Rates of CKD5 are better than expected

Bill Peckham

The United States Renal Data Systems (USRDS) is the agency that collects and reports provision of dialysis data. In 2000 the USRDS was reporting 1998 data (the reports are frustratingly always two years behind) showing (pdf link) that at the end of 1998 there were a total of about 310,000 people with stage 5 chronic kidney disease (CKD5) with 219,408 people managing their CKD5 with dialysis and 88,311 people managing their CKD5 with a transplant - the USRDS categorizes these people as prevalent patients. The USRDS also reports on the number of people newly diagnosed with CKD5,  referred to as incident patients; in 1998 61,761 were treated for CKD5 with either dialysis or transplant (of note is that the USRDS does not track CKD 5 incident patients who decline treatment).

The USRDS also predicts the future need for renal replacement. Chapter One of the 2000 USRDS report (pdf link) extends the trend lines for incident and prevalent patients to predict the demand for renal replacement in 2010:

The ESRD population in the United States and its territories continues to increase. Incident counts are projected to rise to 172,667 by 2010, while 1998 prevalent counts—influenced by increased rates of disease, better dialysis therapy and anemia control, improved graft survival, and lower death rates—are projected to rise approximately 77% to exceed 660,000 in 2010 (fig 1.3).

The referenced graph (fig. 1.3) is to the right. The upper trend line represents prevalent patients; the lower trend line represents incident patients. Each trend line is bracketed by two lines that represent a 95% Confidence interval. Thankfully, this prediction was off by about 10%.

In 2006 (the most recent data year (pdf link)) there were 354,754 people using dialysis to manage their CKD and about 151,50 using kidney transplant; growth was a bit higher than it was between 2000 and 2005 but still below the projections of the previous decade:

While long-term data on the ESRD population continue to show a flattening of incident rates, between 2005 and 2006 the number of new cases grew 3.4 percent — the first growth of more than 3 percent since 2001.

This suggests that in 2010 there should be fewer than 600,000 people with CKD5. That is a big number but it is not as big as it was projected to be which shows these trend lines can change. Identifying people with early stages of CKD and improving their care to slow the progression of their kidney disease will further flatten the trend lines. There is hope that we will continue to out perform predictions.

Comments

[Dori]

It's important to know WHY the numbers have dropped. Are we truly doing a better job with early CKD--or are more people dying of heart disease or diabetic complications before they reach CKD-5? How would we know the difference?

[Bill Peckham]

I wondered what mortality rate they used for those using dialysis to manage their CKD5. In the report they state that the growth be influenced by (due to) "better dialysis therapy and anemia control, improved graft survival, and lower death rates"

The lower death rates have not occurred. If the annual mortality rate had improved by two percentage points over the ten year period, the projection would have been accurate.