There is increasing information about the incidence and prevalence of chronic kidney disease (CKD) in the United States and worldwide, but most adults remain unaware of their current and future risk for developing CKD. Awareness of risks carries the potential to encourage lifestyle, medication, and other interventions to help reduce the risk for CKD progression. Furthermore, in the setting of rising health care costs and the large percentage of Medicare expenditures going toward the care of patients with CKD and ESRD, developing accurate projections about the future prevalence of the various stages of CKD is essential for planning allocation of resources and nephrology workforce needs.
In their article recently published in AJKD, Hoerger et al apply projection algorithms to patients in the NHANES database from 1999-2010 in order to predict the prevalence of CKD in 2020-2030 as well as the proportion of individuals who will receive a new diagnosis of CKD in their lifetime. Data regarding baseline prevalence of diabetes, hypertension, race, and albuminuria status were used to predict rates of GFR decline over time.
Future development of CKD of any stage is projected to be 54.1% for ages 30-49, 52% for ages 50-64, and 41.8% for ages 65 and above. The projections for developing CKD stage 3b or higher are lower, and range from 19.7-24.2%. Estimates regarding future prevalence of CKD are also provided, and compared to current prevalence data. For adults older than age 30, CKD prevalence is predicted to increase from 13.2% currently to 14.4% in 2020 and 16.7% in 2030. The majority of the increase in prevalence is attributed to an increase in patients with CKD stage 3a, while the prevalence of stages 4 and 5 is projected to be relatively constant.
While the data presented by Hoerger et al does not predict an epidemic of ESRD, there are concerning trends regarding the future incidence and prevalence of all stages of CKD. Considering the excess cardiovascular risk and mortality associated with this population, they represent a potential target for additional education and more aggressive management with regard to cardiovascular risk reduction, blood pressure control, and other factors. The data also underline future nephrology workforce challenges as the prospect of caring for nearly 17% of the adult population easily overwhelms the current capacity, and will require creative solutions with regard to co management with primary care providers and use of additional providers and adherence to practice guidelines.
John W. O’Bell, M.D.
Assistant Professor of Medicine, Division of Kidney Disease and Hypertension, The Warren Alpert Medical School of Brown University
AJKD Blog Contributor