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Published ahead of print on November 24, 2004
Journal of the American Society of Nephrology
© 2004 American Society of Nephrology
doi: 10.1681/ASN.2004070539
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CLINICAL SCIENCE: Epidemiology and Outcomes

Chronic Kidney Disease Awareness, Prevalence, and Trends among U.S. Adults, 1999 to 2000

Josef Coresh 1*, Danita Byrd-Holt 2, Brad C. Astor 3, Josephine P. Briggs 4, Paul W. Eggers 4, David A. Lacher 5, Thomas H. Hostetter 4

1 *Departments of Epidemiology; {dagger}Biostatistics, Johns Hopkins Bloomberg School of Public Health; {ddagger}Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions; and {sect}Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore
2 ||Social & Scientific Systems, Inc., Silver Spring
3 *Departments of Epidemiology; and {ddagger}Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions
4 Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda
5 #Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland

* To whom correspondence should be addressed. E-mail: coresh{at}jhu.edu.


  Abstract

The incidence of kidney failure treatment in the United States increased 57% from 1991 to 2000. Chronic kidney disease (CKD) prevalence was 11% among U.S. adults surveyed in 1988 to 1994. The objective of this study was to estimate awareness of CKD in the U.S. population during 1999 to 2000 and to determine whether the prevalence of CKD in the United States increased compared with 1988 to 1994. Analysis was conducted of nationally representative samples of noninstitutionalized adults, aged 20 yr and older, in two National Health and Nutrition Examination Surveys conducted in 1988 to 1994 (n = 15,488) and 1999 to 2000 (n = 4101) for prevalence ± SE. Awareness of CKD is self-reported. Kidney function (GFR), kidney damage (microalbuminuria or greater), and stages of CKD (GFR and albuminuria) were estimated from calibrated serum creatinine, spot urine albumin to creatinine ratio (ACR), age, gender, and race. GFR was estimated using the simplified Modification of Diet in Renal Disease Study equation. Self-reported awareness of weak or failing kidneys in 1999 to 2000 was strongly associated with decreased kidney function and albuminuria but was low even in the presence of both conditions. Only 24.3 ± 6.4% of patients at GFR 15 to 59 ml/min per 1.73 m2 and albuminuria were aware of CKD compared with 1.1 ± 0.3% at GFR of 90 ml/min per 1.73 m2 or greater and no microalbuminuria. At moderately decreased kidney function (GFR 30 to 59 ml/min per 1.73 m2), awareness was much lower among women than men (2.9 ± 1.6 versus 17.9 ± 5.9%; P = 0.008). The prevalence of moderately or severely decreased kidney function (GFR 15 to 59 ml/min per 1.73 m2) remained stable over the past decade (4.4 ± 0.3% in 1988 to 1994 and 3.8 ± 0.4% in 1999 to 2000; P = 0.23). At the same time, the prevalence of albuminuria (ACR ≥ 30 mg/g) in single spot urine increased from 8.2 ± 0.4% to 10.1 ± 0.7% (P = 0.01). Overall CKD prevalence was similar in both surveys (9% using ACR > 30 mg/g for persistent microalbuminuria; 11% in 1988 to 1994 and 12% in 1999 to 2000 using gender-specific ACR cutoffs). Despite a high prevalence, CKD awareness in the U.S. population is low. In contrast to the dramatic increase in treated kidney failure, overall CKD prevalence in the U.S. population has been relatively stable.


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Early Referral for Chronic Kidney Disease: Good for Those Who Need It, but Who Are They?
Mayo Clin. Proc., November 1, 2006; 81(11): 1420 - 1422.
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 Mayo Clin Proc.Home page
A. D. Rule, R. J. Rodeheffer, T. S. Larson, J. C. Burnett Jr, F. G. Cosio, S. T. Turner, and S. J. Jacobsen
Limitations of Estimating Glomerular Filtration Rate From Serum Creatinine in the General Population
Mayo Clin. Proc., November 1, 2006; 81(11): 1427 - 1434.
[Abstract] [Full Text] [PDF]

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 J. Am. Soc. Nephrol.Home page
C. A. Peralta, M. G. Shlipak, D. Fan, J. Ordonez, J. P. Lash, G. M. Chertow, and A. S. Go
Risks for End-Stage Renal Disease, Cardiovascular Events, and Death in Hispanic versus Non-Hispanic White Adults with Chronic Kidney Disease
J. Am. Soc. Nephrol., October 1, 2006; 17(10): 2892 - 2899.
[Abstract] [Full Text] [PDF]

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 CJASNHome page
N. R. Powe
Reverse Race and Ethnic Disparities in Survival Increase with Severity of Chronic Kidney Disease: What Does This Mean?
Clin. J. Am. Soc. Nephrol., September 1, 2006; 1(5): 905 - 906.
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 ANN INTERN MEDHome page
J. Coresh and B. Astor
Decreased Kidney Function in the Elderly: Clinical and Preclinical, Neither Benign
Ann Intern Med, August 15, 2006; 145(4): 299 - 301.
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 Nephrol Dial TransplantHome page
C. Jacobs
Costs and benefits of improving renal failure treatment--where do we go?
Nephrol. Dial. Transplant., August 1, 2006; 21(8): 2049 - 2052.
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 J. Am. Soc. Nephrol.Home page
S. I. Hallan, J. Coresh, B. C. Astor, A. Asberg, N. R. Powe, S. Romundstad, H. A. Hallan, S. Lydersen, and J. Holmen
International Comparison of the Relationship of Chronic Kidney Disease Prevalence and ESRD Risk
J. Am. Soc. Nephrol., August 1, 2006; 17(8): 2275 - 2284.
[Abstract] [Full Text] [PDF]

