The burden of chronic kidney disease (CKD) in the U.S. increased by half over the past 15 years, largely due to the prevalence of risk factors such as being overweight and high blood pressure, epidemiologists said.
An analysis of data from the 2016 Global Burden of Disease (GBD 2016) study and other health databases found that CKD disability-adjusted life years increased by nearly 53% from 2002 to 2016, and from 1,269,049 to 1,935,954, said researchers led by Benjamin Bowe, MPH, of the Veterans Affairs St. Louis Health Care System in Missouri.
Deaths due to CKD rose by 58% during the same time period, from 52,127 deaths in 2002 to 82,539 in 2016. An increase in CKD due to diabetes and hypertension, especially among people ages 20-55, was a large factor in the growing public health impact of this disease, Bowe's group wrote online in JAMA Network Open.
"In the past 15 years, demographic, social, and epidemiologic changes have occurred in the United States. From 2002 to 2016, the U.S. population grew from 287 million to 323 million and life expectancy increased from 76.8 to 78.8 years. In addition, measures of sociodemographic development and exposure to risk factors for CKD have substantially increased over the same period," the researchers said.
"Population growth, aging, changes in sociodemographic development, and risk factor epidemiologic changes have likely contributed to changes in the burden of CKD," the team added. "These findings suggest that an effort to target the reduction of CKD through greater attention to metabolic and dietary risks, especially among younger adults, is necessary."
In addition to data from the GBD 2016 study, which provides epidemiologic information on more than 300 diseases and 80 risk factors for 195 countries, Bowe's team examined data from the U.S. National Vital Statistics System, the Renal Data System, and the National Health and Nutrition Examination Survey. They assessed deaths from CKD, and also determined the disease burden using an age-standardized rate for years of life lost, years living with disability, and disability-adjusted life years, and a combination of the two.
Risk factors for CKD included in the analysis were classified as metabolic (high fasting plasma glucose, systolic blood pressure, and body-mass index); dietary (high intake of sodium or sugar-sweetened beverages); and environmental (exposure to lead).
Geographic Findings and Expert Recommendations
A state-by-state analysis found that the burden of CKD increased in all states, but the increase was much higher -- and sometimes twice as high -- in southern states. States with the greatest increase in disability-adjusted life years per 100,000 people included Mississippi (697), Louisiana (681), and Alabama (604). States with the highest age-standardized CKD death rates per 100,000 were Louisiana (28), Mississippi (27), and West Virginia (23).
States with the smallest increases in CKD disability-adjusted life years per 100,000 were Vermont (321), Washington (328), and Colorado (331). Those with the lowest age-standardized CKD death rates were Vermont (11), Montana (11), and Washington (12). Although the study provided detailed information on each state, it could not capture trends for smaller locales, such as counties or zip codes, and it could not assess differences between urban and rural areas, Bowe and colleagues explained.
The geographic findings have been echoed in other studies, Joseph Vassalotti, MD, chief medical officer of the National Kidney Foundation (NKF), told MedPage Today. "This is a similar geographic pattern to what has been called the stroke belt by public health experts for the high incidence of stroke and other forms of cardiovascular disease," he said via email.
Vassalotti, who was not involved in the study, noted that the adult prevalence of CKD in the United States has increased from a mean estimate of 26 million to 30 million in recent years, according to data from the CDC. "The percentage of affected Americans has been relatively stable. Awareness of the condition among Americans has also remained low and stable or essentially unchanged at less than 10%, based on the same CDC survey results," he said.
Vassalotti offered the following tips for diagnosing, preventing, and treating CKD, based on published recommendations from the NKF and the Kidney Disease Outcomes Quality Initiative:
- In clinical practice, the most common tests for CKD include estimated glomerular filtration rate (eGFR) from the serum creatinine concentration and albuminuria from the urinary albumin-to- creatinine ratio
- Assessment of eGFR and albuminuria should be performed for persons with diabetes and/or hypertension, but is not recommended for the general population
- Tight risk factor control of diabetes and/or hypertension should prevent CKD
- Management of detected CKD includes reducing the patient's risk of CKD progression and risk of associated complications, such as acute kidney injury and cardiovascular disease, anemia, and metabolic acidosis, as well as mineral and bone disorders
- Preventing CKD progression requires blood pressure <140/90 mm Hg, use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for patients with albuminuria and hypertension, a hemoglobin A1c target of 7% for patients with diabetes, and correction of CKD-associated metabolic acidosis
- To prevent cardiovascular events, a lower blood pressure target of <130/80 mm Hg and statin-based therapies should be considered; to reduce patient safety hazards from medications, the level of eGFR should be considered when prescribing, and nephrotoxins should be avoided, such as prolonged use of nonsteroidal anti-inflammatory drugs
- The main reasons to refer to nephrology specialists are eGFR <30 mL/min/1.73 m2, severe albuminuria, and acute kidney injury
The study was funded by the Institute for Public Health at Washington University in St. Louis and the U.S. Department of Veterans Affairs.
Bowe and co-authors reported having no conflicts of interest.
JAMA Network Open
Source Reference: Bowe B, et al "Changes in the US burden of chronic kidney disease from 2002 to 2016: an analysis of the Global Burden of Disease study" JAMA Network Open 2018; DOI: 10.1001/jamanetworkopen.2018.4412.