United States Renal Data System public health surveillance of chronic kidney disease and end-stage renal disease

Allan J Collins, Robert N Foley, David T Gilbertson, Shu-Cheng Chen, Allan J Collins, Robert N Foley, David T Gilbertson, Shu-Cheng Chen

Abstract

The United States Renal Data System (USRDS) began in 1989 through US Congressional authorization under National Institutes of Health competitive contracting. Its history includes five contract periods, two of 5 years, two of 7.5 years, and the fifth, awarded in February 2014, of 5 years. Over these 25 years, USRDS reporting transitioned from basic incidence and prevalence of end-stage renal disease (ESRD), modalities, and overall survival, as well as focused special studies on dialysis, in the first two contract periods to a comprehensive assessment of aspects of care that affect morbidity and mortality in the second two periods. Beginning in 1999, the Minneapolis Medical Research Foundation investigative team transformed the USRDS into a total care reporting system including disease severity, hospitalizations, pediatric populations, prescription drug use, and chronic kidney disease and the transition to ESRD. Areas of focus included issues related to death rates in the first 4 months of treatment, sudden cardiac death, ischemic and valvular heart disease, congestive heart failure, atrial fibrillation, and infectious complications (particularly related to dialysis catheters) in hemodialysis and peritoneal dialysis patients; the burden of congestive heart failure and infectious complications in pediatric dialysis and transplant populations; and morbidity and access to care. The team documented a plateau and decline in incidence rates, a 28% decline in death rates since 2001, and changes under the 2011 Prospective Payment System with expanded bundled payments for each dialysis treatment. The team reported on Bayesian methods to calculate mortality ratios, which reduce the challenges of traditional methods, and introduced objectives under the Health People 2010 and 2020 national health care goals for kidney disease.

Keywords: United States Renal Data System; end-stage renal disease; public health; surveillance.

Figures

Figure 1
Figure 1
Trends in prevalent dialysis death rates. pt-years, patient-years.
Figure 2
Figure 2
Causes of death in incident dialysis patients, 2009–2011, first 180 days.
Figure 3
Figure 3
Change in adjusted all-cause and cause-specific hospitalization rates, by modality. CV, cardiovascular; ESRD, end-stage renal disease.
Figure 4
Figure 4
Catheter, fistula, and graft insertions, 1991–2011.
Figure 5
Figure 5
Adjusted rates of hospital admissions, by modality and diagnostic code type: infection.
Figure 6
Figure 6
Mean monthly hemoglobin and mean epoetin alfa (EPO) dose per week: hemodialysis patients.
Figure 7
Figure 7
Geographic variation in adjusted incident rates of end-stage renal disease (ESRD) per million population, 2011, by Health Service Area (HSA).
Figure 8
Figure 8
Distribution of general (fee-for-service) Medicare patients and costs for chronic kidney disease (CKD), congestive heart failure (CHF), diabetes (DM), and end-stage renal disease (ESRD), 2011.
Figure 9
Figure 9
United States Renal Data System Annual Data Report cover image, 2009.
Figure 10
Figure 10
United States Renal Data System Annual Data Report cover image, 2013.

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Source: PubMed

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