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Am J Kidney Dis. 2016 Dec;68(6):862-872. doi: 10.1053/j.ajkd.2016.05.030. Epub 2016 Aug 28.

Risk of ESRD in the United States.

Author information

1
Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor, MI; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI.
2
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI; Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI; Department of Urology, Medical School, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI. Electronic address: halm@umich.edu.
3
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Arbor Research Collaborative for Health, Ann Arbor, MI; Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, MI.
4
Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor, MI; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, MI.

Abstract

BACKGROUND:

Although incidence rates of end-stage renal disease (ESRD) in the United States are reported routinely by the US Renal Data System (USRDS), risks (probabilities) are not reported. Short- and long-term risk estimates need to be updated and expanded to minority populations, including Native Americans, Asian/Pacific Islanders, and Hispanics.

STUDY DESIGN:

Risk estimation from surveillance data in large populations using life-table methods. A competing-risks framework was applied by constructing a hypothetical cohort followed from birth to death.

SETTING & PARTICIPANTS:

Total US population. Incidence and mortality rates of ESRD were obtained from the USRDS; all-cause mortality rates were obtained from CDC WONDER.

PREDICTORS:

Age, sex, race/ethnicity, and year.

OUTCOMES:

10-year to lifetime risks (cumulative incidence) of ESRD.

RESULTS:

Among males, lifetime risks of ESRD from birth using 2013 data were 3.1% (95% CI, 3.0%-3.1%) for non-Hispanic whites, 8.0% (95% CI, 7.9%-8.2%) for non-Hispanic blacks, 3.8% (95% CI, 3.4%-4.9%) for non-Hispanic Native Americans, 5.1% (95% CI, 4.8%-5.4%) for non-Hispanic Asians/Pacific Islanders, and 6.2% (95% CI, 6.1%-6.4%) for Hispanics. Among females, lifetime risks were 2.0% (95% CI, 2.0%-2.1%) for non-Hispanic whites, 6.8% (95% CI, 6.7%-6.9%) for non-Hispanic blacks, 3.6% (95% CI, 3.3%-4.2%) for non-Hispanic Native Americans, 3.8% (95% CI, 3.6%-4.0%) for non-Hispanic Asian/Pacific Islanders, and 4.3% (95% CI, 4.2%-4.5%) for Hispanics. Lifetime risk of ESRD from birth increased from 3.5% in 2000 to 4.0% in 2013 in males and decreased from 3.0% to 2.8% in females.

LIMITATIONS:

Standard life-time assumption of fixed age-specific rates over time and possible ESRD misclassification. To be useful in clinical practice, this application will require additional predictors (eg, comorbid conditions and chronic kidney disease stage).

CONCLUSIONS:

ESRD risk in the United States varies more than 2-fold among racial/ethnic groups for both sexes.

KEYWORDS:

End-stage renal disease (ESRD); US Renal Data System (USRDS); cumulative incidence; epidemiology; health inequity; incidence; lifetable; lifetime risk; mortality; nationwide surveillance; public health; racial disparity; risk; risk estimate

PMID:
27578184
PMCID:
PMC5123906
DOI:
10.1053/j.ajkd.2016.05.030
[Indexed for MEDLINE]
Free PMC Article

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