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Indicator Details — Emerging Topics: Residual and Unconditional Lifetime Incidence of CKD
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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




The CKD Health Policy Model was used to simulate the residual and unconditional lifetime incidence of CKD in the U.S. population. According to this model, the residual lifetime incidence of CKD decreases as age increases, while the unconditional lifetime incidence of CKD increases as age increases.
Chart Explanation: The residual lifetime incidence of CKD represents the projected percentage of persons who do not currently have CKD, but are expected to develop the disease at some point in their lifetime. The unconditional lifetime incidence of CKD represents the probability of starting or progressing to any stage of CKD and takes into account both participants with CKD at the start of the simulation, as well as the residual lifetime incidence for persons who do not have CKD at the start.
 
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, lifetime incidence, and residual incidence of CKD through the year 2030.

Residual lifetime risk of CKD is defined as the probability of reaching any stage of CKD (stages 1-5) in individuals who do not have CKD at the start of the simulation. In the simulation, persons must progress through stage 3a before reaching stage 3b, through stages 3a and 3b before reaching stage 4, and through stages 3a, 3b, and 4 before reaching stage 5. However, it is possible to reach stage 3a or higher without going through stages 1 and 2 if a person never has elevated albuminuria. The unconditional lifetime incidence is defined as the probability of starting with or progressing to any stage of CKD. This calculation accounts for both those that have CKD at the start of the simulation, as well as the residual lifetime incidence for those who do not have CKD at the start. 
 
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 MeasureResidual and unconditional lifetime incidence of CKD
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 residual lifetime incidence calculations: NHANES participants older than 30 years of age who did not have CKD at the start of the simulation but developed CKD (stages 1-5) as they are progressed throught the simulation model; for unconditional lifetime incidence calculations: NHANES participants older than 30 years of age who did have CKD at the start of the simulation as well as participants who did not have CKD at the start of the simulation, but developed CKD (stages 1-5) as they are progressed throught the simulation model.
DenominatorAll NHANES participants aged 30 years or older
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- to 13-year-olds and females 13-17; and k=0.65 for males 13-17
ProteinuriaUrinary albumin-to-creatinine ratios of 30-299 mg/g (microalbuminuria) and >300 mg/g (macroalbuminuria); pregnant/menstruating women excluded
Primary Data Source IndicatorResidual lifetime incidence and unconditional lifetime incidence
Primary Indicator Method of MeasurementThe eGFR was calculated for NHANES participants aged 30 to 49 years, 50 to 64 years, and 65 years or older; these values were used to simulate an individual's progression through the model until the person died or reached age 90; in the model, eGFR declined annually, and certain subgroups of the populations (i.e., African Americans, diabetics); had different rates than the rest of the population
Frequency of MeasurementOnce
Period Currently Available1999–2010
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