Incidence of End-Stage Renal Disease Attributed to Diabetes Among Persons with Diagnosed Diabetes - United States and Puerto Rico, 2000-2014.

Nilka Rios Burrows,Ann Albright,Edward W Gregg,Israel Hora,Linda S Geiss

doi:10.15585/mmwr.mm6643a2

Abstract

During 2014, 120,000 persons in the United States and Puerto Rico began treatment for end-stage renal disease (ESRD) (i.e., kidney failure requiring dialysis or transplantation) (1). Among these persons, 44% (approximately 53,000 persons) had diabetes listed as the primary cause of ESRD (ESRD-D) (1). Although the number of persons initiating ESRD-D treatment each year has increased since 1980 (1,2), the ESRD-D incidence rate among persons with diagnosed diabetes has declined since the mid-1990s (2,3). To determine whether ESRD-D incidence has continued to decline in the United States overall and in each state, the District of Columbia (DC), and Puerto Rico, CDC analyzed 2000-2014 data from the U.S. Renal Data System and the Behavioral Risk Factor Surveillance System. During that period, the age-standardized ESRD-D incidence among persons with diagnosed diabetes declined from 260.2 to 173.9 per 100,000 diabetic population (33%), and declined significantly in most states, DC, and Puerto Rico. No state experienced an increase in ESRD-D incidence rates. Continued awareness of risk factors for kidney failure and interventions to improve diabetes care might sustain and improve these trends.

Highlights

The incidence of end-stage renal disease attributed to diabetes (ESRD-D) in the U.S. population with diagnosed diabetes began to decline in the mid-1990s
Review of the performance of methods to identify diabetes cases among vital statistics, administrative, and survey data

Summary

Discussion

ESRD is a costly and disabling condition that often results in premature death (1). During 2000–2014, the overall agestandardized incidence of ESRD-D among adults with diagnosed diabetes decreased by 33%. Reasons for the decline might include reductions in risk factors for kidney failure (e.g., hyperglycemia and hypertension) in the diabetic population or better treatment of kidney disease, including the use of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, which slow the decline in kidney function in addition to lowering blood pressure, delaying the onset of ESRD-D (6). ESRD-D incidence rates are declining, the number of patients with newly diagnosed ESRD-D is likely to increase as the number of persons with diabetes increases (2). Self-report of diabetes is highly accurate (persons with diagnosed diabetes are likely to report having diabetes) (10), the total number of adults with diabetes is underestimated, which results in an overestimation of ESRD-D incidence. Using different surveillance data to estimate the U.S diabetic population yielded a similar overall decline in ESRD-D incidence rates (3).

Summary

Conflict of Interest