Kidney Disease Statistics for the United States

National Kidney and Urologic Diseases Information Clearinghouse

The Growing Burden of Kidney Disease CKD General Prevalence

Kidney disease statistics for the United incidence of kidney disease. This demo States convey the burden of chronic graphic information helps direct targeted kidney disease (CKD) and end-stage renal programs to the people who need them disease (ESRD). Based on these statis most. Statistics can later help measure tics, researchers can estimate the size of progress in preventing and treating kidney the ESRD population in years to come disease. With the knowledge provided and gauge the need for resources such as by statistics, researchers and health care dialysis and transplant clinics to treat the providers can make great gains in the ﬁ ght One in 10 growing ESRD population. against kidney disease. American adults, Over time, kidney disease statistics show Unless otherwise noted, the following trends and movement. For example, sta statistics are from the United States Renal more than tistics show which ethnic and age groups Data System’s 2010 Annual Data Report and 20 million, have and geographical regions have the highest 2011 Annual Data Report. some level of CKD.

Source: Centers for Disease Control and Prevention Defi nitions end-stage renal disease (ESRD): total and permanent kidney failure. When chronic kidney disease (CKD): the kidneys fail, the body retains fl uid. any condition that causes reduced Harmful wastes build up. A person with kidney function over a period of ESRD needs treatment to replace the time. CKD is present when a patient’s work of the failed kidneys. glomerular filtration rate remains below 60 milliliters per minute for more than acute kidney injury (AKI): sudden, 3 months or when a patient’s urine temporary, and sometimes fatal loss of albumin-to-creatinine ratio is over kidney function 30 milligrams (mg) of albumin for each incidence: the number of new cases gram (g) of creatinine (30 mg/g). of a disease in a given time period prevalence: the number of existing cases of a disease at a given point in time CKD Incidence ■ The incidence of CKD is increasing most rapidly in people ages 65 and older.

■ The incidence of recognized CKD in people ages 65 and older more than doubled between 2000 and 2008.

■ The incidence of recognized CKD among 20- to 64-year-olds is less than 0.5 percent.

Percent of Population with New Cases of CKD, by Age Group

4.5 B 4.0 B B Medicare ages 65+ B 3.5 J MarketScan ages 20–64

3.0 B B 2.5 B B B

Percent 2.0 B 1.5

1.0

0.5 J J J J J J J J J 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year *MarketScan represents data from employer group health plans.

CKD Prevalence Percent of Population with ■ The prevalence of CKD is growing most rapidly Stage 3 CKD, by Age Group in people ages 60 and older. 30 ■ Between the 1988–1994 National Health and Ages 20–39 Nutrition Examination Survey (NHANES) Ages 60+ 26.0% 25 24.5% study and the 2003–2006 NHANES study, the 24.2% prevalence of CKD in people ages 60 and older 20 jumped from 18.8 to 24.5 percent. 18.8%

■ During that same period, the prevalence of CKD in people between the ages of 20 and 15 39 stayed consistently below 0.5 percent. Percent

0.1% 0.3% 0.1% 0.2% 0 NHANES NHANES NHANES NHANES 1988–1994 1999–2002 2003–2006 2001–2008 Years

2 | Kidney Disease Statistics for the United States ESRD Incident Rate After rising steadily from 1980 to 2001, the incident rate of ESRD leveled off.

Adjusted Incident Rates of ESRD

400

350

300

250

200

150 Rate per Million

100

1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year

ESRD Incident Rates by Race ■ ESRD incident rates are more than three times higher for African Americans than for Caucasians.

■ After rising from 1980 to 2000, the incident rates for all races stabilized.

■ African American rates rose more quickly than rates for all other races.

■ In 2001, incident rates for American Indians started to decline.

Adjusted Incident Rates of ESRD by Race 1,200 J African American B All J J J J J 1,000 F American Indian J J J J J J J J Asian J H Caucasian J J J 800 J J J F F J F 600 F F F F F F F J F F F F F F J F F F F F Rate per Million J J F 400 J F J F J F F J F H H H H H H H H H H H J H H H 200 F H H H H H F F H H H H H H H H H H H 0

1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year

Kidney Disease Statistics for the United States | 3 ESRD Prevalence and Prevalent Rate ■ At the end of 2009, more than 871,000 people were being treated for ESRD.

■ Between 1980 and 2009, the prevalent rate for ESRD increased nearly 600 percent, from 290 to 1,738 cases per million.

