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Trends in Prevalence of CKD among U.S. Adults with Hypertension

Trends in Prevalence of CKD among U.S. Adults with Hypertension

Crude prevalence of chronic kidney disease (CKD) among adults with hypertension was over three times as high as that among adults without hypertension (24.4% vs 7.5%, 2017–March 2020). The prevalence of CKD among those with hypertension has remained constant from 2001 through March 2020. Age-standardized trends were consistent with the crude trends.

Data Source: NHANES


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Data includes CKD stages 1–5. Age-standardized estimates were standardized to the 2010 U.S. Census population for adults.

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.

Note: Not all NHANES variables are collected for all years; therefore, some NHANES indicators may not utilize the full 20-year span.

FieldData
Description of Measure

Prevalence of CKD stages 1–5 in the U.S. population, by hypertension.

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

Adults aged ≥ 18 years with CKD.

Denominator

Adults aged ≥ 18 years with serum creatinine and urine albumin measurements.

Definition of CKD

CKD is defined by an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m² or albuminuria (urine albumin to creatinine ratio [UACR] ≥30 mg/g). Estimates are based on single estimates of eGFR and UACR.

Estimated glomerular filtration rate (eGFR)

Based on CKD-EPI (2021) equation for calibrated creatinine: eGFR=142 x [min(serum creatinine in mg/dL) /κ, 1)]**α x [max(serum creatinine/κ, 1)]**-1.20 x 0.9938**age x (1.012 if female).

κ = 0.7 if female and 0.9 if male
α = -0.241 if female and -0.302 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.

Hypertension

Hypertension is defined by self-report of hypertension, taking hypertension medications, or average systolic blood pressure greater than 140 mmHg (130 mmHg for CKD and diabetes) and diastolic blood pressure greater than 90 mmHg (80 mmHg for CKD and diabetes).

Age Standardization

Age-standardized estimates were standardized to the 2010 U.S. Census population for adults. 18–39 years: 37.1%, 40–59 years: 38.1%, 60–69 years: 12.8%, and 70+ years: 12.0%.

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 the 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.


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