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Prevalence of CKD Among U.S. Adults with Diabetes

Prevalence of chronic kidney disease (CKD) among adults with diabetes is more than three times higher than among adults without diabetes (38.7% vs. 11.3%). Lower prevalence of CKD is observed among adults with diabetes after 2001–2004 (42.3%), with the lowest prevalence of CKD among adults with diabetes observed in 2013–2016 (35.2%).

Data Source: NHANES

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Prevalence of CKD Among U.S. Adults with Diabetes by Overall and Diabetes National Health and Nutrition Examination Survey
Diabetes	2001-2004	2005-2008	2009-2012	2013-2016	2017-2020
Diabetes	42.3 (CI 39.1-45.4)	38.7 (CI 35.6-41.9)	37.0 (CI 34.3-39.8)	35.2 (CI 31.9-38.5)	38.7 (CI 34.8-42.5)
No Diabetes	11.3 (CI 10.3-12.4)	11.5 (CI 10.3-12.7)	10.5 (CI 9.7-11.3)	11.7 (CI 10.6-12.9)	10.9 (CI 9.7-12.1)
Total	14.0 (CI 13.1-14.9)	14.3 (CI 13.1-15.4)	13.4 (CI 12.4-14.3)	14.7 (CI 13.5-15.9)	14.8 (CI 13.5-16.2)

Data includes CKD stages 1–4. Stage 5 was excluded from this analysis due to small numbers. 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 stages 1–4 in the general U.S. population, by diabetes status.
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.
Denominator	Adults aged ≥ 18 years with serum creatinine and urine albumin measurements.
Definition of CKD and CKD Stage	CKD is defined by estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m² or albuminuria (urine albumin to creatinine ratio [UACR] ≥ 30 mg/g). Stage 1: eGFR ≥ 90 ml/min/1.73 m² and albuminuria; Stage 2: eGFR 60–89 ml/min/1.73 m² and albuminuria; Stage 3: eGFR 30–59 ml/min/1.73 m²; Stage 4: 15–29 ml/min/1.73 m²; Stage 5: excluded. Estimates are based on single estimates of eGFR and UACR.
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	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 immunoassay.
Diabetes	Diabetes is defined by self-report of diabetes, taking insulin or diabetes pills, or HbA1c ≥ 6.5%.
Hypertension	Hypertension is defined by self-report of hypertension, hypertension medications, or the average of systolic blood pressure greater than 140 mmHg (130 mmHg for CKD and diabetes) and diastolic blood pressure greater than 90 mmHg (80 mmHg for CKD and diabetes).
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.