CDC Surveillance System: Physical Functioning Limitation by CKD Status in U.S. Adults Aged 20-64

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Indicator Details: Percent of the U.S. Population Age 20-64 Reporting Physical Functioning Limitation by CKD^a,b

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NHANES

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Adults Age 20-64 Reporting Functional Limitations by Type of Physical Functioning Limitation and CKD Stage^a,b National Health and Nutrition Examination Survey
Year	Definition	No CKD	CKD Stages 1 & 2	CKD Stages 3 & 4
1999–2004	Limitations in Ability to Work	7.6% (CI 6.6-8.5)	11.3% (CI 8.7-13.8)	13.5% (CI 5.3-21.8)
1999–2004	Limitations in Type or Amount of Work Performed	9.3% (CI 8.1-10.5)	12.8% (CI 10.2-15.4)	15.2% (CI 7.0-23.3)
1999–2004	Limitations in Walking	6.0% (CI 4.8-7.2)	7.3% (CI 5.4-9.3)	10.8% (CI 6.3-15.2)
1999–2004	Limitations Due to Confusion	4.4% (CI 3.8-5.0)	7.5% (CI 4.8-10.2)	*
1999–2004	Difficulties in ADL	6.2% (CI 5.4-6.9)	9.9% (CI 7.5-12.3)	9.2% (CI 5.2-13.2)
1999–2004	Difficulties in IADL	8.6% (CI 7.8-9.5)	13.0% (CI 10.2-15.8)	12.8% (CI 6.5-19.0)
1999–2004	Difficulties in LSA	6.2% (CI 5.5-7.0)	8.7% (CI 6.5-10.9)	8.9% (CI 4.6-13.3)
1999–2004	Difficulties in LEM	12.8% (CI 11.6-13.9)	17.3% (CI 14.6-20.0)	13.5% (CI 8.4-18.7)
1999–2004	Difficulties in GPA	12.9% (CI 11.6-14.1)	15.5% (CI 13.0-18.1)	14.0% (CI 9.7-18.4)
2005–2010	Limitations in Ability to Work	6.9% (CI 6.1-7.7)	14.4% (CI 11.2-17.5)	8.8% (CI 6.6-11.0)
2005–2010	Limitations in Type or Amount of Work Performed	11.2% (CI 10.1-12.3)	18.8% (CI 15.1-22.5)	10.3% (CI 7.8-12.9)
2005–2010	Limitations in Walking	3.0% (CI 2.6-3.4)	6.2% (CI 4.5-7.8)	4.8% (CI 3.0-6.5)
2005–2010	Limitations Due to Confusion	4.0% (CI 3.4-4.5)	7.3% (CI 5.1-9.5)	3.8% (CI 2.2-5.5)
2005–2010	Difficulties in ADL	5.0% (CI 4.4-5.6)	9.9% (CI 8.0-11.8)	6.3% (CI 4.5-8.0)
2005–2010	Difficulties in IADL	6.7% (CI 6.0-7.3)	12.2% (CI 9.3-15.0)	6.2% (CI 4.4-8.1)
2005–2010	Difficulties in LSA	5.1% (CI 4.6-5.7)	10.8% (CI 8.0-13.5)	5.1% (CI 3.6-6.7)
2005–2010	Difficulties in LEM	11.1% (CI 10.0-12.1)	19.2% (CI 15.9-22.5)	13.5% (CI 11.1-15.9)
2005–2010	Difficulties in GPA	11.1% (CI 10.2-11.9)	19.3% (CI 15.9-22.7)	12.1% (CI 9.5-14.7)
2011–2016	Limitations in Ability to Work	8.2% (CI 7.1-9.2)	11.0% (CI 9.4-12.7)	21.7% (CI 8.9-34.5)
2011–2016	Limitations in Type or Amount of Work Performed	12.3% (CI 11.1-13.4)	16.4% (CI 13.9-18.9)	33.5% (CI 17.8-49.2)
2011–2016	Limitations in Walking	3.5% (CI 2.9-4.1)	5.3% (CI 3.9-6.7)	*
2011–2016	Limitations Due to Confusion	4.3% (CI 3.8-4.8)	5.9% (CI 4.7-7.2)	*
2011–2016	Difficulties in ADL	5.7% (CI 4.9-6.4)	9.4% (CI 7.6-11.2)	*
2011–2016	Difficulties in IADL	8.4% (CI 7.5-9.4)	13.1% (CI 10.3-15.9)	*
2011–2016	Difficulties in LSA	6.9% (CI 6.0-7.9)	10.1% (CI 8.2-12.1)	*
2011–2016	Difficulties in LEM	12.0% (CI 10.8-13.1)	17.5% (CI 14.5-20.6)	25.6% (CI 12.9-38.3)
2011–2016	Difficulties in GPA	12.9% (CI 11.6-14.3)	16.6% (CI 14.1-19.1)	31.3% (CI 16.4-46.3)

Notes:

* Indicates that the result for this cell was suppressed because of imprecision due to a sample size that was too small or the standard error of the result being too large (>30% of the estimate).
95% confidence intervals, when available, are shown in parentheses.