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 J. Am. Soc. Nephrol.Home page
P. E. de Jong and G. C. Curhan
Screening, Monitoring, and Treatment of Albuminuria: Public Health Perspectives
J. Am. Soc. Nephrol., August 1, 2006; 17(8): 2120 - 2126.
[Abstract] [Full Text] [PDF]

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 J. Am. Soc. Nephrol.Home page
B. Stengel and C. Couchoud
Chronic Kidney Disease Prevalence and Treated End-Stage Renal Disease Incidence: A Complex Relationship
J. Am. Soc. Nephrol., August 1, 2006; 17(8): 2094 - 2096.
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 J. Am. Soc. Nephrol.Home page
S. T. Turner, S. L.R. Kardia, T. H. Mosley, A. D. Rule, E. Boerwinkle, and M. de Andrade
Influence of Genomic Loci on Measures of Chronic Kidney Disease in Hypertensive Sibships
J. Am. Soc. Nephrol., July 1, 2006; 17(7): 2048 - 2055.
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 NEJMHome page
L. A. Stevens, J. Coresh, T. Greene, and A. S. Levey
Assessing kidney function--measured and estimated glomerular filtration rate.
N. Engl. J. Med., June 8, 2006; 354(23): 2473 - 2483.
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 J. Am. Soc. Nephrol.Home page
F. Locatelli, P. Pozzoni, and L. Del Vecchio
Renal Manifestations in the Metabolic Syndrome.
J. Am. Soc. Nephrol., April 1, 2006; 17(4_suppl_2): S81 - S85.
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 J. Am. Soc. Nephrol.Home page
A. M. O'Hare, D. Bertenthal, K. E. Covinsky, C. S. Landefeld, S. Sen, K. Mehta, M. A. Steinman, A. Borzecki, and L. C. Walter
Mortality Risk Stratification in Chronic Kidney Disease: One Size for All Ages?
J. Am. Soc. Nephrol., March 1, 2006; 17(3): 846 - 853.
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 ANN INTERN MEDHome page
M. Rahman, S. Pressel, B. R. Davis, C. Nwachuku, J. T. Wright Jr., P. K. Whelton, J. Barzilay, V. Batuman, J. H. Eckfeldt, M. A. Farber, et al.
Cardiovascular Outcomes in High-Risk Hypertensive Patients Stratified by Baseline Glomerular Filtration Rate
Ann Intern Med, February 7, 2006; 144(3): 172 - 180.
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 Nephrol Dial TransplantHome page
R. J. Middleton, R. N. Foley, J. Hegarty, C. M. Cheung, P. McElduff, J. M. Gibson, P. A. Kalra, D. J. O'Donoghue, and J. P. New
The unrecognized prevalence of chronic kidney disease in diabetes
Nephrol. Dial. Transplant., January 1, 2006; 21(1): 88 - 92.
[Abstract] [Full Text] [PDF]

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 J. Am. Soc. Nephrol.Home page
M. Shlipak and C. Stehman-Breen
Observational Research Databases in Renal Disease
J. Am. Soc. Nephrol., December 1, 2005; 16(12): 3477 - 3484.
[Abstract] [Full Text] [PDF]

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 Arch Intern MedHome page
P. Muntner, A. Menke, K. B. DeSalvo, F. A. Rabito, and V. Batuman
Continued Decline in Blood Lead Levels Among Adults in the United States: The National Health and Nutrition Examination Surveys
Arch Intern Med, October 10, 2005; 165(18): 2155 - 2161.
[Abstract] [Full Text] [PDF]

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 Mayo Clin Proc.Home page
A. D. Rule and S. C. Textor
Cardiovascular Risk Linked to Chronic Kidney Disease--But Who Actually Has Chronic Kidney Disease?
Mayo Clin. Proc., October 1, 2005; 80(10): 1267 - 1269.
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 CMAJHome page
A. X. Garg, L. Moist, D. Matsell, H. R. Thiessen-Philbrook, R. B. Haynes, R. S. Suri, M. Salvadori, J. Ray, W. F. Clark, and for The Walkerton Health Study Investigators
Risk of hypertension and reduced kidney function after acute gastroenteritis from bacteria-contaminated drinking water
Can. Med. Assoc. J., August 2, 2005; 173(3): 261 - 268.
[Abstract] [Full Text] [PDF]

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 Diabetes CareHome page
P. Muntner, R. P. Wildman, K. Reynolds, K. B. DeSalvo, J. Chen, and V. Fonseca
Relationship Between HbA1c Level and Peripheral Arterial Disease
Diabetes Care, August 1, 2005; 28(8): 1981 - 1987.
[Abstract] [Full Text] [PDF]

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 J. Am. Soc. Nephrol.Home page
L. A. Stevens, G. Fares, J. Fleming, D. Martin, K. Murthy, J. Qiu, P. C. Stark, K. Uhlig, F. Van Lente, and A. S. Levey
Low Rates of Testing and Diagnostic Codes Usage in a Commercial Clinical Laboratory: Evidence for Lack of Physician Awareness of Chronic Kidney Disease
J. Am. Soc. Nephrol., August 1, 2005; 16(8): 2439 - 2448.
[Abstract] [Full Text] [PDF]

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 HypertensionHome page
C. A. Peralta, L. S. Hicks, G. M. Chertow, J. Z. Ayanian, E. Vittinghoff, F. Lin, and M. G. Shlipak
Control of Hypertension in Adults With Chronic Kidney Disease in the United States
Hypertension, June 1, 2005; 45(6): 1119 - 1124.
[Abstract] [Full Text] [PDF]

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 The OncologistHome page
J. Balla
The Issue of Renal Safety of Zoledronic Acid from a Nephrologist's Point of View
Oncologist, May 1, 2005; 10(5): 306 - 308.
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