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Indicator Details: Incidence of End-Stage Renal Disease (ESRD) by U.S. Statea,b,c
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a Adapted from the 2020 USRDS Annual Data Report (United States Renal Data System, 2020).

b Estimates show the incidence per million state residents.

c Per million rates are adjusted for age, sex, race and ethnicity. 

ESRD incidence varied widely by state in 2018, with values of ~400 per million and greater in Alabama, Arkansas, District of Colombia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Dakota, Ohio, Oklahoma, South Dakota, Tennessee, Texas, and West Virginia; and less than 200 per million in Vermont, and New Hampshire.

Chart Explanation: 

Shown is the geographic distribution of ESRD incidence. From 1999-2018, in many states the rate of ESRD incidence has remained stable, but there have been some slight increases and decreases. In 2018, the states with the lowest incidence were New Hampshire (178 per million), Vermont (183 per million), Colorado (218 per million), and Alaska (226 per million). States with the highest incidence of ESRD include North Dakota (464 per million), Arkansas (460 per million), Louisiana (456 per million), Mississippi (454 per million), District of Columbia (449 per million), and Texas (440 per million).

The United States Renal Data System (USRDS) is national registry of all patients treated for end-stage renal disease (ESRD) in the United States. It is sponsored by the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) and the Centers for Medicare & Medicaid Services (CMS). U.S. population denominators are determined through U.S. Census data. Tables from the USRDS annual report (United States Renal Data System, 2020) are publicly available for download.

Description of MeasureIncidence of treated end-stage renal disease (ESRD) (stage 5)
Type of Data SourcePublic
Health Care System DataYes
Regional or National?National
Demographic GroupMedicare-eligible U.S. citizens with ESRD-related claims with known age, race/ethnicity, and gender
NumeratorNumber of patients with new diagnosis of ESRD
DenominatorU.S. resident population from U.S. census from corresponding year
Definition of CKDStage 5, <15 ml/min/1.73 m² with Medicare-eligibility for ESRD-related treatment
Primary Data Source IndicatorNumber of patients reported to have a new diagnosis of ESRD, as indicated by first treatment (dialysis or functioning transplant)
Primary Indicator Method of MeasurementClaims
Frequency of Measurement (Primary)Annual (cross-sectional)
U.S. Region Covered by Primary VariableAll
Period Currently Available


Pending Data


Additional Data Items of InterestYear, age (from date of birth), race/ethnicity (from Medicare 2728 form), gender (from Medicare 2728 form), assigned cause of ESRD (from Medicare 2728 form), body mass index (BMI)
Limitations of IndicatorOnly those who are Medicare-eligible are captured & eligibility may be delayed; changes in 2728 form
Analytic ConsiderationsDenominators change with missing stratification variables
References and Sources:
  • United States Renal Data System. 2020 USRDS Annual Data Report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2020.

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