CKD patients more likely to die from heart disease than to develop kidney failure

Rates of chronic kidney disease (CKD) in the United States have increased by more than 20% over the last decade, causing loss of life and sky-rocketing health care costs, according to the 2008 annual report released by the U.S. Renal Data System (USRDS).

Its increasing impact, now estimated to affect nearly 27 million adult Americans, led the USDRS for the first time to dedicate a separate volume to CKD in its 20th annual report.

According to the National Kidney Foundation, CKD is a progressive disease, in which early stages are evidenced by the presence of protein in the urine. In late stage CKD, the kidney’s ability to filter out the body’s waste products is severely compromised.

Based on data from the National Health and Nutrition Examination Surveys (NHANES), produced by the U.S. Centers for Disease Control and Prevention, the prevalence rose from 12 percent in 1988-1994 to 15 percent in 2003-2006. Among those age 60 and older, the prevalence increased from 32 percent to 38 percent during the same time period.

The CKD population carries a high burden of disease, leading many physicians to call it “a risk multiplier for mortality.” Contributing to the problem are trends in which treatment and control of comorbid diseases lag behind recommended practices.

Individuals over the age of 60 are nearly six times more likely than people in their 30s and 40s to have CKD. Rates of CKD are approximately doubled among patients with diabetes, chronic hypertension, or cardiovascular disease. Rates are also higher among women than among men.

“The data suggests that awareness of diabetes, hypertension and lipid disorders [associated with CKD] is high, but control of factors such as blood pressure and lipid levels worsens as CKD advances,” says Bryan Becker, MD, President, National Kidney Foundation.

For example, more than 80% of patients with reduced filtration capacity have high blood pressure, but only 20% are being successfully treated for it. As a result, CKD patients are five times more likely to die than to ever reach end-stage renal disease, in which dialysis is required to take over the function of the kidney. Furthermore, hospitalizations for any reason are four to five times more frequent for patients with CKD than for those without the diagnosis.

Even without taking into account the cost of caring for patients on dialysis, costs for Medicare patients with CKD exceeded $49 billion in 2006 — nearly 5 times greater than in 1993.

"Clearly, CKD has emerged as a major public health issue. We at the National Kidney Foundation interpret this increase in the rate of CKD as a call to action for doctors, people most at risk, and their families,” says Becker.

“These findings reaffirm the importance of identifying kidney disease at its early stages, when treatment is most effective, to prevent further long-term complications. Through the Kidney Early Evaluation Program (KEEP), which provides free kidney screenings for those at increased risk — anyone with high blood pressure, diabetes or a family history of kidney disease– the foundation tests 2,500 American adults each month and will be stepping that number up to 4,000," continues Becker.

(Source: National Kidney Foundation: National Health and Nutrition Examination Surveys (NHANES), produced by the U.S. Centers for Disease Control, and Prevention, October 2008.)