after KAS, disparities in preemptive kidney transplantation persisted after the 2014 KAS policy changes and were exacerbated for racial minorities and Medicare patients.

Project description:BackgroundAdults with chronic kidney disease (CKD) are hospitalized more frequently than those without CKD, but the magnitude of this excess morbidity and the factors associated with hospitalizations are not well known.Methods and findingsData from 3,939 participants enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study between 2003 and 2008 at 7 clinical centers in the United States were used to estimate primary causes of hospitalizations, hospitalization rates, and baseline participant factors associated with all-cause, cardiovascular, and non-cardiovascular hospitalizations during a median follow up of 9.6 years. Multivariable-adjusted Poisson regression was used to identify factors associated with hospitalization rates, including demographics, blood pressure, estimated glomerular filtration rate (eGFR), and proteinuria. Hospitalization rates in CRIC were compared with rates in the Nationwide Inpatient Sample (NIS) from 2012. Of the 3,939 CRIC participants, 45.1% were female, and 41.9% identified as non-Hispanic black, with a mean age of 57.7 years, and the mean eGFR is 44.9 ml/min/1.73m2. CRIC participants had an unadjusted overall hospitalization rate of 35.0 per 100 person-years (PY) [95% CI: 34.3 to 35.6] and 11.1 per 100 PY [95% CI: 10.8 to 11.5] for cardiovascular-related causes. All-cause, non-cardiovascular, and cardiovascular hospitalizations were associated with older age (≥65 versus 45 to 64 years), more proteinuria (≥150 to <500 versus <150 mg/g), higher systolic blood pressure (≥140 versus 120 to <130 mmHg), diabetes (versus no diabetes), and lower eGFR (<60 versus ≥60 ml/min/1.73m2). Non-Hispanic black (versus non-Hispanic white) race/ethnicity was associated with higher risk for cardiovascular hospitalization [rate ratio (RR) 1.25, 95% CI: 1.16 to 1.35, p-value < 0.001], while risk among females was lower [RR 0.89, 95% CI: 0.83 to 0.96, p-value = 0.002]. Rates of cardiovascular hospitalizations were higher among those with ≥500 mg/g of proteinuria irrespective of eGFR. The most common causes of hospitalization were related to cardiovascular (31.8%), genitourinary (8.7%), digestive (8.3%), endocrine, nutritional or metabolic (8.3%), and respiratory (6.7%) causes. Hospitalization rates were higher in CRIC than the NIS, except for non-cardiovascular hospitalizations among individuals aged >65 years. Limitations of the study include possible misclassification by diagnostic codes, residual confounding, and potential bias from healthy volunteer effect due to its observational nature.ConclusionsIn this study, we observed that adults with CKD had a higher hospitalization rate than the general population that is hospitalized, and even moderate reductions in kidney function were associated with elevated rates of hospitalization. Causes of hospitalization were predominantly related to cardiovascular disease, but other causes contributed, particularly, genitourinary, digestive, and endocrine, nutritional, and metabolic illnesses. High levels of proteinuria were observed to have the largest association with hospitalizations across a wide range of kidney function levels.

Dataset Information

Trends in Prevalence of Chronic Kidney Disease in the United States.

Publications

Trends in Prevalence of Chronic Kidney Disease in the United States.

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