Abstract
Chronic kidney disease (CKD) is serious and common, yet recognition and public health responses are limited. To describe clinical features of, prevalence of, major risk factors for, and care for CKD among patients treated in 2 large US health care systems. This cohort study collected data from the Center for Kidney Disease Research, Education, and Hope (CURE-CKD) registry, an electronic health record-based registry jointly curated and sponsored by Providence St Joseph Health and the University of California, Los Angeles. Patients were adults and children with CKD (excluding end-stage kidney disease) and adults at risk of CKD (ie, with diabetes, hypertension, or prediabetes) identified by laboratory values, vital signs, prescriptions, and administrative codes. Data were collected from January 2006 through December 2017, with analyses performed from March 2019 through November 2019. Diabetes, hypertension, and prediabetes. Clinical and demographic characteristics, prevalence, and prescribed medications. Of 2 625 963 adults and children in the sample, 606 064 adults (23.1%) with CKD had a median (interquartile range [IQR]) age of 70 (59-81) years, with 338 785 women (55.9%) and 434 474 non-Latino white individuals (71.7%). A total of 12 591 children (0.4%) with CKD had a median (IQR) age of 6 (1-13) years, with 7079 girls (56.2%) and 6653 non-Latino white children (52.8%). Median (IQR) estimated glomerular filtration rate was 53 (41-61) mL/min/1.73 m2 among adults and 70 (50-95) mL/min/1.73 m2 in children. Prevalence rates for CKD in adults were 4.8% overall (606 064 of 12 669 700) with 1.6% (93 644 of 6 011 129) during 2006 to 2009, 5.7% (393 455 of 6 903 084) during 2010 to 2013, and 8.4% (683 574 of 8 179 860) during 2014 to 2017 (P < .001). A total of 226 693 patients (37.4%) had category 3a CKD; 100 239 (16.5%), category 3b CKD; 39 125 (6.5%), category 4 CKD; and 20 328 (3.4%), category 5 CKD. Among adults with CKD, albuminuria and proteinuria assessments were available in 52 551 (8.7%) and 25 035 (4.1%) patients, respectively. A renin-angiotensin system inhibitor was prescribed to 124 575 patients (20.6%), and 204 307 (33.7%) received nonsteroidal anti-inflammatory drugs or proton pump inhibitors. Of 1 973 258 adults (75.1%) at risk, one-quarter had diabetes or prediabetes (512 299 [26.0%]), nearly half had hypertension (955 812 [48.4%]), and one-quarter had both hypertension and diabetes or prediabetes (505 147 [25.6%]). This registry-based cohort study revealed a burgeoning number of patients with CKD and its major risk factors. Rates of identification and use of kidney protective agents were low, while potential nephrotoxin use was widespread, underscoring the pressing need for practice-based improvements in CKD prevention, recognition, and treatment.
Highlights
Diabetes is the leading cause of Chronic kidney disease (CKD) and a global health emergency, with 425 million individuals affected worldwide in 2017 and a projected 629 million individuals affected by 2045.8-10 Hypertension is the second most frequent cause of CKD, affecting nearly one-third of US adults and 1.13 billion people globally in 2015.11,12 The estimated population size for prediabetes was 78.5 million among adults in the United States between 2011 and 2014, and nearly one-tenth have been reported with CKD.13
Awareness of CKD and its major risk factors remains strikingly low among health care professionals and patients alike
We identified CKD categories 1 and 2 by an administrative code, urine albumin to creatinine ratio greater than 30 mg/g, and/or urine protein to creatinine ratio greater than 150 mg/g
Summary
An estimated 1 in 7 to 10 adults worldwide have CKD, with only approximately 10% surviving to ESKD and only half of survivors receiving dialysis or a kidney transplant because of lack of access or high costs.. The increasing prevalence of CKD is closely tied to the increase of at-risk populations with diabetes, hypertension, and prediabetes. Diabetes is the leading cause of CKD and a global health emergency, with 425 million individuals affected worldwide in 2017 and a projected 629 million individuals affected by 2045.8-10 Hypertension is the second most frequent cause of CKD, affecting nearly one-third of US adults and 1.13 billion people globally in 2015.11,12 The estimated population size for prediabetes was 78.5 million among adults in the United States between 2011 and 2014, and nearly one-tenth have been reported with CKD.. Diabetes is the leading cause of CKD and a global health emergency, with 425 million individuals affected worldwide in 2017 and a projected 629 million individuals affected by 2045.8-10 Hypertension is the second most frequent cause of CKD, affecting nearly one-third of US adults and 1.13 billion people globally in 2015.11,12 The estimated population size for prediabetes was 78.5 million among adults in the United States between 2011 and 2014, and nearly one-tenth have been reported with CKD. Even so, awareness of CKD and its major risk factors remains strikingly low among health care professionals and patients alike.
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