Healthy People 2010Focus Area 4

Chronic Kidney Disease Progress Review

November 20, 2002

Source: United States Renal Data System (USRDS)

ESRD % transplantedwithin 3 yrs

AV fistula use hemodialysis (new patients)

ESRD due to diabetes

CV deaths in persons with

ESRD

Chronic Kidney Disease Objectives Targets and Levels Achieved

% ontransplant

wait list

% of diabetics with exam / tests

to prevent ESRD

2010 Target Current levelDirection of change desired

% with counseling prior to start of

renal replacement therapy (per 1,000,000 population)

- - - - - Incidence - - - - - -(per 1,000 patient years)

334

217

145

7852

82.650%

66%

27.2% 21.3% 19.6% 26.3%

60%

45%

Targets-to-be-determined

0

50

100

150

200

250

300

350

1992 1993 1994 1995 1996 1997 1998 1999 2000

2010 Target

Diabetes Prevalence, 2000Trends in ESRD: Incidence

Source: United States Renal Data System, (USRDS)

334(current)

217(target)

Adjusted for age, gender, and race.

Incident rate

Rate per million population

End Stage Renal Disease

Source: United States Renal Data System, (USRDS), modified maps from the USRDS 2002 Annual Data Report (ADR).

Incident rate: 1990 Incident rate: 2000

370+ (371)300 to <370213 to <300156 to <213below 156 (135)

370+ (452)300 to <370213 to <300156 to <213below 156 (136)

Unadjusted, per million population

Trends in ESRD Incident Rates, by Age and Race/Ethnicity

*Adjusted for gender and race.

* **

**Adjusted for age and gender.

Source: United States Renal Data System, (USRDS), graphs from the USRDS 2002 Annual Data Report.

Trends in ESRD Incident rates, by Primary Diagnosis

Adjusted for age, gender, and raceSource: United States Renal Data System, (USRDS), graphs from the USRDS 2002 Annual Data Report.

Adjusted for age, gender, and race.

Incident Rates of ESRD with Primary Diagnosis Diabetes

Source: United States Renal Data System, (USRDS), modified maps from USRDS 2002 Annual Data Report.

205+ (245)125 to <20557 to <12549 to <57below 49 (NA)

Unadjusted, per million population

1990 2000

205+ (260)125 to <20557 to <12549 to <57below 49 (44)

Trends in Incident Rates of ESRD Due to Diabetesby Race/Ethnicity

Adjusted for age and gender.

Source: United States Renal Data System, (USRDS), graph from the USRDS 2002 Annual Data Report.

0

2

4

6

8

10

12

14

16

1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Rat

e p

er 1

,000

po

pu

lati

on

0-44 Years

Total

45-64 Years

65-74 Years75+ Years

Note: Data are three-year averages. Data from 1997 and later years my not be comparable with earlier years due to a redesign of the NHIS in 1997.Source: National Health Interview Survey (NHIS), CDC, NCHS.

Prevalence of Diagnosed Diabetes by Age:

United States, 1980-1999

20

40

60

160

140

120

100

80

Source: National Health Interview Survey (NHIS), CDC, NCHS.

0

25

50

75

100

125

150

American Indian/Alaska Native

White, notHispanic

Black, notHispanic

HispanicAsian/Pacific Islander

2010Target

Diabetes Prevalence, 2000

Age-adjusted per 1,000 standard population

Source: National Health and Nutrition Examination Survey (NHANES), CDC, NCHS. *Body Mass Index > 30

Obesity*: Adults, Age 20 and Olderby Race/Ethnicity

0

5

10

15

20

25

30

35

40

45

White, notHispanic

Black, notHispanic

2010 Target

Total

Mexican American

1988-94 1999-2000

Trends in All-Cause and Cardiovascular Mortality Rates in ESRD Patients by Race/Ethnicity

Source: United States Renal Data System, (USRDS), graphs from the USRDS 2002 Annual Data Report.

0

10

20

30

40

50

1996 1997 1998 1999-2000

2010 Target

Diabetes Prevalence, 2000

Source: United States Renal Data System, (USRDS), modified graph from the 2002 USRDS ADR.

27.2%(current)

50%(2010 target)

Adjusted for age, gender, and race.

Percent of patients

Trends in Arteriovenous Fistula Use Incident Hemodialysis Patients (Age 20 and

Older)

New PatientsUsing AV fistulas

0

10

20

30

40

50

60

70

American Indian/Alaska Native

White, notHispanic

Black, notHispanic

HispanicAsian/Pacific Islander

2010 Target

Diabetes Prevalence, 2000Proportion of Dialysis Patients Registered on the Waiting List for Transplantation:

by Race/Ethnicity, 2000

Percent

Source: United States Renal Data System, (USRDS) Note: Patients younger than 70.

0

5

10

15

20

25

1992-1994 1995 1996 1997

2010 Target

Diabetes Prevalence, 2000Percent of Dialysis Patients Receiving a TransplantWithin Three Years of Initiation of Therapy*

Source: United States Renal Data System, (USRDS). Note: Patients younger than 70. *Target to be determined

Adjusted for age, gender, and race.

Percent of patients

Dialysis Patients Receiving a Transplant Within 3 years by Age, Gender, Race/Ethnicity and Diagnosis

Source: United States Renal Data System, (USRDS). Note: Patients younger than 70, graphs from the USRDS 2002 ADR.

Diabetic Patients Receiving All Three Preventive Tests (Age 67 and Older)*

**Pre-ESRD data: incident ESRD patients with diabetes one year prior to start of ESRD. Graphs from the 2002 USRDS ADR.

*Developmental objective, target to be determined

**

0

10

20

30

40

50

60

American Indian/Alaska Native

White, notHispanic

Black, notHispanic

HispanicAsian/Pacific Islander

2010 Target

Diabetes Prevalence, 2000Counseling for Chronic Kidney Failure Care,by Race/Ethnicity, 1996

Percent of new ESRD persons who’ve had counseling at least a year before renal replacement therapy

Source: United States Renal Data System, (USRDS).

2010 Target

Data NotesFull citation for USRDS data, graphs, and maps: U.S. Renal Data System, USRDS 2002 Annual Data Report: Atlas of End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 2002.USRDS data are adjusted by the direct adjustment method with 1999 as the standard population.

NCHS data are age adjusted by the direct adjustment method with 2000 as the standard population.

For the NCHS data, the race/ethnicity groups, American Indian/Alaska Native and Asian/Pacific Islander includes persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race.

A detailed race/ethnicity description of the USRDS data can be found in the USRDS 2002 ADR.

The graphs listed below have additional documentation in the 2002 ADR:

Trends in arteriovenous fistula use in hemodialysis patients-Includes only patients for whom an access type is known.

Dialysis patients receiving a transplant within three years…-”Medicare dialysis patients initiating therapy in the given year; patients older than 69 or with prior transplants are excluded. Cumulative percents are estimated using the Kaplan-Meier methodology. Followup is censored at death or the end of the three-year period.”

Diabetic patients receiving all three preventive health tests…-”General Medicare data: individuals diagnosed with diabetes in 1997, 1998, or 1999, age 67 or older on December 31 of the diagnosis year, and continuously enrolled in Medicare during 1996-1997, 1997-1998, or 1998-1999. Patients diagnosed with ESRD during one of these three periods, enrolled in a managed care program, or with Medicare as secondary payor are excluded. Pre-ESRD data: incident ESRD patients with diabetes one year prior to start of ESRD. Patients enrolled in a managed care program or with Medicare as secondary payor are excluded. The three tests are (1) eye exam, (2) lipids, and (3) A1C test.