Chronic kidney disease has plateaued, but few patients know they have it

The overall prevalence of chronic kidney disease (CKD) has stabilized at about 14% in the U.S., yet only about 1 in 10 patients know they have the disease, according to the latest annual report from the United States Renal Data System (USRDS).

The USRDS also reported that the prevalence of end-stage kidney disease continued to rise, which indicates that survival is increasing for end-stage patients. The largest increase occurred in patients with Stage 3 CKD, from 4.5% in 1988 to 6.0% in 2012.

The population of end-stage patients on dialysis also increased 4% in 2013, and is now 63.2% larger than in 2000. At the same time, fewer deaths have been reported among both dialysis patients (down 28%) and kidney transplant patients (down 40%) since 1996.

“Overall trends for end-stage kidney disease are promising for those affected,” said Rajiv Saran, MD, Director of the USRDS Coordinating Center and Professor of Internal Medicine at University of Michigan Health System, in Ann Arbor, MI. “Patients on dialysis are living longer and, equally positive, survival rates have steadily improved among recipients of both living and deceased donor kidney transplants.”

The report was released by the USRDS Coordinating Center, based at the University of Michigan Kidney Epidemiology and Cost Center, in partnership with Arbor Research Collaborative for Health, in Ann Arbor, MI. 

Other key findings of the report include:

• Almost half of individuals with CKD also have diabetes and self-reported cardiovascular disease.
• Home dialysis use is now 52% higher than a decade ago.
• While 17,600 kidney transplants were performed in 2013, the active waiting list for kidney transplants is now 2.7 times greater than the current supply of donor kidneys.
• As survival increases, so too do medical costs. Medicare spending for CKD patients 65 and older exceeded $50 billion in 2013 and represented 20% of all Medicare spending in that age group.

In short, “CKD is common, and is associated with high morbidity, mortality, and cost, yet is readily identifiable by simple testing of blood and urine,” the authors state in the report. “Timely recognition and treatment has the potential to delay progression of the disease and reduce complications.”

Despite this, patient awareness remains very low—less than 10% for those with stages 1 to 3. Awareness is higher among those with Stage 4 CKD, when patients often experience overt symptoms.

“Awareness of this silent but deadly killer may help prevent those with early-stage kidney disease from progressing,” Dr. Saran said. “Learning more about risk factors for the disease and early diagnosis are of vital importance, as symptoms of kidney disease develop much later.”

CKD should be recognized around the world as a non-communicable disease in its own right—along with diabetes, hypertension, and obesity—and directly addressed in national programs to combat such diseases, the authors stated in the report.