Prevalence of Chronic Kidney Disease in the United States | Chronic Kidney Disease | JAMA | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
National Kidney Foundation.  K/DOQI Clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification.  Am J Kidney Dis. 2002;39(2):(suppl 1)  S1-S26611904577Google ScholarCrossref
Levey AS, Eckardt KU, Tsukamoto Y.  et al.  Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO).  Kidney Int. 2005;67(6):2089-210015882252Google ScholarCrossref
Sarnak MJ, Levey AS, Schoolwerth AC.  et al.  Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention.  Hypertension. 2003;42(5):1050-106514604997Google ScholarCrossref
US Renal Data Systems.  USRDS 2006 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2007
Gregg EW, Cheng YJ, Cadwell BL.  et al.  Secular trends in cardiovascular disease risk factors according to body mass index in US adults.  JAMA. 2005;293(15):1868-187415840861Google ScholarCrossref
Mokdad AH, Ford ES, Bowman BA.  et al.  Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001.  JAMA. 2003;289(1):76-7912503980Google ScholarCrossref
Fields LE, Burt VL, Cutler JA, Hughes J, Roccella EJ, Sorlie P. The burden of adult hypertension in the United States 1999 to 2000: a rising tide.  Hypertension. 2004;44(4):398-40415326093Google ScholarCrossref
Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988-2000.  JAMA. 2003;290(2):199-20612851274Google ScholarCrossref
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):1-1212500213Google ScholarCrossref
Coresh J, Byrd-Holt D, Astor BC.  et al.  Chronic kidney disease awareness, prevalence, and trends among US adults, 1999 to 2000.  J Am Soc Nephrol. 2005;16(1):180-18815563563Google ScholarCrossref
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 Disdoi:10.1053/j.ajkd.2007.08.020Google Scholar
Go AS, Lo JC. Epidemiology of non–dialysis-requiring chronic kidney disease and cardiovascular disease.  Curr Opin Nephrol Hypertens. 2006;15(3):296-30216609298Google ScholarCrossref
Keith DS, Nichols GA, Gullion CM, Brown JB, Smith DH. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization.  Arch Intern Med. 2004;164(6):659-66315037495Google ScholarCrossref
Manjunath G, Tighiouart H, Coresh J.  et al.  Level of kidney function as a risk factor for cardiovascular outcomes in the elderly.  Kidney Int. 2003;63(3):1121-112912631096Google ScholarCrossref
Manjunath G, Tighiouart H, Ibrahim H.  et al.  Level of kidney function as a risk factor for atherosclerotic cardiovascular outcomes in the community.  J Am Coll Cardiol. 2003;41(1):47-5512570944Google ScholarCrossref
US Department of Health and Human Services; Centers for Disease Control and Prevention.  National Health and Nutrition Examination Survey. Accessed January 11, 2007
National Center for Health Statistics.  National Health and Nutrition Examination Survey (NHANES) Analytic Guidelines. http://wwwcdcgov/nchs/about/major/nhanes/nhanes2003-2004/analytical_guidelineshtm. Accessed May 9, 2007
National Center for Health Statistics; Centers. for Disease Control and Prevention.  Analytic and reporting guidelines: the Third National Health and Nutrition Examination Survey, NHANES III (1988-94). Accessibility verified September 25, 2007
US Department of Health and Human Services.  Health statistics: plan and operation of the Third National Health and Nutrition Examination Survey, 1988-94. Accessibility verified September 25, 2007
National Center for Health Statistics; Centers for Disease Control.  Survey operations manuals, brochures, and consent documents: 1999-current NHANES. Accessibility verified September 25, 2007
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D.Modification of Diet in Renal Disease Study Group.  A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation.  Ann Intern Med. 1999;130(6):461-47010075613Google ScholarCrossref
Levey AS, Coresh J, Greene T.  et al.  Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate.  Ann Intern Med. 2006;145(4):247-25416908915Google ScholarCrossref
Davies DF, Shock NW. Age changes in glomerular filtration rate, effective renal plasma flow, and tubular excretory capacity in adult males.  J Clin Invest. 1950;29(5):496-50715415454Google ScholarCrossref
Ong KL, Cheung BM, Man YB, Lau CP, Lam KS. Prevalence, awareness, treatment, and control of hypertension among United States adults 1999-2004.  Hypertension. 2007;49(1):69-7517159087Google ScholarCrossref
Kannel WB, Vokonas PS. Primary risk factors for coronary heart disease in the elderly: the Framingham Study. In: Wenger NK, Furberg CD, Pitt E, eds. Coronary Heart Disease in the Elderly. New York, NY: Elsevier Science Publishing Co Inc; 1986:60-92
Stevens LA, Coresh J, Feldman HI.  et al.  Evaluation of the modification of diet in renal disease study equation in a large diverse population.  J Am Soc Nephrol. 2007;18(10):2749-275717855641Google ScholarCrossref
Hsu CY, Lin F, Vittinghoff E, Shlipak MG. Racial differences in the progression from chronic renal insufficiency to end-stage renal disease in the United States.  J Am Soc Nephrol. 2003;14(11):2902-290714569100Google ScholarCrossref
Levey AS, Coresh J, Greene T.  et al.  Expressing the Modification of Diet in Renal Disease Study equation for estimating glomerular filtration rate with standardized serum creatinine values.  Clin Chem. 2007;53(4):766-77217332152Google ScholarCrossref
 Prevalence of chronic kidney disease and associated risk factors–United States, 1999-2004.  MMWR Morb Mortal Wkly Rep. 2007;56(8):161-16517332726Google Scholar
Gilbertson DT, Liu J, Xue JL.  et al.  Projecting the number of patients with end-stage renal disease in the United States to the year 2015.  J Am Soc Nephrol. 2005;16(12):3736-374116267160Google ScholarCrossref
Stevens LA, Coresh J, Greene T, Levey AS. Assessing kidney function–measured and estimated glomerular filtration rate.  N Engl J Med. 2006;354(23):2473-248316760447Google ScholarCrossref
Rule AD, Larson TS, Bergstralh EJ, Slezak JM, Jacobsen SJ, Cosio FG. Using serum creatinine to estimate glomerular filtration rate: accuracy in good health and in chronic kidney disease.  Ann Intern Med. 2004;141(12):929-93715611490Google ScholarCrossref
US Census Bureau.  PCT 16 group quarters population by group quarters type. Accessibility verified September 26, 2007
Original Contribution
November 7, 2007

