Surveillance for chronic kidney disease (CKD) using nationally representative samples of the US population is central in providing information about the magnitude and trends in CKD burden that will guide disease management and prevention planning for clinicians and public health authorities. We used a cross-sectional study design to estimate the change in prevalence of CKD over time by using National Health and Nutrition Examination Survey (NHANES) data. NHANES III (1988-1994) included 15,488 participants and NHANES rounds 1999-2004 included 13,233 participants older than 20 years with serum creatinine measurements who were examined in a mobile examination center. Early stages of CKD were defined by glomerular filtration rate (GFR) estimated by using the Modification of Diet in Renal Disease (MDRD) Study equation and urinary albumin-creatinine ratio following the classification system established by the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative. Moderately decreased GFR increased in prevalence from 5.4% to 7.7% (P < 0.001) and severely decreased GFR increased from 0.21% to 0.35% (P = 0.02) from 1988-1994 to 1999-2004. Within CKD stage 3, 18.6% +/- 1.6% (SE) of individuals should be referred to a nephrologist following a proposed set of criteria for referral; referral rates were highest for individuals with diabetes and lower in whites compared with other race-ethnicity groups. These survey data suggest that the prevalence of CKD has increased between 1988-1994 and 1999-2004. Surveillance for early stages of CKD (stages 1 to 4) should monitor these and other trends.