CDC Surveillance System: CKD Stages 1-4 Among U.S. Adults

Crude Prevalence of CKD Stages 1–4^a by Year and Race/Ethnicity National Health and Nutrition Examination Survey
Race/Ethnicity	1999–2000	2001–2002	2003–2004	2005–2006	2007–2008	2009–2010	2011–2012	2013–2014	2015–2016
Non-Hispanic White	14.3% (CI 12.8-15.9)	15.1% (CI 13.7-16.5)	14.3% (CI 12.6-16.0)	14.4% (CI 11.8-17.0)	14.5% (CI 12.9-16.1)	13.2% (CI 11.9-14.5)	13.8% (CI 11.6-16.0)	16.4% (CI 13.8-19.0)	14.9% (CI 12.6-17.2)
Non-Hispanic Black	16.0% (CI 13.7-18.3)	15.7% (CI 12.6-18.7)	14.5% (CI 10.7-18.3)	16.7% (CI 13.6-19.8)	15.5% (CI 12.6-18.3)	14.1% (CI 11.5-16.7)	17.4% (CI 15.4-19.5)	16.0% (CI 13.9-18.1)	15.5% (CI 12.4-19.0)
Mexican-American	11.1% (CI 8.4-13.9)	11.2% (CI 9.5-13.0)	11.9% (CI 8.4-15.4)	11.7% (CI 9.8-13.6)	12.3% (CI 10.8-13.9)	11.6% (CI 8.5-14.7)	12.9% (CI 6.7-18.1)	12.5% (CI 8.3-16.6)	12.7% (CI 8.7-16.6)
Total	14.5% (CI 13.1-15.9)	14.6% (CI 13.3-14.9)	14.4% (CI 12.9-16.0)	14.5% (CI 12.3-16.7)	14.1% (CI 12.8-15.4)	12.8% (CI 11.7-13.9)	14.0% (CI 12.2-15.7)	15.5% (CI 13.7-17.2)	14.2% (CI 12.2-16.3)

Footnotes:
^a Stages 1 and 2 defined by single assessment of albuminuria (i.e., no estimation of persistence) and eGFR ≥90 and 60-89 ml/min/1.73 m², respectively; stages 3 and 4 defined as 30-59 and 15-29 ml/min/1.73 m², respectively.

Crude prevalence of CKD stages 1-4, was between 12% to 15% over the time periods 1999 to 2016. Prevalence was estimated to be highest in in people aged 70 years or older, females, non-Hispanic blacks, and persons with diabetes or hypertension.

Chart Explanation: From 1999 to 2016, the overall crude prevalence of CKD ranged between 12.8% and 15.5%. Over this time period, the crude prevalence was consistently highest in older individuals. In 2015-2016, 45.0% of people aged 70 years or older were classified as having CKD, compared to 5.6% in those aged 20 to 39 years. In the same years, prevalence continued to be higher in females (16.0%) than in males (12.4%). Non-Hispanic blacks had the highest prevalence estimate for most years (approximately 15% to 16%), while Mexican-Americans (12.7%) consistently had the lowest prevalence. Compared to their counterparts, people with diabetes (33.4% vs. 11.9%) or hypertension (25.9% vs. 8.6%) had a higher prevalence of CKD than people without these conditions. As expected, this has remained the same from 1999 to 2016. For 2015-2016, all comparisons within subgroup were statistically significantly different (P<0.05 by χ² test), except for gender and race/ethnicity.

The National Health and Nutrition Examination Survey (NHANES) is a nationally representative, cross-sectional survey that is currently conducted every 2 years by the Centers for Disease Control and Prevention's National Center for Health Statistics to examine disease prevalence and trends over time in noninstitutionalized U.S. 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 (MEC). Here, we examined data from the 1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010, 2011-2012, 2013-2014, and 2015-2016 NHANES, in addition to data from NHANES III (1988-1994). Estimated glomerular filtration rate (eGFR) was calculated according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for calibrated creatinine (Levey et al., 2009). Serum creatinine was calibrated for 1999-2000 and 2005-2006 participants; no correction was required for calibrated serum creatinine in participants in the 2001-2002, 2003-2004, 2007-2008, 2009-2010, 2011-2012, 2013-2014, and 2015-2016 surveys (Selvin et al., 2007). Albuminuria was defined by urinary albumin-to-creatinine ratio ≥30 mg/g; moderate albuminuria ranges between 30 and 299 mg/g and severe albuminuria is ≥300 mg/g; pregnant women were excluded. For comparisons across the 18-year period 1999-2016, albuminuria was corrected in 1999-2006 to account for differences in the instrumentation and method for urine creatinine starting in 2007. Prevalence of CKD is likely overestimated by single measurements of albuminuria and kidney function (eGFR). In clinical practice, CKD is defined by persistent albuminuria or reduced kidney function for ≥3 months.

