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Indicator Details — Emerging Topics: Projected Prevalence of CKD in 2020 and 2030 in Adults Aged 65 Years or Oldera
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  • NHANES and the CKD HPM

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Published literature or one-time analysis, ongoing surveillance not available Published literature or one-time analysis, ongoing surveillance not available

Footnotes:
a The value shown by the graph for the prevalence of Stage 5 CKD for the period 1999-2010 is not an accurate reflection of the prevalence during this period. The prevalence for this period shows up as zero on the graph because individuals with Stage 5 CKD were excluded from the NHANES survey. 




The prevalence of CKD in adults aged 65 years or older is expected to decrease between now and 2030. Stage 3a was the most prevalent stage of CKD in adults aged 65 years or older for the period 1999-2010, and it is expected to remain the most prevalent in this age group until at least 2030. 
Chart Explanation: The CKD Health Policy Model was used to project the prevalence of CKD in adults aged 65 years or older in 2020 and 2030. While the current prevalence of CKD in adults aged 65 years or older is 39.6%, according to this model, the projected prevalence of CKD in this population is expected to be 36.4% in 2020 and 37.8% in 2030. Stage 3a is expected to remain the most prevalent stage for this age group until at least 2030. 
The CKD Health Policy Model is a microsimulation model for CKD progression that simulates the history of CKD for adults aged 30 to 90 years. All adults used in the model had been participants in the National Health and Nutrition Examination Survey (NHANES) from 1999 through 2010. The model placed participants into one of seven different categories: no CKD, Stages 1-5, and death. CKD stage was determined by eGFR and the presence of albuminuria using the NKF-KDOQI guidelines. The model was used to project the prevalence and lifetime incidence of CKD through the year 2030. 
 
The NHANES is currently conducted every 2 years by the National Center for Health Statistics to examine disease prevalence and trends over time in different cross-sectional representative samples of noninstitutionalized 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, and 2009-2010 NHANES. 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 (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.


This indicator is based upon analysis in published literature: Hoerger TJ, Simpson SA, Yarnoff BO, et al. The future burden of CKD in the United States: a simulation model for the CDC CKD Initiative. Am J Kidney Dis. 2015;65(3):403-411.
http://www.ncbi.nlm.nih.gov/pubmed/25468386
FieldData
Description of MeasureProjected Prevalence of CKD in 2020 and 2030 in Adults 65 Years or Older
Data SourceNCHS/CDC and the CKD Health Policy Model
Type of Data SourcePublic
Data SetNHANES 1999-2010
Health Care Data SystemNo
Regional or National?National
Demographic GroupNoninstitutionalized U.S. adults aged 10 years or older
NumeratorFor 1999-2010 prevalence: NHANES participants aged 65 years or older who have CKD; for projected prevalence in 2020: NHANES participants who will be 65 years or older in 2020, and are projected to have CKD in 2020; for projected prevalence in 2030: NHANES participants who will be 65 years or older in 2030, and are projected to have CKD in 2030
Denominator
For 1999-2010 prevalence: all NHANES participants aged 65 years or older ; for projected prevalence in 2020: all NHANES participants who will be 65 years or older in 2020; for projected prevalence in 2030: all NHANES participants who will be 65 years or older in 2030
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
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) Schwartz formula for 12- to 17-year-olds: eGFR=k × (height in cm) × (serum creatinine in mg/dl), where k=0.55 for 1-13-year-olds and females 13-17; and k=0.65 for males 13-17
Proteinuria
Urinary albumin-to-creatinine ratios of 30-299 mg/g (microalbuminuria) and >300 mg/g (macroalbuminuria); pregnant/menstruating women excluded
Primary Data Source IndicatorProjected prevalence
Primary Indicator Method of MeasurementNHANES participants were used to calculate the size, age, sex, and race/ethnicity proportions of the current 34- to 54-year-old cohort; this cohort was ascribed eGFR, diabetes, hypertension, and albuminuria characteristics drawn from the current 45- to 54- year-old population and then the cohorots were progressed through the CKD health policy model beginning from the year they turned 65 years old
Frequency of MeasurementOnce
Period Currently Available1999–2030
Pending DataNone
U.S. Region Covered by the Primary VariableAll
Additional Data Items of InterestAge, stage of CKD
Limitations of IndicatorThe model assumes eGFR declines at a constant rate between 30 and 49 years of age; the model does not account for CKD resulting from acute kidney infections; projected estimates are based on current treatment patterns and mortality rates, which may change over the course of the next 20 years
Analytical ConsiderationsThe model assumes that a person’s eGFR declines at a constant rate between the ages of 30 and 49 years, with a slightly faster decline beginning at age 50 
References and Sources:
  • Hoerger TJ, Simpson SA, Yarnoff BO, et al. The future burden of CKD in the United States: a simulation model for the CDC CKD Initiative. Am J Kidney Dis. 2015;65(3):403-411.
    http://www.ncbi.nlm.nih.gov/pubmed/25468386

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