U.S. Renal Data System 2019 annual data report: Epidemiology of kidney disease in the United States

The United States Renal Data System (USRDS) has just released its Annual Data Report in the form of an executive summary for 2019 on the nation’s epidemiology of kidney disease.

The USRDS Coordinating Center based at the University of Michigan’s Kidney Epidemiology and Cost Center. in partnership with Arbor Research Collaborative for Health, prepared this year’s report.

Some important highlights from this year’s ADR include:

• The incidence of kidney failure requiring dialysis or transplantation for end stage renal disease (ESRD) in the U.S. ranks among the highest in the world, but it may also be on the decline. In 2017, there were 124,500 new cases of registered ESRD, compared to 125,408 the prior year. The rate of new cases of ESRD at 340.7 per million in 2017 was the lowest since 1998. This likely reflects the impact of improvements in the prevention or postponement of kidney failure in the U.S.

• The prevalence of ESRD continues to rise, and reached 746,557 in 2017 (versus 727,912 in 2016). This represents a 2.6% increase since 2016, which is the result of decreasing death rates in the ESRD population.

• The total Medicare spending on both chronic kidney disease and ESRD patients was in excess of $120 billion in 2017. For identified CKD (not ESRD), the total Medicare expenditure was $84 billion. Spending for ESRD patients totaled $35.9 billion, accounting for 7.2% of the overall Medicare-paid claims in the fee-for-service system, a share that has remained relatively constant for a decade.

• The number of dialysis patients on the kidney transplant waiting list as of December 31, 2017, marked a third consecutive year of decline with an 8.8% reduction from the previous year. A total of 75,745 candidates are were on the list, with 85% of whom were awaiting their first kidney transplant. This decrease almost certainly resulted from the Kidney Allocation System (KAS) policy changes that took effect on December 4, 2014.

• The prevalence of recognized CKD cases, based on the analysis of Medicare data, has steadily risen year after year across all stages of the disease. From 2016 to 2017, the proportion of Medicare patients with recognized CKD increased from 13.8% to 14.5%.

• Rates of urine testing for albumin remain low among Medicare beneficiaries. Among those without a CKD diagnosis, but with both diabetes mellitus and hypertension, 43.2% had urine albumin testing in 2017. This is a relatively low rate of testing given that this is a high-risk population.

• In 2017, a third of incident ESRD patients had received little or no pre-ESRD nephrology care, and a large majority (80%) of hemodialysis patients started dialysis using an indwelling catheter.

“The overall burden of kidney failure in the United States is among the highest in the world, with many areas and specific populations being disproportionately affected,” says Rajiv Saran, M.D., professor of internal medicine at the University of Michigan and director of the USRDS coordinating center from 2014-2019. “Despite the beginning of an early decline in the high rate of kidney failure, there is no room for complacency – vigorous, multi-sectoral efforts and greater attention to prevention of kidney disease will be vital to the continuation (and even acceleration) of this early success.”

Saran says the USRDS remains the most comprehensive resource for those seeking detailed information, data and trends on a wide variety of kidney disease topics.

The report is entirely web-based www.usrds.org, and is also regularly published in the American Journal of Kidney Diseases.

Authors: In addition to Saran, the report's U-M authors include Bruce Robinson, M.D., Vahakn Shahinian, M.D., John Ayanian, M.D., Nicole Bhave, M.D., Jennifer Bragg-Gresham, Ph.D., Debbie Gipson, M.D., Kevin He, Ph.D., William Herman, M.D., Michael Heung, M.D., Richard A. Hirth, Ph.D., David Hutton, Ph.D., Hal Morgenstern, Ph.D., Zubin Modi, M.D., Brahmajee Nallamothu, M.D., Ronald Pisoni, Ph.D., Douglas E. Schaubel, Ph.D., David T. Selewski, M.D., and Kenneth J. Woodside, M.D.

Funding: Funding for the project came from the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, and the U.S. Department of Health and Human Services, under contract HHSN276201400001C, and the USRDS Coordinating Center Team, which consists of investigators and staff from the University of Michigan Health System, the Kidney Epidemiology and Cost Center, in partnership with Arbor Research Collaborative for Health.

Disclosure: Morgenstern is a consultant at Arbor Research Collaborative for Health.  Herman is the Chair of Data Safety Monitoring Board for Merck Sharp & Dohme. On August 8, 2019, the USRDS contract transferred to the Chronic Disease Research Group at the Hennepin Health Research Institute, Minneapolis, Minnesota.

Reference: Saran R, Robinson B, Abbott KC, et al. US Renal Data System 2019 Annual Data Report: epidemiology of kidney disease in the United States. Am J Kidney Dis. 2020;75(1)(suppl 1):Svii-Sviii, S1-S64.