Epidemiology of CKD

I found an interesting article entitled “Socioeconomic Disparities in Chronic Kidney Disease”[1].  I discovered this article by searching the PubMed database using the terms “epidemiology chronic kidney disease United States”.  While CKD is a global health issue, I was most interested in learning how it affects people living in the United States.  This article, published in "Advances in Chronic Kidney Disease", examines how low socioeconomic status and being African American can increase a person’s risk for developing end-stage renal disease (ESRD).  End-stage renal disease can be costly not only to the quality of life of the patient, but also to their family, their community, and the United States healthcare system.  Patients with ESRD will require costly services such as dialysis and transplantation. 

As an example of the staggering healthcare dollars being directed towards treatment of the disease, here is a map illustrating the 2007 Medicare spending on CKD across the United States:

Image source http://www.usrds.org/2007/view/01_ckd.asp

As I mentioned in my last post, it is estimated that 10% of the US population has CKD and that number is growing, especially in older adults[2].  Not only are more people developing CKD, more people are developing ESRD.  Studies show that African Americans and Hispanics are developing ESRD at much high rates than Caucasians.  CKD is closely linked to diabetes and hypertension, which could explain why African Americans and Hispanics are having worse outcomes than Caucasians[3].  However, authors of the paper believe the problem goes deeper than that.  Limited access to healthcare, as well as not receiving the same quality of treatment by healthcare providers as Caucasians also plays a role in patient outcomes. 

Mortality: Overall the number of people dying from CKD has increased from 10,478 deaths in 1980 to 90,118 deaths in 2009.  Though many more people are dying, the rate of deaths is actually going down[4].

Let me take a moment and explain the rate…

Suppose that in 1980, 10 people had the disease, and of those original 10 people 5 people died.  That is a death rate of 50%.  Now, today we’ll say 100 people have the disease and 30 of them die.  That means now the death rate is 30%.  So even though 30 people is substantially more than 5 people, 30% of people dying is a lower rate than 50% of the people dying. 

Perhaps this is easier to explain visually:

Mortality Rates of ESRD Patients

Image source http://kidney.niddk.nih.gov/KUDiseases/pubs/kustats/

Morbidity: This is the quality of life of people living with CKD.  From my research this has not really been studied too much in the United States – though I did find an interesting article about dialysis patients in Brazil.  Most of the patients had no formal education beyond grade school[5].  The study found that these patients were very satisfied with their lives, despite living with chronic illness. 

I hope you've learned about the social and economic cost issues associated with CKD.  Next week I plan to delve into the pathophysiology (how the disease affects the body) of CKD-- stay tuned!

References

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[1] Nicolas S, Kalantar-Zadeh K, Norris K. Socioeconomic Disparities in Chronic Kidney Disease. Advances in Chronic Kidney Disease 2015;22(1

†):15

[2] Kidney and Disease Statistics for the United States. Bethesda, MD: National Institute of Health, 2012.

[3] Chronic Kidney Disease (CKD) Surveillance Project. 2015;2015(01/14/2015)

[4] Morbidity and Mortality in Patients with CKD. In: Control CfD, ed. Annual Data Report. Ann Arbor, MI: United States Renal Data System, 2012.

[5] Rusa S, Peripato G, Pavarini S, Inouye K, Zazzetta M, Orlandi F. Quality of life/spirituality, religion and personal beliefs of adults and elderly chronic kidney patients under hemodialysis. Revista Latino-Americana de Enfermagem 2015;22(6)