Association of CKD with disability in the United States

Am J Kidney Dis. 2011 Feb;57(2):212-27. doi: 10.1053/j.ajkd.2010.08.016. Epub 2010 Oct 30.


Background: Little is known about disability in early-stage chronic kidney disease (CKD).

Study design: Cross-sectional national survey (National Health and Nutrition Examination Survey 1999-2006).

Setting & participants: Community-based survey of 16,011 noninstitutionalized US civilian adults (aged ≥20 years).

Predictor: CKD, categorized as no CKD, stages 1 and 2 (albuminuria and estimated glomerular filtration rate [eGFR] ≥60 mL/min/1.73 m²), and stages 3 and 4 (eGFR, 15-59 mL/min/1.73 m²).

Outcome: Self-reported disability, defined by limitations in working, walking, and cognition and difficulties in activities of daily living (ADL), instrumental ADL, leisure and social activities, lower-extremity mobility, and general physical activity.

Measurements: Albuminuria and eGFR assessed from urine and blood samples; disability, demographics, access to care, and comorbid conditions assessed using a standardized questionnaire.

Results: Age-adjusted prevalence of reported limitations generally was significantly greater with CKD: for example, difficulty with ADL was reported by 17.6%, 24.7%, and 23.9% of older (≥65 years) and 6.8%, 11.9%, and 11.0% of younger (20-64 years) adults with no CKD, stages 1 and 2, and stages 3 and 4, respectively. CKD also was associated with greater reported limitations and difficulty in other activities after age adjustment, including instrumental ADL, leisure and social activities, lower-extremity mobility, and general physical activity. Other demographics, socioeconomic status, and access to care generally only slightly attenuated the observed associations, particularly in older individuals; adjustment for cardiovascular disease, arthritis, and cancer attenuated most associations such that statistical significance no longer was achieved.

Limitations: Inability to establish causality and possible unmeasured confounding.

Conclusion: CKD is associated with a higher prevalence of disability in the United States. Age and other comorbid conditions account for most, but not all, of this association.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Activities of Daily Living*
  • Adult
  • Age Factors
  • Aged
  • Chronic Disease
  • Disability Evaluation*
  • Female
  • Glomerular Filtration Rate / physiology
  • Health Surveys
  • Humans
  • Kidney Diseases / epidemiology*
  • Kidney Diseases / physiopathology*
  • Male
  • Middle Aged
  • Nutrition Surveys
  • Prevalence
  • Severity of Illness Index*
  • Surveys and Questionnaires
  • United States / epidemiology