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Indicator Details — Native Americans: Age- and Gender-adjusted Incidence of ESRD
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Over approximately 10 years, age- and gender-adjusted incidence of ESRD was 0.5, 7.1, 12.1, and 62.5 per 1,000 person-years for American Indian participants with no CKD, CKD stage 1, stage 2, and stages 3-5, respectively.
In the same time period, incidence was 0.7, 4.4, and 54.5 per 1,000 person-years, after adjustment for age and gender, for those no albuminuria, microalbuminuria, and macroalbuminuria at baseline, respectively.
Chart Explanation: Age- and gender-adjusted incidence of end-stage renal disease was high in this cohort. By the third exam, the rate was 0.5 per 1,000 person-years for those with no evidence of CKD at baseline, compared to 7.1, 12.7, and 62.5 per 1,000 person-years for those with CKD stage 1, stage 2, and stages 3-5, respectively. For those without albuminuria, the rate was 0.7 per 1,000 person-years, versus 4.4 and 54.5 for those with micro- and macroalbuminuria, respectively.
The Strong Heart Study consisted of several components and three study exams (baseline, 1989-1992; second exam, 1993-1995; and third exam, 1998-1999), followed by morbidity and mortality surveillance of 4,500 tribal participants. Strong Heart enrolled men and women aged 45-74 at baseline from 13 American Indian tribes/communities in Arizona, Oklahoma, and the Dakotas. A total of 3,705 Strong Heart participants had both baseline information on both kidney function (eGFR) and albuminuria (albumin:creatinine ratio) and information on treated ESRD status at the third exam, ascertained through USRDS records. Incidence was adjusted for age and gender.
Description of MeasureAge- and gender-adjusted incidence of ESRD
Data SourceStrong Heart Study
Type of Data SourcePrivate
Data SetSHS
Health Care System DataNo
Regional or National?National
Demographic GroupAmerican Indians aged 45-74 from 13 tribes/communities 
NumeratorNumber of participants initiating treatment for ESRD by third exam
DenominatorAll participants free of ESRD at baseline exam who survived to third exam
Definition of CKDNo CKD, eGFR >90 ml/min/1.73 m2 & albumin:creatinine ratio <30 mg/g
Stage 1, eGFR >90 ml/min/1.73 m2 & albumin:creatinine ratio >30 mg/g
Stage 2, eGFR 60-89 ml/min/1.73 m2 & albumin:creatinine ratio >30 mg/g
Stages 3-5, eGFR <60 ml/min/1.73 m
Glomerular filtration rateCalculated by MDRD-4 Study equation
ProteinuriaSpot urine albumin:creatinine ratio
Primary Data Source IndicatorRate of initiating ESRD treatment, by self-report
Primary Indicator Method of MeasurementQuestionnaire
Frequency of Measurement (Primary)Once (cross-sectional at third exam)
U.S. Region Covered by Primary VariableArizona, Oklahoma, and the Dakotas
Period Currently Available1989–2007
Pending DataPossible continued passive follow-up only
Additional Data Items of InterestAge, gender, diabetes, hypertension
Limitations of IndicatorLoss to follow-up may introduce bias into the measurement of incident ESRD
Analytical ConsiderationsAnalysis performed by SHS investigators; denominators for each study exam and indicator must be defined properly

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