CKD Prevalence

The prevalence of CKD is best estimates from national health surveys. In the US, it has been estimated from National Health and Nutrition Examination Surveys, a nationally representative sample of non institutionalized adults aged 20 years or older.   Using the MDRD Study equation, the prevalence of CKD in the United States was estimated to be 13% in the NHANES 99-04 survey, which was an increase from 10% estimates in the NHANES 1988-1994 (Coresh JAMA 2008).  The increasing prevalence of diabetes and hypertension is likely the main factors for the rise in CKD prevalence.  Using the more accurate CKD-EPI equation, the prevalence of CKD in NHANES 1999-2006 was estimated to be 11.5% (Levey, Annals 2009).

Using the CKD-EPI equation, the prevalence of CKD stages in NHANES 1999-2006 and 2000 U.S. Population Estimates stages are as follows:

CKD Stage % (95% CI) N (1000’s) (95% CI)
Stages 1-4 11.52 (10.62 – 12.43) 23,157 (21,340 – 24,978)
Stage 1 2.24 (1.74 – 2.77) 4,509 (3,487 – 5,575)
Stage 2 2.56 (2.05 – 3.07) 5,145 (4,124 – 6,160)
Stage 3 6.32 (5.79 – 6.86) 12,702 (11,636 – 13,775)
Stage 4 0.40 (0.29 – 0.50) 801 (587 – 1,013)

Lower stages of CKD account for most of the population identified as having CKD.  Compared to people in higher stages who are at higher risk for kidney failure than cardiovascular disease, people at lower stages are at a higher risk of cardiovascular disease than the risk of progression to kidney failure  (insert link to CKD prognosis page).

The main concern with estimating prevalence of CKD from creatinine based estimated is that it may overestimate GFR and underestimate CKD prevalence in people who are frail with chronic disease who have low muscle mass.  We therefore compared the prevalence of GFR < 60 ml/min per 1.73m2 (CKD Stages 3-5) using creatinine and cystatin C based estimated GFR in NHANES 1988-1994 and 1999-2002.  The prevalence of GFRcys < 60 ml/min per 1.73m2 was 5.5% and 8.7% in the 2 surveys, respectively (Grams, 2013), compared to 4.7% and 6.5% for creatinine, respectively )

NHANES 1988- 1994 NHANES 1999-2002
eGFR cr 4.7% 6.5%
eGFR cys 5.5% 8.7%

The increased prevalence of reduced eGFRcys confirms the previous observations of the increase in the prevalence of reduced eGFRcr. However, eGFRcys provides estimated CKD prevalence that is higher than creatinine.   For each estimating equation, the magnitude of difference between the two surveys decreased with sequential adjustment for age, sex and race, diabetes and hypertension, and BMI.  This suggests that difference in prevalence rates between the two surveys is partially related to changes in the population of these risk factors for CKD

Last Updated: July 2014