Annual Report Targets Chronic Kidney
Disease in the United States
A 30 percent increase in chronic kidney disease over the past
decade has prompted the U.S. Renal Data System (USRDS) to issue
for the first time a separate report documenting the magnitude
of the disease, which affects an estimated 27 million Americans
and accounts for more than 24 percent of Medicare costs. The USRDS
is funded by the National Institute of Diabetes and Digestive and
Kidney Diseases (NIDDK), part of the National Institutes of Health
(NIH). The USRDS 2008 Annual Data Report: Atlas of Chronic Kidney
Disease and End-Stage Renal Disease, is online at www.usrds.org.
"NIDDK's annual analysis and publication of data on kidney
disease in the United States is essential in quantifying public
health trends, guiding funding priorities, and designing targeted
kidney research programs," said NIH Director Elias A. Zerhouni,
M.D. "The major focus on chronic kidney disease in this year's
report acknowledges that this disorder is a growing public health
issue deserving of wider public awareness and intensified scientific
investigation."
Using data from multiple sources, the USRDS has created a new
handbook of information that can be used by researchers, government
officials, health program planners, and others to develop research
goals, assess public health needs, set program priorities, and
inform policymakers and the public. USRDS research depends on collaborations
with other agencies of the U.S. Department of Health and Human
Services, especially the Centers for Medicare and Medicaid Services,
the Health Resources and Services Administration, and the Centers
for Disease Control and Prevention. Patient registries for other
countries also contribute data for analyses.
Volume One of the report defines the disease burden of chronic
kidney disease and examines cardiovascular and other related health
problems, rates of adverse health events, preventive care, prescription
medication therapies, delivery of care in the transition to end-stage
renal disease, and the cost to Medicare and employer group health
plans.
One of the major findings central to public health is that those
with chronic kidney disease are more likely to die from cardiovascular
disease than to reach end-stage kidney disease. However, cardiovascular
risk factors can be detected and treated. This suggests that those
transitioning from chronic to end-stage kidney disease merit more
attention. Expenditures during the transition from chronic to end-stage
kidney disease are considerable, ranging from $14,500 for Medicare
patients to $29,000 for those covered by employer group health
plans in the month of dialysis initiation.
"These latest data on kidney disease underscore the importance
of the research we fund," said NIDDK Director Griffin P. Rodgers,
M.D. "With rising rates of chronic and end-stage kidney disease,
we need to stimulate research that will help us discover new, effective
therapies for these devastating disorders."
Volume Two reports that the number of people with end-stage kidney
disease is increasing in size and cost. The incidence of chronic
kidney disease in 2006 was more than 100,000, or 360 per one million
people, an increase of 3.4 percent over the 2005 incidence rate.
There were more than half a million patients with end-stage kidney
disease in 2006. Of these, 70 percent were on dialysis. An important
step before a patient begins dialysis is the preparation of a vascular
access, which is the site on the patient's body where blood is
removed and returned during dialysis.
The three types of vascular access for dialysis are arteriovenous
(AV) fistula, an AV graft, and a venous catheter. Both the fistula
and the graft involve connecting an artery to a vein, usually beneath
the skin in a patient's arm. The fistula is considered the best
long-term vascular access for dialysis. The catheter is a tube
inserted into a vein in the patient's neck, chest, or leg near
the groin. It is usually only used as a temporary access until
a permanent fistula or graft can be developed. This volume reports
that more than 80 percent of new dialysis patients started with
a catheter, more than 50 percent of current dialysis patients had
a fistula, and 30 percent had a graft. For more information on
vascular access, visit: http://kidney.niddk.nih.gov/kudiseases/pubs/vascularaccess/index.htm.
Volume Two also reports that Medicare paid about $70,000 per dialysis
patient. Patients with end-stage kidney disease accounted for a
little more than 1 percent of the Medicare population and more
than 7 percent of Medicare costs. Total cost for end-stage kidney
disease was $33.6 billion. This number includes Medicare spending
and all expenditures by other payers, such as employer group health
plans.
In addition, more than 18,000 kidney transplants were performed
in 2006, an increase of 3.5 percent over 2005. Use of deceased
donor kidneys increased between 2003 and 2006 at a rate of about
6 percent to 7 percent. Use of living donors fell 3 percent during
that period, but the use of living unrelated donors continues to
increase relative to the total number of living donations, and
now accounts for 45 percent of all living donor transplantations.
For more information on kidney transplantation, visit: http://kidney.niddk.nih.gov/kudiseases/pubs/transplant/index.htm.
NIDDK conducts and supports research in diabetes and other endocrine
and metabolic diseases; digestive diseases, nutrition, and obesity;
and kidney, urologic, and hematologic diseases. Spanning the full
spectrum of medicine and afflicting people of all ages and ethnic
groups, these diseases encompass some of the most common, severe,
and disabling conditions affecting Americans. For more information
about NIDDK and its programs, see www.niddk.nih.gov.
The National Institutes of Health (NIH) — The Nation's
Medical Research Agency — includes 27 Institutes and
Centers and is a component of the U.S. Department of Health and
Human Services. It is the primary federal agency for conducting
and supporting basic, clinical and translational medical research,
and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and
its programs, visit www.nih.gov. |