Adjusted Prevalent Rates of ESRD

2,000

1,500

1,000 Rate per Million

500

1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year

4 | Kidney Disease Statistics for the United States AKI Incidence ■ The number of hospitalizations that included an AKI diagnosis rose from 3,942 in 1996 to 23,052 in 2008. ■ The percentage of AKI diagnoses that required dialysis declined from 13.39 in 1996 to 2.25 in 2008.

Any AKI Diagnosis

25,000 B

20,000

15,000 B

10,000 B

Number of Hospitalizations 5,000 B B

0 1996 1999 2002 2005 2008

Year

AKI Diagnosis with Dialysis

14 J

10 J

8 J

Percent 6

J 4

J 2

0 1996 1999 2002 2005 2008 Year

Kidney Disease Statistics for the United States | 5 CKD Co-morbidities ■ People with no CKD are more likely than people with stage 3 to 5 CKD to be alive 1 year after a heart attack. ■ The 1-year mortality for heart attack patients without identiﬁ ed CKD is 36 percent, compared with 51 percent for patients with stage 3 to 5 CKD.

All-cause Survival in Patients with a First Diagnosis of Cardiovascular Disease, by CKD Stage, 2007–2008

1.0 BJ 0.9

0.8 B B J B B 0.7 B B B J B B B J B B 0.6 J J J J J J 0.5 J J J Percent 0.4

0.3 B 0.2 No CKD J CKD Stage 3–5 0.1

0 0 1 2 3 4 5 6 7 8 9 10 11 12 Months

ESRD Treatment Modality Number of ESRD Patients ■ At the end of 2009, 398,861 ESRD patients by Treatment Modality were being treated with some form of dialysis; 400,000 172,553 ESRD patients had a working trans planted kidney. 350,000 ■ More than 10 times as many ESRD patients receive hemodialysis (HD) treatments at a 300,000 Dialysis Patients clinic as those who do peritoneal dialysis (PD) Other or uncertain dialysis (1,262) and home HD combined. 250,000 Continuous cycler-assisted peritoneal dialysis (18,064) 200,000 Continuous ambulatory peritoneal dialysis (9,458) Home HD (4,511) 150,000 In-center HD (365,566) Number of ESRD Patietns

100,000

50,000

0 Transplant Dialysis Patients Patients (172,553) (398,861)

6 | Kidney Disease Statistics for the United States Kidney Transplantation After rising steadily from 1980 to 2006, the annual number of kidney transplants declined in 2007 and 2008.

Annual Number of Kidney Transplants

20,000 J J J J J J J 15,000 J J J J J J J J J J 10,000 J J J Number J J H H H H H H H H H 5,000 H H H H H H H H H H H H H J Total B Deceased Donor H Living Donor 0

1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year

Kidney Disease Statistics for the United States | 7 ESRD Mortality ■ Though the total number of ESRD patient deaths has continued to rise, the death rate has declined in recent years after peaking in 2001. ■ The number of deaths from ESRD rose from 10,478 in 1980 to 90,118 in 2009.

Unadjusted Annual Mortality for ESRD Patients

Mortality Rates for ESRD Patients

200

150

100

50 Number of Deaths per 1,000 Patients, Years at Risk 0 1980 1985 1990 1995 2000 2005 2009 Year

Total Patient Deaths for ESRD Patients

100,000

90,000 B B 80,000 B 70,000

60,000 B 50,000

40,000 B 30,000 Number of Patient Deaths 20,000 B 10,000 B

0 1980 1985 1990 1995 2000 2005 2009 Year

8 | Kidney Disease Statistics for the United States Mortality Rates for Dialysis Patients After rising from 1980 to 2001, mortality rates for dialysis patients started to fall every year. By 2008, they had returned to early 1980s levels.

Death Rates for Patients on Dialysis

250

200

150

100

50 Number of Deaths p er 1,000 Patients, Years at Risk

1980 1985 1990 1995 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year

General Graft Survival Rates 10-year General Graft Survival Rates The percentage of grafts transplanted in 1980 that survived to 1990 was 25.7. That per- 50 centage improved steadily in the following decades, with the survival rate from 1999 to 2009 rising to 44.9. 40

30 Percent 20

1980–19901985–19951990–20001995–20051996–20061997–20071998–20081999–2009 Years

Kidney Disease Statistics for the United States | 9 Graft Survival Rates by Race While graft survival is lower in African Americans than in Caucasians, patient survival rates are about equal.