Prevalence of Chronic Kidney Disease in the United States

Author Affiliations

Author Affiliations: Department of Epidemiology, Bloomberg School of Public Health, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland (Drs Coresh, Selvin, and Manzi); Division of Nephrology, Tufts-New England Medical Center, Boston, Massachusetts (Drs Stevens and Levey); National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland (Drs Kusek and Eggers); and Department of Clinical Pathology, Cleveland Clinic Foundation, Cleveland, Ohio (Dr Van Lente).

JAMA. 2007;298(17):2038-2047. doi:10.1001/jama.298.17.2038

Context The prevalence and incidence of kidney failure treated by dialysis and transplantation in the United States have increased from 1988 to 2004. Whether there have been changes in the prevalence of earlier stages of chronic kidney disease (CKD) during this period is uncertain.

Objective To update the estimated prevalence of CKD in the United States.

Design, Setting, and Participants Cross-sectional analysis of the most recent National Health and Nutrition Examination Surveys (NHANES 1988-1994 and NHANES 1999-2004), a nationally representative sample of noninstitutionalized adults aged 20 years or older in 1988-1994 (n = 15 488) and 1999-2004 (n = 13 233).

Main Outcome Measures Chronic kidney disease prevalence was determined based on persistent albuminuria and decreased estimated glomerular filtration rate (GFR). Persistence of microalbuminuria (>30 mg/g) was estimated from repeat visit data in NHANES 1988-1994. The GFR was estimated using the abbreviated Modification of Diet in Renal Disease Study equation reexpressed to standard serum creatinine.

Results The prevalence of both albuminuria and decreased GFR increased from 1988-1994 to 1999-2004. The prevalence of CKD stages 1 to 4 increased from 10.0% (95% confidence interval [CI], 9.2%-10.9%) in 1988-1994 to 13.1% (95% CI, 12.0%-14.1%) in 1999-2004 with a prevalence ratio of 1.3 (95% CI, 1.2-1.4). The prevalence estimates of CKD stages in 1988-1994 and 1999-2004, respectively, were 1.7% (95% CI, 1.3%-2.2%) and 1.8% (95% CI, 1.4%-2.3%) for stage 1; 2.7% (95% CI, 2.2%-3.2%) and 3.2% (95% CI, 2.6%-3.9%) for stage 2; 5.4% (95% CI, 4.9%-6.0%) and 7.7% (95% CI, 7.0%-8.4%) for stage 3; and 0.21% (95% CI, 0.15%-0.27%) and 0.35% (0.25%-0.45%) for stage 4. A higher prevalence of diagnosed diabetes and hypertension and higher body mass index explained the entire increase in prevalence of albuminuria but only part of the increase in the prevalence of decreased GFR. Estimation of GFR from serum creatinine has limited precision and a change in mean serum creatinine accounted for some of the increased prevalence of CKD.

Conclusions The prevalence of CKD in the United States in 1999-2004 is higher than it was in 1988-1994. This increase is partly explained by the increasing prevalence of diabetes and hypertension and raises concerns about future increased incidence of kidney failure and other complications of CKD.