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Indicator Details: Percentage with CKD Stage 3 or 4 Who Were Aware of Their Diseasea
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a Missing data represent estimates that were suppressed due to relative standard error of 30% or more.

Reported awareness of disease, among those with CKD stages 3 and 4, was 12.4% in 2013-214. Over the past 16 years, no distinct increasing or decreasing trends have been noted.

In 2011-2014, persons who were male (14%), had comorbid diagnoses of diabetes (21%) or hypertension (14%), or were Mexican-Americans (28%) had the greatest levels of reported awareness relative to their counterparts. 
Chart Explanation: Reported awareness of CKD for stage 3 and 4 was 12.4% in 2013-2014. Across all survey periods, no clear trend was observed between 1999-2000 and 2013-2014. When examining awareness by stratifcations, it appeared that the most elderly participants (70+ years) were less likely to be aware (7.6% in 1999-2004 to 11.6% in 2011-2014) compared to the younger age groups (21.1% to 19.3% in 30-49 years). Awareness was dramatically different by gender, with males having greater awareness compared to females for all years groupings (13.8% vs. 11.5% in 2011-2014). Mexican-American and non-Hispanic black participants both had greater awareness of their disease than non-Hispanic white participants (28.1% and 26.5% vs. 10.5% for 2011-2014). Participants with comorbid conditions as diabetes (21.3% in 2011-2014) and hypertension (14.4% in 2011-2014) had greater awareness of thier CKD disease compared to their counterparts. Despite some of the stratifications appearing to show increased prevalence in 2011-2014, reported awareness of CKD continues to be very low in the U.S. population.
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 and blood and urine collection 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, and 2013-2014 NHANES. Awareness of CKD was defined as a “yes” response to the question “Have you ever been told by a health care provider you have weak or failing kidneys (excluding kidney stones, bladder infections, or incontinence)?” during the interview. CKD was diagnosed by laboratory testing and defined as an eGFR of ≥60 ml/min/1.73 m² and the presence of albuminuria (first single measurement of albumin:creatinine ratio from random spot urine) or by eGFR alone for CKD stage 3 or 4 (stage 5 was excluded).
Description of MeasureAwareness of CKD among those with kidney disease diagnosed by laboratory testing
Data SourceNCHS
Type of Data SourcePublic
Health Care System DataNo
Regional or National?National
Demographic GroupNon-institutionalized U.S. residents aged 20+ years
NumeratorParticipants with CKD who have been told they have weak or failing kidneys
DenominatorParticipants with CKD
Definition of CKDStage 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 rateEstimated 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 0.993age 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
ProteinuriaUrinary albumin-to-creatinine ratios of 30-299 mg/g (microalbuminuria) and >300 mg/g (macroalbuminuria); pregnant/menstruating women excluded
Primary Data Source Indicatorkiq022/kiq010: “Have you ever been told by a doctor or health professional that you have weak or failing kidneys (excluding kidney stones, bladder infections, or incontinence)?” yes/no
Primary Indicator Method of MeasurementQuestionnaire (interviewer-administered)
Secondary (1) Variablelbxscr: Serum creatinine
Secondary (1) Indicator Method of MeasurementExamination/Laboratory
Secondary (2) Variableridageyr: Age in years
Secondary (2) Indicator Method of MeasurementQuestionnaire (interviewer-administered)
Secondary (3) Variableridgendr: Gender
Secondary (3) Indicator Method of MeasurementQuestionnaire (interviewer-administered)
Secondary (3) from Medical Record? No
Secondary (4) Data Source Indicatorridreth1: Race/ethnicity
Secondary (4) Indicator Method of Measurement Questionnaire (interviewer-administered)
Secondary (5) Data Source Indicatorurxuma: Urine albumin
Secondary (5) Indicator Method of Measurement Examination/lab
Secondary (5) Data Source Indicatorurxucr: Urine creatinine
Secondary (5) Indicator Method of Measurement Examination/lab
Frequency of Measurement (Primary)Once (cross-sectional)
U.S. Region Covered by Primary VariableAll
Period Currently Available1999–2014
Pending Data2015-2016
Additional Data Items of InterestStage of CKD, year, other stratification variables of interest (diabetes by self-report, hypertension by self-report)
Limitations of IndicatorProteinuria can only be assessed from a one-time cross-sectional measurement in 1999-2008; two measurements only in 2009-2010, including first random and second first-morning void ~2 weeks after MEC exam; participants who have been told they have proteinuria may not answer yes
Analytical ConsiderationsAppropriate NHANES survey weights must be used for all analyses; creatinine measurements must be calibrated for NHANES years 1999-2000 and 2005-2006; if 2007-2008 data are combined with 1999-2006 data, the earlier data on urinary creatinine must be corrected; many variable names differ across surveys; if SE 30% or more of estimate, must suppress estimates and report as “low precision”; second urine albumin and creatinine measurements only available in 2009-2010 and not for 2011+

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