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The Burden of CKD in the USA

The Burden of CKD in the US: 

Over 30 million people (about the population of Texas) or approximately 15% of US adults are estimated to have chronic kidney disease CKD. More than half of them have advanced CKD.  

Approximately 20% of dollars in traditional Medicare funding—$114 billion a year—are spent on Americans with kidney disease. While more than 100,000 Americans are started on dialysis to treat end-stage kidney disease each year, one in five dies within a year.   

The burden of CKD can be measured in several ways, including: 

1- Individual or societal costs  

2- Higher death rates and years of life lost  

3- Years on disability  

An analysis of the Global Burden of Disease Study showed that the years of disability and the years of life lost attributed to CKD within the United States increased by 52.6% from 2002 to 2016, with Southern states faring the worst. This increase exceeded the disability and the years of life lost increase from any chronic disorder in the United States during this period. In fact, the disability and the years of life lost from cancer and cardiovascular disease (CVD) decreased in the United States from 2002 to 2016 by more than 450% and 890%, respectively.           

Both early-stage CKD and kidney failure are associated with high morbidity (suffering and sickness) and increased health care utilization. The risk of hospitalization and cardiovascular events (heart attacks and stroke) in patients with CKD progressively increases as GFR (Glomerular Filtration Rate) declines. The rates of hospitalization and hospital days per patient-year at risk were three times higher among patients with CKD than in the general population. 

Patients with CKD, particularly those with kidney failure, are at increased risk of mortality, particularly from CVD. In 2011 alone, more than 92,221 kidney failure patients died. 

Because patients with CKD have a high rate of end-stage kidney disease (ESKD), cardiovascular disease, and death, CKD is an important target for prevention, early detection, and management by non-nephrologist clinicians and public health agencies. 

Most of the healthcare guidelines recommend that all patients with severely decreased GFR (less than 30 mL/min) should be referred for co-management with a nephrologist. In such patients, late referral to a nephrologist (eg, less than three months before the start of dialysis therapy) is associated with higher mortality after the initiation of dialysis. 

Chronic kidney disease is a condition that impacts many Americans and their families. Proper management of this condition by a kidney specialist is important to limit and reduce the burden and progression of this complex disease.  

Ghayas Habach M.D., M.P.H.

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