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Indicator Details: Prevalence of Elevated Lipid Levels in CKD People 1999–2004 vs. 2005–2010 vs. 2020 Targeta,b,c
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  • NHANES

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Footnotes:
a Family income was calculated as a percentage of the Federal Poverty Limit.

b Educational attainment data was collected only for people aged 25 years or over

c Health insurance status was limited to individuals younger than 65 years of age in order to exclude potential Medicare patients




To improve cardiovascular care in people with CKD, Healthy People 2020 objective 6b aims to reduce the proportion of people with CKD who have elevated lipid levels. CKD is accompanied by characteristic abnormalities of lipid metabolism, which are reflected in an altered apolipoprotein profile as well as elevated plasma lipid levels. Dyslipidemia is a major risk for cardiovascular morbidity and mortality in patients with CKD. In 2011-2016, the percentage of adults with CKD as well as males and females with elevated lipid levels (defined as abnormal lipid values or the use of cholesterol-lowering medication) was higher than prior years.

Chart Explanation: 

In 2011-2016 people with CKD with elevated lipid levels increased from prior years to 21.9%. In addition, lipid levels increased for both males (24.2%) and females (20.0%) from prior years. Lipid levels for whites decreased to 13.8% and increased for both Hispanics (23.2%) and Blacks (19.0%).
The NHANES (National Health and Nutrition Examination Survey) is a nationally representative, cross-sectional survey that is currently conducted every 2 years by the National Center for Health Statistics to examine disease prevalence and trends over time in non-institutionalized U.S. civilian residents.

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 and 2011-2016 NHANES, in addition to data from NHANES III (1988-1994). eGFR was calculated according to the modified MDRD study formula for calibrated creatinine (Levey et al., 2005; Levey et al., 2006). Serum creatinine was calibrated for 1999-2000 and 2005-2006 participants; no correction was required for calibrated serum creatinine in participants in the 2001-2002, 2003-2004, 2007-2008, and 2009-2010 surveys (Selvin et al., 2007). Albuminuria was defined by urinary albumin-to-creatinine ratios of 30-299 mg/g (microalbuminuria) and >300 mg/g (macroalbuminuria); pregnant women were excluded. For comparisons across the 12-year period 1999-2010, albuminuria was corrected in 1999-2006 to account for differences in the instrumentation and method for urine creatinine starting in 2007. Prevalence of CKD is likely overestimated due to single measurements of albuminuria and kidney function since chronic disease is defined as having albuminuria or reduced kidney function for ≥3 months.

FieldData
Description of MeasurePercent of persons with chronic kidney disease who have hyperlipidemia
Data SourceNCHS
Type of Data SourcePublic
Data SetNHANES
Health Care System DataNo
Regional or National?National
Demographic GroupNon-institutionalized adults 18+ years with CKD.
NumeratorNumber of adults 18 years or older with chronic kidney disease (CKD) stages 1-4 with abnormal lipid values, or reported prescription for statins . Abnormal lipid values defined by ATP III guidelines [1] (all values in mg/dl).
DenominatorAll those with CKD stages 1-4 who answered the awareness question.
Definition of CKDStage 1, eGFR ≥ 90 ml/min/1.73 m² and estimated persistent albuminuria; Stage 2, eGFR 60-89 ml/min/1.73 m² and estimated persistent albuminuria; Stage 3, eGFR 30-59 ml/min/1.73 m²; Stage 4, 15-29 ml/min/1.73 m²; Stage 5, excluded
DefinitionsEducational attainment data was collected only for subjects 25 years and over; health insurance status is limited to individuals under 65 years of age in order to exclude potential Medicare patients; family income was calculated as a percent of the Federal Poverty Limit.
Glomerular filtration rateEstimated using MDRD study formula for calibrated creatinine: eGFR=175 × [(calibrated serum creatinine in mg/dl)-1.154] × age-0.203 × (0.742 if female) × (1.210 if African-American)
ProteinuriaUrinary albumin-to-creatinine ratios of 30-299 mg/g (microalbuminuria) and >300 mg/g (macroalbuminuria); pregnant/menstruating women excluded
Primary Data Source Indicatorlbxscr: Serum creatinine
Primary Indicator Method of MeasurementExamination/Laboratory
Secondary (1) Variableridageyr: Age in years
Secondary (1) Indicator Method of MeasurementQuestionnaire (interviewer-administered)
Secondary (2) Variableridgendr: Gender
Secondary (2) Indicator Method of MeasurementQuestionnaire (interviewer-administered)
Secondary (3) VariableNo
Secondary (3) Indicator Method of Measurementridreth1: Race/ethnicity
Secondary (3) from Medical Record?Questionnaire (interviewer-administered)
Secondary (4) Data Source Indicatorurxuma: Urine albumin
Secondary (4) Indicator Method of MeasurementExamination/lab
Secondary (5) Data Source Indicatorurxucr: Urine creatinine
Secondary (5) Indicator Method of MeasurementExamination/lab
Frequency of Measurement (Primary)Once (cross-sectional)
U.S. Region Covered by Primary VariableAll
Period Currently Available

1999–2016

Pending Data

2017-2018

Additional Data Items of InterestStage of CKD, year, other stratification variables of interest (diabetes by self-report, hypertension by self-report)
Limitations of IndicatorAlbuminuria and kidney function can only be assessed from a one-time cross-sectional measurement, leading to overestimation of prevalence; second measures of albuminuria are available for only 2009-2010 and were first-morning rather than spot urine samples; no second measures of creatinine
Analytic ConsiderationsAppropriate NHANES survey 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; if SE 30% or more of estimate, must report as "low precision"
References1. Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). National Cholesterol Education Program. National Heart, Lung, and Blood Institute National Institutes of Health NIH Publication No. 02-5215 September 2002.

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