Lifetime incidence of CKD stages 3-5 in the United States

Am J Kidney Dis. 2013 Aug;62(2):245-52. doi: 10.1053/j.ajkd.2013.03.009. Epub 2013 Apr 6.


Background: Lifetime risk estimates of chronic kidney disease (CKD) can motivate preventative behaviors at the individual level and forecast disease burden and health care use at the population level.

Study design: Markov Monte Carlo model simulation study.

Setting & population: Current US black and white population.

Model, perspective, & timeframe: Markov models simulating kidney disease development, using an individual perspective and lifetime horizon.

Outcomes: Age-, sex-, and race-specific residual lifetime risks of CKD stages 3a+ (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m²), 3b+ (eGFR <45 mL/min/1.73 m²), 4+ (eGFR <30 mL/min/1.73 m²), and end-stage renal disease (ESRD).

Measurements: State transition probabilities of developing CKD and of dying prior to its development were modeled using: (1) mortality rates from the National Vital Statistics Report, (2) mortality risk estimates from a 2-million person meta-analysis, and (3) CKD prevalence from National Health and Nutrition Examination Surveys. Incidence, prevalence, and mortality related to ESRD were supplied by the US Renal Data System.

Results: At birth, the overall lifetime risks of CKD stages 3a+, 3b+, 4+, and ESRD were 59.1%, 33.6%, 11.5%, and 3.6%, respectively. Women experienced greater CKD risk yet lower ESRD risk than men; blacks of both sexes had markedly higher CKD stage 4+ and ESRD risks (lifetime risks for white men, white women, black men, and black women, respectively: CKD stage 3a+, 53.6%, 64.9%, 51.8%, and 63.6%; CKD stage 3b+, 29.0%, 36.7%, 33.7%, and 40.2%; CKD stage 4+, 9.3%, 11.4%, 15.8%, and 18.5%; and ESRD, 3.3%, 2.2%, 8.5%, and 7.8%). Risk of CKD increased with age, with approximately one-half the CKD stage 3a+ cases developing after 70 years of age.

Limitations: CKD incidence was modeled from prevalence estimates in the US population.

Conclusions: In the United States, the lifetime risk of developing CKD stage 3a+ is high, emphasizing the importance of primary prevention and effective therapy to reduce CKD-related morbidity and mortality.

Keywords: Chronic kidney disease; end-stage renal disease; incidence; lifetime risk.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Renal Insufficiency, Chronic / epidemiology*
  • Risk Assessment
  • Severity of Illness Index
  • United States / epidemiology
  • Young Adult