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Prevalence of CKD in the United States: a sensitivity analysis using the National Health and Nutrition Examination Survey (NHANES) 1999-2004.
Am J Kidney Dis. 2009 Feb; 53(2):218-28.AJ

Abstract

BACKGROUND

Estimates of chronic kidney disease (CKD) in the United States using the continuous National Health and Nutrition Examination Survey (NHANES) data set 1999-2004 indicate that 13.1% of the population (26.3 million people based on the 2000 census) has CKD stages 1 to 4.

STUDY DESIGN

We performed sensitivity analyses to highlight assumptions underlying these estimates and illustrate their robustness to varying assumptions.

SETTING & PARTICIPANTS

NHANES 1999-2004 was a nationally representative cross-sectional continuous survey of the civilian noninstitutionalized US population. Our sample included participants 20 years and older.

REFERENCE TEST

Estimated glomerular filtration rate (GFR) less than 60 mL/min/1.73 m(2) defined from the 4-variable Modification of Diet in Renal Disease (MDRD) Study equation; albuminuria defined as persistence of urinary albumin-creatinine ratio greater than 30 mg/g.

INDEX TESTS

We compared prevalence estimates using the MDRD Study equation with 2 other GFR estimating equations (equation 5 by Rule et al from the Mayo Clinic Donors study; Cockcroft-Gault equation adjusted for body surface area and corrected for the bias in the MDRD Study sample), and sex-specific cutoff values to define albuminuria.

RESULTS

We found CKD stages 1 to 4 prevalence estimates ranging from 11.7% to 24.9%, a more than 2-fold difference resulting in population estimates of 25.8 million to 54.0 million people using 2006 population estimates. Considering only stages 3 and 4, which are not affected by the choice of cutoff values to define albuminuria, prevalence estimates ranged from 6.3% to 18.6%, resulting in population estimates of 13.7 million to 40.3 million people, a nearly 3-fold difference.

LIMITATIONS

NHANES 1999-2004 is a cross-sectional survey and allows for GFR and albumin-creatinine ratio estimates at 1 point in time. NHANES does not account for seniors in long-term care facilities.

CONCLUSIONS

Although CKD prevalence is high regardless of varying modeling assumptions, different assumptions yield large differences in prevalence estimates.

Authors+Show Affiliations

Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA. jsnyder@usrds.orgNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

18950914

Citation

Snyder, Jon J., et al. "Prevalence of CKD in the United States: a Sensitivity Analysis Using the National Health and Nutrition Examination Survey (NHANES) 1999-2004." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 53, no. 2, 2009, pp. 218-28.
Snyder JJ, Foley RN, Collins AJ. Prevalence of CKD in the United States: a sensitivity analysis using the National Health and Nutrition Examination Survey (NHANES) 1999-2004. Am J Kidney Dis. 2009;53(2):218-28.
Snyder, J. J., Foley, R. N., & Collins, A. J. (2009). Prevalence of CKD in the United States: a sensitivity analysis using the National Health and Nutrition Examination Survey (NHANES) 1999-2004. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 53(2), 218-28. https://doi.org/10.1053/j.ajkd.2008.07.034
Snyder JJ, Foley RN, Collins AJ. Prevalence of CKD in the United States: a Sensitivity Analysis Using the National Health and Nutrition Examination Survey (NHANES) 1999-2004. Am J Kidney Dis. 2009;53(2):218-28. PubMed PMID: 18950914.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence of CKD in the United States: a sensitivity analysis using the National Health and Nutrition Examination Survey (NHANES) 1999-2004. AU - Snyder,Jon J, AU - Foley,Robert N, AU - Collins,Allan J, Y1 - 2008/10/31/ PY - 2008/02/21/received PY - 2008/07/18/accepted PY - 2008/10/28/pubmed PY - 2009/2/12/medline PY - 2008/10/28/entrez SP - 218 EP - 28 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 53 IS - 2 N2 - BACKGROUND: Estimates of chronic kidney disease (CKD) in the United States using the continuous National Health and Nutrition Examination Survey (NHANES) data set 1999-2004 indicate that 13.1% of the population (26.3 million people based on the 2000 census) has CKD stages 1 to 4. STUDY DESIGN: We performed sensitivity analyses to highlight assumptions underlying these estimates and illustrate their robustness to varying assumptions. SETTING & PARTICIPANTS: NHANES 1999-2004 was a nationally representative cross-sectional continuous survey of the civilian noninstitutionalized US population. Our sample included participants 20 years and older. REFERENCE TEST: Estimated glomerular filtration rate (GFR) less than 60 mL/min/1.73 m(2) defined from the 4-variable Modification of Diet in Renal Disease (MDRD) Study equation; albuminuria defined as persistence of urinary albumin-creatinine ratio greater than 30 mg/g. INDEX TESTS: We compared prevalence estimates using the MDRD Study equation with 2 other GFR estimating equations (equation 5 by Rule et al from the Mayo Clinic Donors study; Cockcroft-Gault equation adjusted for body surface area and corrected for the bias in the MDRD Study sample), and sex-specific cutoff values to define albuminuria. RESULTS: We found CKD stages 1 to 4 prevalence estimates ranging from 11.7% to 24.9%, a more than 2-fold difference resulting in population estimates of 25.8 million to 54.0 million people using 2006 population estimates. Considering only stages 3 and 4, which are not affected by the choice of cutoff values to define albuminuria, prevalence estimates ranged from 6.3% to 18.6%, resulting in population estimates of 13.7 million to 40.3 million people, a nearly 3-fold difference. LIMITATIONS: NHANES 1999-2004 is a cross-sectional survey and allows for GFR and albumin-creatinine ratio estimates at 1 point in time. NHANES does not account for seniors in long-term care facilities. CONCLUSIONS: Although CKD prevalence is high regardless of varying modeling assumptions, different assumptions yield large differences in prevalence estimates. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/18950914/Prevalence_of_CKD_in_the_United_States:_a_sensitivity_analysis_using_the_National_Health_and_Nutrition_Examination_Survey__NHANES__1999_2004_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(08)01237-7 DB - PRIME DP - Unbound Medicine ER -