Original InvestigationPathogenesis and Treatment of Kidney DiseasePrevalence of CKD in the United States: A Sensitivity Analysis Using the National Health and Nutrition Examination Survey (NHANES) 1999-2004
Section snippets
Methods
The prevalence of CKD stages 1 to 4 was assessed by using data from the continuous NHANES 1999-2004. From 1999 to 2004, the National Center for Health Statistics used NHANES to continually monitor the health of the US population. NHANES uses a complex multistage probability sampling design to assess the health of a nationally representative sample of the civilian noninstitutionalized US population. The National Center for Health Statistics releases data from NHANES in 2-year intervals. This
Results
Age, sex, and race data were present for all 14,213 participants included in the analysis. Serum creatinine values were missing for 939 participants (6.6%), and urinary albumin or creatinine values, for 424 (3.0%). Thus, GFR was estimated using the MDRD Study equation or Mayo equation for 13,274 participants (93.4%). Body surface area values were missing for 502 participants (3.5%). Thus, GFR was estimated using the Cockcroft-Gault equation for 12,895 participants (90.7%).
Table 4 lists
Discussion
Results of this analysis show how varying assumptions can affect CKD prevalence estimates using continuous NHANES 1999-2004 data. At one end of the spectrum of assumptions, an estimated 25.8 million people 20 years and older in the United States have CKD stages 1 to 4. At the other end of the spectrum, an additional 28.2 million people, or 54.0 million total, have CKD.
The largest difference in estimated prevalence is caused by using differing GFR estimating equations. The MDRD Study equation is
Acknowledgements
The authors thank Aaron R. Folsom, MD, MPH; David R. Jacobs, PhD; Richard H. Grimm, MD, PhD; David T. Gilbertson, PhD; and Eric D. Weinhandl, MS, for guidance; US Renal Data System colleagues Beth Forrest, BBA, and Shane Nygaard, BA, for manuscript preparation; and Nan Booth, MSW, MPH, for manuscript editing.
Support: This study was performed as a deliverable under Contract No. HHSN267200715002C (National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health,
References (34)
- et al.
Proteinuria and other markers of chronic kidney disease: A position statement of the National Kidney Foundation (NKF) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Am J Kidney Dis
(2003) - et al.
Serum creatinine levels in the US population: Third National Health and Nutrition Examination Survey
Am J Kidney Dis
(1998) - et al.
Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey
Am J Kidney Dis
(2003) - et al.
Calibration of serum creatinine in the National Health and Nutrition Examination Surveys (NHANES) 1988-1994, 1999-2004
Am J Kidney Dis
(2007) - et al.
Impact of creatinine calibration on performance of GFR estimating equations in a pooled individual patient database
Am J Kidney Dis
(2007) - et al.
Measured and estimated GFR in healthy potential kidney donors
Am J Kidney Dis
(2004) - et al.
Computer-assisted prescribing of kanamycin for patients with renal insufficiency
Lancet
(1972) Estimation of creatinine clearance when urine cannot be collected
Lancet
(1971)Creatinine clearance estimation from serum creatinine values: An analysis of three mathematical models of glomerular function
Am J Kidney Dis
(1985)- et al.
Prevalence of chronic kidney disease in the United States
JAMA
(2007)
K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, classification, and stratification
Am J Kidney Dis
A simplified equation to predict glomerular filtration rate from serum creatinine
J Am Soc Nephrol
Expressing the Modification of Diet in Renal Disease Study equation for estimating glomerular filtration rate with standardized serum creatinine values
Clin Chem
Standards of medical care in diabetes
Diabetes Care
Effect of duration of type I diabetes on the prevalence of stages of diabetic nephropathy defined by urinary albumin/creatinine ratio
J Am Soc Nephrol
Gender- and race-specific determination of albumin excretion rate using albumin-to-creatinine ratio in single, untimed urine specimens: The Coronary Artery Risk Development in Young Adults Study
Am J Epidemiol
Prevalence of high blood pressure and elevated serum creatinine level in the United States: Findings from the Third National Health and Nutrition Examination Survey (1988-1994)
Arch Intern Med
Cited by (0)
Originally published online as doi:10.1053/j.ajkd.2008.07.034 on October 28, 2008.