Footnotes:
^a ADL, activities of daily living (getting in and out of bed, using fork/knife/cup [eating], dressing oneself); IADL, instrumental activities of daily living (managing money, house chores, preparing meals); LSA, leisure and social activities (going to the movies, attending social event, leisure activity at home); LEM, lower extremity mobility (walking ¼ mile, walking up 10 steps, stooping/kneeling/crouching, walking between rooms on same floor, standing up from armless chair): GPA, general physical activity (lifting or carrying heavy objects, reaching up overhead, grasping/holding small objects, standing for long periods, sitting for long periods).

^b Missing data represent estimates that were suppressed due to a relative standard error of 30% or more.

General physical and cognitive limitations were reported by a substantial percentage of the U.S. population. Even after age adjustment, prevalence of disability was higher in those with CKD. Those with CKD reported more limitations in their ability to work (22%) and the in type of work they performed (34%) that than those without CKD.

Similarly, the age-adjusted percentage of the U.S. population reporting at least some difficulty in performing activities was higher in those with CKD, with 26-31% reporting difficulties in lower extremity mobility and general physical activity.

Chart Explanation: Age-adjusted rates of reported difficulties in performing activities were generally high among U.S. adults during 2011-2016. Specifically, among those aged 20-64 years with CKD of greater severity (stages 3 and 4), limitations were reported more in the type of amount of work performed (33.5%), in lower extremity mobility (25.6%), and general physical activity (31.3%). Many measures of disability remained associated with CKD status even after additional adjustment for comorbid conditions (obesity, diabetes, hypertension, cardiovascular disease, arthritis, and cancer) that could affect disability (not shown in figure). Additionally, even with adjustment for age within age groups, those in the older age group (≥65 years) reported 2- to 3-fold greater prevalence of limitations than those in the younger (20-64 years) group.

The National Health and Nutrition Examination Survey (NHANES) is a nationally representative, cross-sectional survey that is currently conducted every 2 years by the Centers for Disease Control and Prevention's National Center for Health Statistics to examine disease prevalence and trends over time in noninstitutionalized U.S. civilian residents

Although much information is available regarding physical functioning among those with ESRD (USRDS, 2011), little has been reported regarding the burden of physical functioning among those with earlier-stage CKD. The survey consists of a standardized in-home interview and a physical examination and blood and urine collection at a mobile examination center (MEC). Here we examined data from the 1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010, 2011-2012, 2013-2014, and 2015-2016 NHANES. Self-reported limitations in physical functioning were defined by answers of “yes” to questions such as “Does a physical, mental or emotional problem now keep you from working at a job or business?” Self-reported difficulties in activities were defined by answers of “some difficulty,” “much difficulty” or “unable to do” to items such as “How much difficulty do you now have getting in and out of bed?”

Field	Data
Description of Measure	Prevalence of physical functioning limiations among those with CKD in the general population
Data Source	NCHS
Type of Data Source	Public
Data Set	NHANES
Health Care System Data	No
Regional or National?	National
Demographic Group	Non-institutionalized U.S. residents aged 20+ years
Numerator	Non-pregnant participants with completed physical functioning surveys and with CKD information who report having limitations
Denominator	Non-pregnant participants with completed physical functioning surveys and with CKD information
Definition of CKD	Presence of single albuminuria or eGFR<60 ml/min/1.73 m²
Glomerular filtration rate	Estimated using CKD-EPI equation for calibrated creatinine: eGFR=141 x [min(calibrated serum creatinine in mg/dL) /κ, 1)]^α x [max(calibrated serum creatinine in mg/dL/κ, 1)]^κ x 0.993^age x (1.018 if female) x (1.159 if NH Black) κ = 0.7 if female, and 0.9 if male α = -0.329 if female, and -0.411 if male
Proteinuria	Urinary albumin-to-creatinine ratios of 30-299 mg/g (microalbuminuria) and >300 mg/g (macroalbuminuria); pregnant/menstruating women excluded
Primary Data Source Indicator	pfq.XXX variables
Primary Indicator Method of Measurement	Questionnaire (computer-assisted); ages 1+
Secondary (1) Variable	lbxscr: Serum creatinine, ages 12+
Secondary (1) Indicator Method of Measurement	Examination/Laboratory
Secondary (2) Variable	ridageyr: Age in years
Secondary (2) Indicator Method of Measurement	Questionnaire (interviewer-administered)
Secondary (3) Variable	ridgendr: Gender
Secondary (3) Indicator Method of Measurement	Questionnaire (interviewer-administered)
Secondary (4) Variable	raceth: Race/ethnicity
Secondary (4) Indicator Method of Measurement	Questionnaire (interviewer-administered)
Frequency of Measurement (Primary)	Once (cross-sectional)
U.S. Region Covered by Primary Variable	All
Period Currently Available	1999–2016
Pending Data	2017-2018
Additional Data Items of Interest	Stage of CKD
Limitations of Indicator	Self-reported, cross-sectional, missing data due to refusal; albuminuria single measurement
Analytic Considerations	Appropriate NHANES survey weights, including interview and MEC weights, must be used for all analyses; creatinine measurements must be calibrated for NHANES III, 1999-2000 and 2005-2006; many variable names differ across surveys; albuminuria must be adjusted over multiple years
Age Adjustment	Adjusted for the distribution of age within the sample.

References and Sources:

National Institute of Diabetes and Digestive and Kidney Diseases. USRDS 2011 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, Bethesda, MD: National Institutes of Health; 2011.
https://www.usrds.org/reference.aspx

Suggested Citation:

Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd