The baseline CKD prevalence estimate is 15.2%, while the current estimate of 14.9% indicates a slight reduction. A downward trend is observed for men and people younger than 75 years of age. However, there is an increase for those aged 75 years and older. While the prevalence of CKD decreases as household income increases, there is no consistent trend in the change over time. However, the largest change was a decrease in the prevalence for people with household income below 100% of the federal poverty level.
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 2011-2012 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, 2009-2010, and 2011-2012 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 1999-2012, 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 due to single measurements of albuminuria and kidney function, since chronic disease is defined as having albuminuria ror reduced kidney function for ≥3 months.
| Field | Data |
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| Description of Measure | Prevalence of CKD stage 1-4 |
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| Data Source | NCHS |
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| Type of Data Source | Public |
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| Data Set | NHANES |
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| Health Care System Data | No |
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| Regional or National? | National |
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| Demographic Group | Non-institutionalized U.S. residents aged 20+ years |
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| Numerator | Number of adults 18 years or older with chronic kidney disease (CKD) stages 1-4. CKD stages 1-4 defined as urinary albumin/creatinine ratio (ACR) ≥30 mg/g (single measurement) or estimated glomerular filtration rate (eGFR) between 15 and 59 ml/min/1.73 m² |
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| Denominator | Number of adults 18 years or older with measured urinary albumin/creatinine ratio (ACR) and information to compute estimated glomerular filtration rate (eGFR) |
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| Definition of CKD | Stage 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 |
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| Glomerular filtration rate | Estimated 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 |
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| Proteinuria | Urinary albumin-to-creatinine ratios of 30-299 mg/g (microalbuminuria) and >300 mg/g (macroalbuminuria); pregnant/menstruating women excluded |
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| Primary Data Source Indicator | lbxscr: Serum creatinine |
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| Primary Indicator Method of Measurement | Examination/Laboratory |
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| Secondary (1) Variable | ridageyr: Age in years |
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| Secondary (1) Indicator Method of Measurement | Questionnaire (interviewer-administered) |
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| Secondary (2) Variable | ridgendr: Gender |
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| Secondary (2) Indicator Method of Measurement | Questionnaire (interviewer-administered) |
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| Secondary (3) Variable | No |
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| Secondary (3) Indicator Method of Measurement | ridreth1: Race/ethnicity |
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| Secondary (3) from Medical Record? | Questionnaire (interviewer-administered) |
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| Secondary (4) Data Source Indicator | urxuma: Urine albumin |
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| Secondary (4) Indicator Method of Measurement | Examination/lab |
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| Secondary (5) Data Source Indicator | urxucr: Urine creatinine |
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| Secondary (5) Indicator Method of Measurement | Examination/lab |
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| Frequency of Measurement (Primary) | Once (cross-sectional) |
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| U.S. Region Covered by Primary Variable | All |
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| Period Currently Available | 1999–2010 |
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| Pending Data | 2011-2016 |
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| Additional Data Items of Interest | Stage of CKD, year, other stratification variables of interest (diabetes by self-report, hypertension by self-report) |
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| Limitations of Indicator | Albuminuria 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 |
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| Analytic Considerations | Appropriate 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” |
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