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Chronic Kidney Disease (CKD) Surveillance System

Indicator Details: Age-Adjusted Prevalence of CKD Stages 1-4a
Data Sources
 
Stratification and Year Choices:

  Source
  • NHANES

  View Data By:
Age-Adjusted Prevalence of CKD Stages 1-4 by Race/Ethnicity 2013–2014 15.22 15.51 17.27 14.91


Footnotes:
a Stages 1 and 2 defined by single assessment of albuminuria (i.e., no estimation of persistence) and eGFR ≥90 and 60-89 ml/min/1.73 m², respectively; stages 3 and 4 defined as 30-59 and 15-29 ml/min/1.73 m², respectively.




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.

The survey consists of a standardized in-home interview and a physical examination with blood and urine collected 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, and 2013-2014 NHANES, in addition to data from NHANES III (1988-1994). Estimated glomerular filtration rate (eGFR) was calculated according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for calibrated creatinine (Levey et al., 2009). 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, 2009-2010, 2011-2012, and 2013-2014 surveys (Selvin et al., 2007). Albuminuria was defined by urinary albumin-to-creatinine ratio ≥30 mg/g; moderate albuminuria ranges between 30 and 299 mg/g and severe albuminuria is ≥300 mg/g; pregnant women were excluded. For comparisons across the 12-year period 1999-2012, 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 by single measurements of albuminuria and kidney function (eGFR). In clinical practice, CKD is defined by persistent albuminuria or reduced kidney function for ≥3 months.
FieldData
Description of MeasurePrevalence of CKD stage 1-4
Data SourceNCHS
Type of Data SourcePublic
Data SetNHANES
Health Care System DataNo
Regional or National?National
Demographic GroupNon-institutionalized U.S. residents aged 20+ years
NumeratorParticipants with CKD
DenominatorParticipants with serum creatinine and urine protein measurements
Definition of CKDStage 1, eGFR ≥ 90 ml/min/1.73 m² and presence of single albuminuria; Stage 2, eGFR 60-89 ml/min/1.73 m² and presence of single 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 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 0.993age 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
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) Variableridreth1: Race/ethnicity
Secondary (3) Indicator Method of MeasurementQuestionnaire (interviewer-administered)
Secondary (3) from Medical Record? No
Secondary (4) Data Source Indicatorurxuma: Urine albumin
Secondary (4) Indicator Method of Measurement Examination/lab
Secondary (5) Data Source Indicatorurxucr: Urine creatinine
Secondary (5) Indicator Method of Measurement Examination/lab
Frequency of Measurement (Primary)Once (cross-sectional)
U.S. Region Covered by Primary VariableAll
Period Currently Available1999–2014
Pending Data2015-2016
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”
Age AdjustmentAdjusted for the distribution of age within the sample.
After age-adjustments, the prevalence of CKD stages 1-4 was approximately 13% to 16%, during the periods 1999 to 2014. Prevalence was higher among females than males, and higher in non-Hispanic blacks and Mexican-Americans than in non-Hispanic whites. Those with diabetes or hypertension had far greater age-adjusted prevalence of CKD than those without these conditions.
Chart Explanation: From 1999 to 2014, the overall age-adjusted prevalence was relatively the save for the 16 years (15.3% in 1999 and 15.2% in 2014). Even with these adjustments, the prevalence of CKD stages 1-4 was still higher in females than in males (17.06% vs. 13.3%). However, the pattern for overall prevalence by race/ethnicity shifted after age adjustments. Non-Hispanic blacks continued to have the highest prevalence throughout the 16 years, but in 2013-2014 they had they highest prevalence after adjustements (17.3%); whereas non-Hispanic whites had the lowest prevalence of 14.9% when compared to their counterparts, while Mexican-Americans had a prevalence of 15.5%. In 2013-2014, those with diabetes (34.5%) or hypertension (20.6%) had higher prevalence of CKD than those without these conditions, as expected, even with adjustment for age. All comparisons within subgroup were statistically significantly different (P<0.001), with age adjustment.
References and Sources:
  • 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.
Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd


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