Graft Survival Rates by Race

100 BJ B 90 J

80 B 70 J 60

50 B Percent 40 J 30 J African Americans 20 B Caucasians

1 year 5 years 3 months 10 years

(2008–2009) (2008–2009) (2004–2009) (1999–2009)

Patient Survival Rates for Dialysis and Transplant Patients At 85.5 percent, the 5-year survival rate for transplant patients is more than twice the 35.8 percent survival rate for dialysis patients.

Patient Survival Rates by Dialysis and Transplant

100 J J 90 J J 80 B

70 B 60 B 50 Percent 40 B 30 B Dialysis Patients 20 J Transplant Patients

0 1 year 2 years 3 years 4 years 5 years (2008–2009) (2007–2009) (2006–2009) (2005–2009) (2004–2009) No data available

10 | Kidney Disease Statistics for the United States ESRD Costs Treating ESRD patients cost the United States over $40 billion in public and private funds in 2009.

ESRD Costs in Billions

$13.47

$10.68 $5.53 $4.70 $29.03 $21.31 $12.04 $13.82

Total: $16.74 Total: $19.35 Total: $31.99 Total: $42.50 1998 2000 2005 2009

Non-Medicare Costs Medicare Costs

Costs per Patient ■ ESRD annual expenditures per patient have increased slightly in recent years. ■ From 2006 to 2007, transplant costs per patient decreased but increased again in 2008. ■ Yearly costs for treating a patient on HD are nearly triple the costs for treating a transplant patient.

Annual ESRD Treatment Costs per Patient for HD, PD, Transplantation (Tx), and all ESRD

$100,000 $90,000

$80,000

$70,000

$60,000 $50,000 Cost $40,000 $30,000

$20,000 $10,000

0 2006 2007 2008 2009 Year HD PD Tx All ESRD

Kidney Disease Statistics for the United States | 11 Defi nition vascular access: a general term to describe where blood is removed from and returned to the body during HD. A vascular access may be an arteriovenous (AV) fistula, an AV graft, or a catheter. An AV fistula is the preferred type of vascular access because it causes fewer problems with infection and clotting. Catheters have the most problems with infection.

AV Fistula Use among Men and Women ■ AV fi stula use increased from 27.9 to 55.0 percent between 1998 and 2007. ■ AV fi stula use increased in both men and women. ■ AV fi stula use rates among men were twice as high as among women in the late 1990s. ■ Women have begun to narrow the gap in AV fi stula use.

Percentage of Patients with an AV Fistula

70 B 60 B B H B H 50 B B H B J B H 40 H J B B H H J J Percent H 30 H H J J J J 20 J J

10 B Male H All J Female

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Year

12 | Kidney Disease Statistics for the United States AV Graft Use among Men and Women ■ The decline in AV graft use mirrors the rise in AV ﬁ stula use. ■ AV graft use among women is higher than among men. ■ The gap in AV graft use among men and women narrowed gradually between 1998 and 2007.

Percent of Patients with an AV Graft

70 J J 60 H J H J J B H 50 B H J B H J B H J 40 B H J B H B J Percent 30 B H H B B 20

10 B Male H All J Female

0 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Year

Kidney Disease Statistics for the United States | 13 Catheter Use for Vascular Access Around 18 percent of dialysis patients use a catheter for their vascular access.

Percent of All Patients with a Catheter

10 Percent

0 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Year

14 | Kidney Disease Statistics for the United States Acknowledgments Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. National Kidney Disease Education Program 3 Kidney Information Way Bethesda, MD 20892 Phone: 1–866–4–KIDNEY (1–866–454–3639) TTY: 1–866–569–1162 Fax: 301–402–8182 Email: [email protected] Internet: www.nkdep.nih.gov The National Kidney Disease Education Pro gram (NKDEP) is an initiative of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, U.S. Department of Health and Human Services. The NKDEP aims to raise awareness of the seriousness of kidney disease, the importance of testing those at high risk, and the availability of treatment to prevent or slow kidney disease.

Kidney Disease Statistics for the United States | 15 National Kidney and Urologic Diseases Information Clearinghouse 3 Information Way Bethesda, MD 20892–3580 Phone: 1–800–891–5390 TTY: 1–866–569–1162 Fax: 703–738–4929 Email: [email protected] Internet: www.kidney.niddk.nih.gov The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1987, the Clearinghouse provides information about diseases of the kidneys and urologic system to people with kidney and urologic disorders and to their families, health care professionals, and the public. The NKUDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about kidney and urologic diseases.

This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired. This publication is available at www.kidney.niddk.nih.gov.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health

NIH Publication No. 12–3895 June 2012

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