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Awareness of CKD by KDIGO Risk Categories

Awareness of CKD by KDIGO Risk Categories

About 1 in 7 adults have CKD; however, about 9 in 10 adults with CKD do not know they have it. Awareness of CKD was analyzed using 2017–March 2020 data from NHANES and displayed as a heatmap using KDIGO (Kidney Disease Improving Global Outcomes) guidelines. Overall, awareness of CKD was lower among adults with earlier stages, while higher awareness was seen among those with more severe or later stages of CKD. Those with moderately increased risk for CKD (yellow cells), representing 22 million U.S. adults, are often not aware of their diagnosis.

Data Source: NHANES
csv PPT
Prevalence of Awareness of CKD among U.S. Adults by Albuminuria category and eGFR category (2017-2020), data can be reviewed in the CSV download
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Green indicates no CKD according to KDIGO guidelines. Yellow indicates moderately increased risk for CKD. Orange indicates high risk for CKD. Red indicates very high risk for CKD. G5 categories are suppressed due to low sample sizes. 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.

Note: Not all NHANES variables are collected for all years; therefore, some NHANES indicators may not utilize the full 20-year span.

FieldData
Description of Measure

Awareness of CKD among adults with CKD by KDIGO risk categories.

Data Set

National Health and Nutrition Examination Survey (NHANES).

Population

Noninstitutionalized U.S. adults ≥ 20 years, pregnant women excluded.

Years Included

2017–March 2020.

Numerator

U.S. adults ≥ 20 years with CKD who answered “Yes” to the question “Have you ever been told by a doctor or other health professional that you had weak or failing kidneys?”

Denominator

U.S. adults ≥ 20 years with CKD.

Definition of CKD

CKD is defined by an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m² or albuminuria (urine albumin to creatinine ratio [UACR] ≥30 mg/g). Estimates are based on single estimates of eGFR and UACR.

Estimated Glomerular Filtration Rate (eGFR)

Based on the CKD-EPI (2021) equation for calibrated creatinine: eGFR=142 x [min(serum creatinine in mg/dL) /κ, 1)]**α x [max(serum creatinine/κ, 1)]**-1.20 x 0.9938**age x (1.012 if female).

κ = 0.7 if female and 0.9 if male
α = -0.241 if female and -0.302 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.

Awareness

Self-reported affirmative response to the question “Have you ever been told by a doctor or other health professional that you had weak or failing kidneys?”

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 the relative standard error is greater than 30%, estimates are not shown.

  • Kidney Disease Improving Global Outcomes (KDIGO). KDIGO Clinical Guidelines for Acute Kidney Injury. Kidney Int. 2012:2(Supp. 1).



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