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Indicator Details: CKD Prevalence by Diabetes Mellitus Status
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The prevalence of CKD in adults with diagnosed diabetes increased from 20% in 1999–2004 to 25% in 2011–2014 (p=.001). Prevalence among adults with prediabetes (12% in 1999-2004 and 14% in 2011–2014) was similar to that among adults with undiagnosed diabetes (10% and 13%, respectively). 
Chart Explanation: Over the periods 1999–2004 to 2011–2014, the prevalence of CKD varied based on diabetes status. Among U.S. adults with diagnosed diabetes, the prevalence significantly increased from 19.5% in 1999–2004 to 24.5% in 2011–2014 (p=.001). During the same period, CKD prevalence among those with pre-diabetes (12.4% to 14.3%), and among those with undiagnosed diabetes (10.1% to 13.2%) was relatively the same.
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.

Diabetes-associated nephropathy is one of the two main causes of CKD. Diabetic nephropathy accounts for 30-40% of CKD and 44% of incident cases of end-stage renal disease (ESRD) in the United States (United States Renal Data System, 2017). Additionally, diabetes-related CKD is associated with high rates of morbidity and mortality (Foley et al., 2005; Go, Chertow, Fan, McCulloch, & Hsu, 2004). Thus, assessing the burden of this risk factor is essential to CKD surveillance. The survey consists of a standardized in-home interview and a physical examination and blood and urine collection at a mobile examination center. Here we examined data from the 1999–2000, 2001–2002, 2003–2004, 2005–2006, 2007–2008, 2009–2010, 2011–2012, and 2013–014 NHANES. Self-reported diabetes was defined by answer of “yes” to the question “have you ever been told by a doctor or other health professional that you have diabetes or sugar diabetes?” Glycohemoglobin, which was approved as a diagnostic test for diabetes in 2010 (American Diabetes Association, 2010), was measured in all participants.
Description of MeasurePrevalence of CKD in the diagnosed diabetes, undiagnosed diabetes, and prediabetes adult population
Data SourceNCHS/CDC
Type of Data SourcePublic
Health Care System DataNo
Regional or National?National
Demographic GroupNoninstitutionalized U.S. residents aged 20+ years
NumeratorNonpregnant participants with CKD
DenominatorNonpregnant participants with completed surveys who report having diabetes (or HbA1c >6.4%)
Definition of CKDPresence of single spot albuminuria or estimated glomerular filtration rate (eGFR) 15-59 ml/min/1.73m2
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 non-Hispanic Black)
κ = 0.7 if female, and 0.9 if male
α = -0.329 if female, and -0.411 if male
Primary Data Source Indicatordiq010: "Other than during pregnancy, have you ever been told by a doctor or health professional that you have diabetes or sugar diabetes?" yes/no
Primary Indicator Method of MeasurementQuestionnaire (interviewer-administered); ages 1+ (proxy provided for ages 1–15); indicator sample covers ages 20+
Secondary (1)lbxgh: Glycohemoglobin
Secondary (1) Indicator Method of MeasurementExamination/Laboratory
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, stratification variables of interest (age, gender, race/ethnicity, body mass index, hypertension by self-report)
Limitations of IndicatorMedication was not applied to analysis, which could potentially misclassify individuals
Analytic ConsiderationsAppropriate NHANES survey weights must be used for all analyses; glucose values must be converted for 2005-2006 and 2007-2008; if relative standard error 30% or more of estimate, must report as "low precision"

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