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Prevalence of CKD Stages 3-4, by Diabetes and Prediabetes

Prevalence of CKD Stages 3-4, by Diabetes and Prediabetes

Data on adults aged 18 years and older from the National Health and Nutrition Examination Survey (NHANES 2001–March 2020) show that prevalence of chronic kidney disease (CKD) stages 3–4 (kidney function 15 to 59 ml/min/1.73m²) among adults with prediabetes is similar to those with undiagnosed diabetes. During this period, prevalence of CKD stages 3–4 was 3.7% among adults without diabetes (representing approximately 5 million U.S. adults), 10% among adults with prediabetes (5 million) or undiagnosed diabetes (0.6 million), and 18% among adults with diagnosed diabetes (5 million).

Data Source: NHANES


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Prediabetes is defined by a hemoglobin A1c (HbA1c) of 5.7% to 6.4%. Data are not adjusted.

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.

Description of Measure

Prevalence of CKD in the adult US population with diagnosed diabetes, undiagnosed diabetes, prediabetes, and no indication of diabetes.

Data Set

National Health and Nutrition Examination Survey (NHANES).


Noninstitutionalized U.S. adults aged ≥ 18 years, pregnant women excluded.

Years Included

2001–March 2020.


Adults aged ≥ 18 years with CKD stages 3–4.


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

Definition of CKD and CKD Stage

CKD stages 3–4 are defined by estimated glomerular filtration rate (eGFR). Stage 3: eGFR 30–59 ml/min/1.73 m²; Stage 4: eGFR 15–29 ml/min/1.73 m²; Stage 5 excluded.

Estimated glomerular filtration rate (eGFR)

Based on CKD-EPI equation for calibrated creatinine: eGFR=141 x [min(serum creatinine in mg/dL) /κ, 1)]**α x [max(serum creatinine/κ, 1)]**-1.20 x 0.993**age x (1.018 if female) x (1.159 if a Black person).

κ = 0.7 if female and 0.9 if male
α = -0.329 if female and -0.411 if male
** = raise to the power


Urine albumin to creatinine ratio (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.


Diabetes is defined by taking insulin, taking diabetes pills, or HbA1c of 6.5% or higher. Diagnosed diabetes is defined by a “Yes” response to the question "Have you been told by a doctor or health professional that you have diabetes or sugar diabetes?" Undiagnosed diabetes is defined as an HbA1c ≥ 6.5% or self-reported use of insulin or diabetes pills with a negative response to being told they have diabetes.


Prediabetes is defined as an HbA1c of 5.7% to 6.4%.

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 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.

eGFR Formula Disclaimer
At the time of the last data update in summer 2022, the race-free eGFR formula was newly recommended and impact on health outcomes is underway. To avoid inconsistent results caused by different formulae, stakeholders continued using the eGFR formula with race during this transition. Since then, comparisons have been made. The estimates for the current website launch are still based on analyses using the eGFR formula with race, however plan is to use race-free eGFR formula for the next data update and upcoming website launch in fall 2023.