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Chronic Kidney Disease (CKD) Surveillance System

Indicator Details: Incidence of CKD Stages 3–5 in a Study Cohort by Stage of Kidney Disease
Data Sources
 
Stratification and Year Choices:

  Source
  • ARIC

  Chart Format


Published literature or one-time analysis, ongoing surveillance not available Published literature or one-time analysis, ongoing surveillance not available

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The incidence of CKD stages 3-5 through 9 years of follow-up among 45- to 64-year old ARIC participants was 10.4 per 1,000 person-years.

Incidence was higher among older, white, and female participants, and double among those with diabetes or hypertension, relative to those without these conditions.
Chart Explanation: Over 9 years of follow-up in the Atherosclerosis Risk in Communities (ARIC) Study, the rate of incidence of CKD stages 3-5 (among those with eGFR >60 ml/min/1.73 m² at baseline) was 10.4 per 1,000 person-years. The incidence rate of CKD stages 3-5 was much higher in those who were ≥60 vs. <60 years old at the start of the study: 21.8 vs. 7.4 per 1,000 person-years (P<0.001). Females had higher incidence rates (11.0 vs. 9.6 per 1,000 person-years (P<0.001) than males, and white participants had higher rates (10.8 vs. 8.9 per 1,000 person-years; P<0.001) than black participants. As expected, participants with diabetes had nearly double the CKD incidence of ARIC participants without diabetes: 18.9 vs. 9.5 per 1,000 person-years (P<0.001). Similarly, participants with hypertension had double the CKD incidence compared to participants without hypertension: 16.7 vs. 7.5 per 1,000 person-years (P<0.001).
The Atherosclerosis Risk in Communities (ARIC) Study is a longitudinal cohort study of 15,792 participants aged 45-64 recruited from four U.S. suburban communities (Forsyth County, NC; Jackson, MS; suburban Minneapolis, MN; and Washington County, MD) with a primary purpose of investigating the etiology and natural history of atherosclerosis. As with all cohort studies, participants may not be representative of all those who live in the communities from which they are recruited, or elsewhere.

Measurements of creatinine, from which CKD stages 3-5 were defined, were taken at the baseline, 3-year, and 9-year visits in ARIC participants. Incidence was calculated as the number of ARIC participants with CKD (eGFR <60 ml/min/1.73 m²) at a follow-up visit, divided by the total number of ARIC participants without CKD at baseline (eGFR ≥60 ml/min/1.73 m²) and the total follow-up time (to death, censoring, or development of CKD) contributed by these participants.
FieldData
Description of MeasureIncidence of CKD stages 3-5
Data SourceARIC
Type of Data SourcePrivate
Data SetARIC baseline, 3 & 9 years
Health Care System DataNo
Regional or National?Regional (Forsyth County, NC; Jackson, MS; suburban Minneapolis, MN; and Washington County, MD)
Demographic GroupU.S. residents aged 45-64 years and living in one of four targeted communities.
NumeratorARIC participants with CKD (as measured by eGFR) at follow-up
DenominatorIndividuals between the ages of 45 and 64 recruited for ARIC study with baseline eGFR ≥60 ml/min/1.73 m²
Definition of CKDeGFR <60 ml/min/1.73 m² (stages 3-5 only)
Glomerular filtration rateEstimated using MDRD study formula for standardized serum creatinine: eGFR=175 × [(calibrated serum creatinine in mg/dl)⁻¹˙¹⁵⁴] × age⁻⁰˙²⁰³ × (0.742 if female) × (1.210 if African-American)
Primary Data Source IndicatorSerum creatinine (BL, 3- and 9-yr follow-up)
Primary Indicator Method of MeasurementExamination/Laboratory
Secondary (1) VariableAge in years
Secondary (1) Indicator Method of MeasurementQuestionnaire (self-report)
Secondary (2) VariableGender
Secondary (2) Indicator Method of MeasurementQuestionnaire (self-report)
Secondary (3) VariableRace/ethnicity
Secondary (3) Indicator Method of MeasurementQuestionnaire (self-report)
Frequency of Measurement (Primary)Three measurements (cross-sectional)
U.S. Region Covered by Primary VariableSee four study sites, above
Period Currently Available1987–1998
Pending DataFuture ARIC visits in subset (pending funding)
Additional Data Items of InterestStage of CKD, other stratification variables of interest (diabetes by self-report/use of meds/fasting glucose, hypertension by self-report/BP)
Limitations of IndicatorProteinuria data @ 4 years only
Analytical ConsiderationsAdjustment for race/ethnicity X study site; To calibrate creatinine in ARIC: -0.24 for visits 1 & 2 and .18 for visit 4, then multiplied by 0.95
References and Sources:
  • Bash LD, Coresh J, Köttgen A, et al. Defining chronic kidney disease in the research setting: the Atherosclerosis Risk in Communities (ARIC) Study.  Am J Epidemiol. 2009;170(4):414-24.
Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd


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