Field	Data
Description of Measure	Prevalence of CKD stage 1-4
Data Source	NCHS
Type of Data Source	Public
Data Set	NHANES
Health Care System Data	No
Regional or National?	National
Demographic Group	Non-institutionalized U.S. residents aged 20+ years
Numerator	Participants with CKD
Denominator	Participants with serum creatinine and urine protein measurements
Definition of CKD	Stage 1, eGFR ≥ 90 ml/min/1.73 m² and presence of single albuminuria; Stage 2, eGFR 60-89 ml/min/1.73 m² and presence of single albuminuria; Stage 3, eGFR 30-59 ml/min/1.73 m²; Stage 4, 15-29 ml/min/1.73 m²; Stage 5, excluded
Glomerular filtration rate	Estimated using CKD-EPI equation for calibrated creatinine: eGFR=141 x [min(calibrated serum creatinine in mg/dL) /κ, 1)]^α x [max(calibrated serum creatinine in mg/dL/κ, 1)]^κ x 0.993^age x (1.018 if female) x (1.159 if NH Black) κ = 0.7 if female, and 0.9 if male α = -0.329 if female, and -0.411 if male
Proteinuria	Urinary albumin-to-creatinine ratios of 30-299 mg/g (microalbuminuria) and >300 mg/g (macroalbuminuria); pregnant/menstruating women excluded
Primary Data Source Indicator	lbxscr: Serum creatinine
Primary Indicator Method of Measurement	Examination/Laboratory
Secondary (1) Variable	ridageyr: Age in years
Secondary (1) Indicator Method of Measurement	Questionnaire (interviewer-administered)
Secondary (2) Variable	ridgendr: Gender
Secondary (2) Indicator Method of Measurement	Questionnaire (interviewer-administered)
Secondary (3) Variable	No
Secondary (3) Indicator Method of Measurement	ridreth1: Race/ethnicity
Secondary (3) from Medical Record?	Questionnaire (interviewer-administered)
Secondary (4) Data Source Indicator	urxuma: Urine albumin
Secondary (4) Indicator Method of Measurement	Examination/lab
Secondary (5) Data Source Indicator	urxucr: Urine creatinine
Secondary (5) Indicator Method of Measurement	Examination/lab
Frequency of Measurement (Primary)	Once (cross-sectional)
U.S. Region Covered by Primary Variable	All
Period Currently Available	1999–2016
Pending Data	2017-2018
Additional Data Items of Interest	Stage of CKD, year, other stratification variables of interest (diabetes by self-report, hypertension by self-report)
Limitations of Indicator	Albuminuria and kidney function can only be assessed from a one-time cross-sectional measurement, leading to overestimation of prevalence; second measures of albuminuria are available for only 2009-2010 and were first-morning rather than spot urine samples; no second measures of creatinine
Analytic Considerations	Appropriate NHANES survey weights must be used for all analyses; creatinine measurements must be calibrated for NHANES III, 1999-2000 and 2005-2006; many variable names differ across surveys; if SE 30% or more of estimate, must report as “low precision”

References and Sources:

Levey AS, Stevens LA, Schmid CH, et al. A New Equation to Estimate Glomerular Filtration Rate. Ann Intern Med. 2009;150(9):604-612.

http://annals.org/aim/article/744469
Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am. J. Kidney Dis. 2003;41(1):1-12.
http://www.ncbi.nlm.nih.gov/pubmed/12500213
Selvin E, Manzi J, Stevens LA, et al. Calibration of serum creatinine in the National Health and Nutrition Examination Surveys (NHANES) 1988-1994, 1999-2004. Am J Kidney Dis. 2007;50(6):918-26.

Suggested Citation:

Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd