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Trends in Prevalence of CKD Stages among U.S. Adults

Trends in Prevalence of CKD Stages among U.S. Adults

Approximately 1 in 7 adults in the United States has chronic kidney disease (CKD) stages 1–5. The overall crude prevalence of CKD was 13.9% during 2017–March 2020 and 12.9% during 2001–2004. CKD stages showed little change over time.

Data Source: NHANES

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Data includes CKD stages 1–5.

*CKD stage 5 was suppressed in 2001–2004 due to small sample sizes (N < 11). Data are not adjusted.

NHANES is a nationally representative, cross-sectional survey that is currently conducted every two years (since 1999) by CDC's National Center for Health Statistics among noninstitutionalized US civilian residents. The survey consists of a standardized in-home interview and a physical examination with blood and urine collected at a mobile examination center. Data were examined by combining two NHANES cycles to represent four-year periods from 2001 to 2016 and the 2017–March 2020 pre-pandemic cycle.

Note: Not all NHANES variables are collected for all years; therefore, some NHANES indicators may not utilize the full 20-year span.

FieldData
Description of Measure

Prevalence of CKD in U.S. Adults, by stage.

Data Set

National Health and Nutrition Examination Survey (NHANES).

Population

Noninstitutionalized US adults aged ≥ 18 years, pregnant women excluded.

Years Included

2001–March 2020.

Numerator

U.S. adults aged ≥ 18 years with CKD stages 1–5.

Denominator

U.S. adults aged ≥ 18 years with serum creatinine and urine albumin measurements.

Definition of CKD and CKD Stage

CKD is defined by an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m² or albuminuria (urine albumin to creatinine ratio [UACR] ≥ 30 mg/g). Stage 1: eGFR ≥90 ml/min/1.73 m² and albuminuria; stage 2: eGFR 60–89 ml/min/1.73 m² and albuminuria; stage 3a: eGFR 45–59 ml/min/1.73 m²; stage 3b: eGFR 30–44 ml/min/1.73 m²; stage 4: 15–29 ml/min/1.73 m²; stage 5: eGFR <15 ml/min/1.73 m². Estimates are based on single estimates of eGFR and UACR.

Estimated glomerular filtration rate (eGFR)

Based on the CKD-EPI (2021) equation for calibrated creatinine: eGFR=142 x [min(serum creatinine in mg/dL) /κ, 1)]**α x [max(serum creatinine/κ, 1)]**-1.20 x 0.9938**age x (1.012 if female).

κ = 0.7 if female and 0.9 if male
α = -0.241 if female and -0.302 if male
** = raise to the power

Albuminuria

UACR is calculated as urine albumin divided by urine creatinine. Albuminuria is defined as UACR ≥ 30 mg/g.

Serum Creatinine

Serum creatinine values used for eGFR calculation are standardized against isotope dilution mass spectrometry (IDMS).

Urine Albumin

Measured in random urine collection by fluorescent immunoassay.

Limitations of Indicator

Albuminuria and kidney function are assessed from one-time cross-sectional measurements, possibly overestimating CKD prevalence. 

Analytical Considerations

Appropriate NHANES survey weights are used for all analyses; if the relative standard error is greater than 30%, the estimates are not shown. Serum creatinine measurements are assay corrected for NHANES years 2005 and 2006 and prior to be combined with later years.

  • Levey AS, Stevens LA, Schmid CH, et al. A New Equation to Estimate Glomerular Filtration Rate. Ann Intern Med. 2009;150(9):604-612.

    http://annals.org/aim/article/744469
  • Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am. J. Kidney Dis. 2003;41(1):1-12.
  • Selvin E, Manzi J, Stevens LA, et al. Calibration of serum creatinine in the National Health and Nutrition Examination Surveys (NHANES) 1988-1994, 1999-2004. Am J Kidney Dis. 2007;50(6):918-26.