Lifetime incidence of CKD stages 3-5 in the United States

Abstract

Background: Lifetime risk estimates of chronic kidney disease (CKD) can motivate preventative behaviors at the individual level and forecast disease burden and health care use at the population level.

Study design: Markov Monte Carlo model simulation study.

Setting & population: Current US black and white population.

Model, perspective, & timeframe: Markov models simulating kidney disease development, using an individual perspective and lifetime horizon.

Outcomes: Age-, sex-, and race-specific residual lifetime risks of CKD stages 3a+ (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m²), 3b+ (eGFR <45 mL/min/1.73 m²), 4+ (eGFR <30 mL/min/1.73 m²), and end-stage renal disease (ESRD).

Measurements: State transition probabilities of developing CKD and of dying prior to its development were modeled using: (1) mortality rates from the National Vital Statistics Report, (2) mortality risk estimates from a 2-million person meta-analysis, and (3) CKD prevalence from National Health and Nutrition Examination Surveys. Incidence, prevalence, and mortality related to ESRD were supplied by the US Renal Data System.

Results: At birth, the overall lifetime risks of CKD stages 3a+, 3b+, 4+, and ESRD were 59.1%, 33.6%, 11.5%, and 3.6%, respectively. Women experienced greater CKD risk yet lower ESRD risk than men; blacks of both sexes had markedly higher CKD stage 4+ and ESRD risks (lifetime risks for white men, white women, black men, and black women, respectively: CKD stage 3a+, 53.6%, 64.9%, 51.8%, and 63.6%; CKD stage 3b+, 29.0%, 36.7%, 33.7%, and 40.2%; CKD stage 4+, 9.3%, 11.4%, 15.8%, and 18.5%; and ESRD, 3.3%, 2.2%, 8.5%, and 7.8%). Risk of CKD increased with age, with approximately one-half the CKD stage 3a+ cases developing after 70 years of age.

Limitations: CKD incidence was modeled from prevalence estimates in the US population.

Conclusions: In the United States, the lifetime risk of developing CKD stage 3a+ is high, emphasizing the importance of primary prevention and effective therapy to reduce CKD-related morbidity and mortality.

Keywords: Chronic kidney disease; end-stage renal disease; incidence; lifetime risk.

Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Markov chain model used to simulate the progression of an initially CKD-free individual through death or the development of CKD. ICKD=one-year probability of developing CKD, QnoCKD=one-year probability of dying prior to the development of CKD, QCKD=one-year probability of dying in an individual with CKD. Here, CKD is treated as a single outcome, representing the stage of interest (CKD 3a+, CKD 3b+, CKD 4+, or ESRD). Progression through CKD stages is not modeled.

Figure 2

Cumulative incidence from birth by race and sex of CKD stage (A) 3a+, (B) 3b+, (C) 4+, and (D) ESRD

Figure 3

CKD stage 3a+ projections by age, race, and sex, scaled by estimated 2012 U.S. population