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Prevalence of CKD Among U.S. Adults, by Stage

Approximately 1 in 7 adults in the United States has chronic kidney disease (CKD) stages 1-4. The overall unadjusted prevalence of CKD is slightly higher during 2017–March 2020 (14.8%) than during 2001–2004 (14.0%). All CKD stages except stage 1 show little change over time.

Data Source: NHANES

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Prevalence of CKD Among U.S. Adults, by Stage National Health and Nutrition Examination Survey
CKD Stage	2001-2004	2005-2008	2009-2012	2013-2016	2017-2020
CKD Stage 1	4.3% (CI 3.7-5.0)	4.8% (CI 4.3-5.3)	4.0% (CI 3.4-4.7)	4.8% (CI 4.3-5.2)	5.3% (CI 4.6-6.0)
CKD Stage 2	3.2% (CI 2.7-3.7)	3.1% (CI 2.7-3.5)	2.9% (CI 2.4-3.3)	3.2% (CI 2.7-3.7)	2.8% (CI 2.3-3.3)
CKD Stage 3	5.9% (CI 5.4-6.5)	5.9% (CI 5.0-6.7)	5.8% (CI 5.1-6.5)	6.2% (CI 5.6-6.9)	6.2% (CI 5.0-7.3)
CKD Stage 4	.4% (CI .3-.6)	.4% (CI .3-.5)	.5% (CI .4-.6)	.4% (CI .3-.5)	.4% (CI .2-.5)
Total	14.0% (CI 13.1-14.9)	14.3% (CI 13.1-15.4)	13.4% (CI 12.4-14.3)	14.7% (CI 13.5-15.9)	14.8% (CI 13.5-16.2)

Data include stages 1–4 CKD. Stage 5 was excluded from this analysis due to small numbers. Data are not adjusted.

NHANES is a nationally representative, cross-sectional survey that is currently conducted every two years (since 1999) by CDC's National Center for Health Statistics among noninstitutionalized US 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.

Data were examined by combining two NHANES cycles to represent four-year periods from 2001 to 2016 and the 2017–March 2020 pre-pandemic cycle.

Field	Data
Description of Measure	Prevalence of CKD stages 1–4.
Data Set	National Health and Nutrition Examination Survey (NHANES).
Population	Noninstitutionalized U.S. adults aged ≥18 years, pregnant women excluded.
Years Included	2001–March 2020.
Numerator	U.S. adults aged ≥ 18 years with stage 1–4 CKD.
Denominator	U.S. adults aged ≥ 18 years with serum creatinine and urine albumin measurements.
Definition of CKD and CKD Stage	CKD is defined by estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m² or albuminuria (urine albumin to creatinine ratio [UACR] ≥ 30 mg/g). Stage 1: eGFR ≥ 90 ml/min/1.73 m² and albuminuria; Stage 2: eGFR 60–89 ml/min/1.73 m² and albuminuria; Stage 3: eGFR 30–59 ml/min/1.73 m²; Stage 4: 15–29 ml/min/1.73 m²; Stage 5: excluded. Estimates are based on single estimates of eGFR and UACR.
Estimated glomerular filtration rate (eGFR)	Based on CKD-EPI equation for calibrated creatinine: eGFR=141 x [min(serum creatinine in mg/dL) /κ, 1)]α x [max(serum creatinine/κ, 1)]-1.20 x 0.993age x (1.018 if female) x (1.159 if a Black person). κ = 0.7 if female and 0.9 if male α = -0.329 if female and -0.411 if male = raise to the power
Albuminuria	UACR is calculated as urine albumin divided by urine creatinine. Albuminuria is defined as UACR ≥ 30 mg/g.
Serum Creatinine	Serum creatinine values used for eGFR calculation are standardized against isotope dilution mass spectrometry (IDMS).
Urine Albumin	Measured in random urine collection by fluorescent immunoassay.
Limitations of Indicator	Albuminuria and kidney function are assessed from one-time cross-sectional measurements, possibly overestimating CKD prevalence.
Analytical Considerations	Appropriate NHANES survey weights are used for all analyses; if relative standard error is greater than 30%, the estimates are not shown. Serum creatinine measurements are assay corrected for NHANES years 2005 and 2006 and prior to be combined with later years.

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.