PERSPECTIVES www.jasn.

org

Update on the Burden of CKD

J Am Soc Nephrol 28: ccc–ccc, 2017. doi: 10.1681/ASN.2016121374

Recent studies confirm that the global populations and 10% in high-risk were aggregated.8,9 Overall, the results
burden of CKD is high but point to in- populations). support a high prevalence of CKD sim-
teresting trends and methodologic chal- Studies of CKD prevalence in the ilar to that of the United States. However,
lenges. Data on CKD burden have grown United States and Europe recently pro- the studies also showed marked varia-
dramatically over the past years, building vided some interesting insights. In the tion in prevalence across countries
on the foundation set by standardizing United States, several decades of ris- from 3.3% in Norway to 17.3% in north-
the definition and staging of CKD in 2002. ing CKD prevalence 4,5 seem to have west Germany. Much of the variation
I will briefly summarize recent landmark reached a plateau in the mid-2000s. 6 persisted, despite stratification by diabe-
studies that estimate the global burden of Interestingly, this reflected a mixed tes and hypertension and attempts to
CKD and ESRD better than ever before picture—decrease in CKD prevalence standardize definitions and assays. It is
and key recent papers on CKD prevalence at older age in the face of a continued unclear how much of the variation is ex-
trends. These data will be discussed in the rise in high-risk groups, including blacks plained and how much is due to residual
context of the methodologic challenges and patients with diabetes. Among methodologic variation. The same
that we must surpass to attain a good un- United States patients with diabetes, group nicely summarized the limitations
derstanding of CKD burden. trends are mixed as well.7 Albuminuria of the existing literature reporting prev-
The global prevalence of CKD was es- prevalence is decreasing, particularly alence of CKD in the European adult
timated in two meta-analyses.1,2 Their among white patients with diabetes. general population. The majority of
results were remarkably similar, although This may be due to the higher rates of studies did not report the sampling
both note major limitations and meth- treatment with angiotensin-converting frame used, and response rates varied
odologic heterogeneity in the studies re- enzyme inhibitors, statins, and hypogly- from 10% to 87%. Additional variation
viewed. A meta-analysis of 44 country cemic medications. However, the preva- was seen in the creatinine assay (67%
prevalence studies estimated the world- lence of low eGFR among United States Jaffe and 13% enzymatic, with 29% cali-
wide prevalence of CKD at 13.4% (95% patients with diabetes continued to rise brated to isotope dilution mass spec-
confidence interval [95% CI], 11.7% to from 1988 to 2014. This may be the re- trometry), the equation used to estimate
15.1%).2 A meta-analysis of 33 prevalence sult of younger age of onset, improved GFR (52% Chronic Kidney Disease Ep-
studies estimated worldwide prevalence cardiovascular survival, or other factors. idemiology Collaboration and 75%
of CKD by sex at 10.4% in men (95% Given the rising prevalence of diabetes Modification of Diet in Renal Disease),
CI, 9.3% to 11.9%) and 11.8% in women and obesity, these results indicate that definition of CKD (92% used eGFR,60),
(95% CI, 11.2% to 12.6%).1 Interestingly, inclusion of urinary markers (in 60% of
the net effect of improved treatment ver-
prevalence estimates were approximately studies), and reporting of 95% CIs (39%
sus higher prevalence is uncertain, and
of studies). The 2013 Kidney Disease Im-
15% higher in low- and middle-income the recent report of stabilizing overall
proving Global Outcomes guidelines keep
countries compared with high-income prevalence should be taken with caution.
the same definition of CKD, but few of the
countries. Prevalence data in low- and Conclusions about trends must be tem-
studies to date incorporate the updated
middle-income countries were expanded pered by realizing that, unfortunately,
by a study of convenience samples from even a 0.04 mg/dl higher mean serum
12 countries in six world regions.3 They creatinine due to calibration issues can Published online ahead of print. Publication date
found a prevalence of 14.3% (95% CI, contribute to meaningful changes (5% available at www.jasn.org.
14.0% to 14.5%) in general populations lower eGFR, 23% higher stage G3 CKD,
Correspondence: Dr. Josef Coresh, 2024 E. Mon-
and 36.1% (95% CI, 34.7% to 37.6%) and 12% higher overall CKD prevalence ument, Suite 2-630, Baltimore, MD 21287. Email:
in high-risk populations. This study estimate for the United States).4 [email protected]
also confirmed that awareness of CKD European studies of CKD burden Copyright © 2017 by the American Society of
remains very low (6% in the general were recently reviewed, and their results Nephrology

J Am Soc Nephrol 28: ccc–ccc, 2017 ISSN : 1046-6673/2804-ccc 1

staging, which includes cause, GFR cate- multiple sources of data globally.14 Ag- REFERENCES
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2 Journal of the American Society of Nephrology J Am Soc Nephrol 28: ccc–ccc, 2017
 www.jasn.org PERSPECTIVES

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J Am Soc Nephrol 28: ccc–ccc, 2017 Update on the Burden of CKD 3