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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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Advanced Stage CKD (stages 3 and 4) Prevalence by Year and Diabetes Status in U.S. Adults National Health and Nutrition Examination Survey
Diabetes Status	2001-2004	2005-2008	2009-2012	2013-2016	2017-2020
Prediabetes	11.5 (CI 9.4-13.5)	11.0 (CI 9.1-12.8)	10.2 (CI 8.9-11.5)	10.6 (CI 9.1-12.1)	9.7 (CI 7.3-12.1)
No Diabetes	4.5 (CI 4.0-5.1)	3.9 (CI 3.1-4.7)	3.2 (CI 2.4-3.9)	3.5 (CI 2.9-4.1)	3.7 (CI 2.9-4.4)
Diagnosed Diabetes	19.4 (CI 16.2-22.6)	18.8 (CI 15.8-21.8)	22.4 (CI 19.9-25.0)	19.4 (CI 16.9-22.0)	18.0 (CI 14.7-21.4)
Undiagnosed Diabetes	11.0 (CI 6.7-15.2)	11.5 (CI 6.8-16.1)	11.3 (CI 8.2-14.4)	12.8 (CI 8.2-17.3)	9.1 (CI 1.9-16.3)

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.

Field	Data
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).
Population	Noninstitutionalized U.S. adults aged ≥ 18 years, pregnant women excluded.
Years Included	2001–March 2020.
Numerator	Adults aged ≥ 18 years with CKD stages 3–4.
Denominator	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 0.993age 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
Albuminuria	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	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	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.