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The Future Burden of CKD in the United States: A Simulation Model for the CDC CKD Initiative

Published:November 25, 2014DOI:https://doi.org/10.1053/j.ajkd.2014.09.023

      Background

      Awareness of chronic kidney disease (CKD), defined by kidney damage or reduced glomerular filtration rate, remains low in the United States, and few estimates of its future burden exist.

      Study Design

      We used the CKD Health Policy Model to simulate the residual lifetime incidence of CKD and project the prevalence of CKD in 2020 and 2030. The simulation sample was based on nationally representative data from the 1999 to 2010 National Health and Nutrition Examination Surveys.

      Setting & Population

      Current US population.

      Model, Perspective, & Timeline

      Simulation model following up individuals from current age through death or age 90 years.

      Outcomes

      Residual lifetime incidence represents the projected percentage of persons who will develop new CKD during their lifetimes. Future prevalence is projected for 2020 and 2030.

      Measurements

      Development and progression of CKD are based on annual decrements in estimated glomerular filtration rates that depend on age and risk factors.

      Results

      For US adults aged 30 to 49, 50 to 64, and 65 years or older with no CKD at baseline, the residual lifetime incidences of CKD are 54%, 52%, and 42%, respectively. The prevalence of CKD in adults 30 years or older is projected to increase from 13.2% currently to 14.4% in 2020 and 16.7% in 2030.

      Limitations

      Due to limited data, our simulation model estimates are based on assumptions about annual decrements in estimated glomerular filtration rates.

      Conclusions

      For an individual, lifetime risk of CKD is high, with more than half the US adults aged 30 to 64 years likely to develop CKD. Knowing the lifetime incidence of CKD may raise individuals’ awareness and encourage them to take steps to prevent CKD. From a national burden perspective, we estimate that the population prevalence of CKD will increase in coming decades, suggesting that development of interventions to slow CKD onset and progression should be considered.

      Index Words

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      Linked Article

      • The Myth of the Future Burden of CKD in United States
        American Journal of Kidney DiseasesVol. 66Issue 1
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          We read with interest the article by Hoerger et al about the future burden of CKD in the United States.1 These authors accept the notion that as humans age, glomerular filtration rate (GFR) falls.2-4 Consequently, the application of a fixed and arbitrary threshold of GFR as a definition for “CKD,” without reference to other signs of kidney damage (such as albuminuria) will always lead to increased “CKD” prevalence as populations age.5 Without an age-adapted definition, the prevalence of CKD is overestimated, with a high proportion of the elderly in stage 3a.
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