Prevalent End-Stage Kidney Disease Cases Double Since 2000

The number of reported incident end-stage kidney disease (ESKD) cases in the United States increased by 41.8%, and the number of prevalent cases more than doubled between 2000 and 2019, according to the latest CDC Morbidity and Mortality Weekly Report.

In 2019, Medicare fee-for-service expenses totaled $37.3 billion for ESKD and accounted for approximately 7% of Medicare paid claims costs. Data was collected from the United States Renal Data System (USRDS) to understand demographic factors and primary causes of ESKD.

Among patients who began treatment for their ESKD in 2019, 47% of cases were caused by diabetes, despite the decline and leveling off of ESKD from diabetes since 2000. Additionally, hypertension was the primary cause for 29% of cases.

“Although these flattening trends in rates are important from a population perspective, the trend in the number of ESKD cases is important from a health systems resources perspective,” the report said.

For incident cases, a total of 92,660 and 131,422 cases were recorded in 2000 and 2019, respectively. Much more prevalent cases were recorded in both years, with 358,247 in 2000 and 783,594 in 2019. Data were stratified by age group, sex, race and ethnicity, and primary cause.

Overall, incident cases increased by 41.8% and prevalent cases increased by 118.7% between 2000 and 2019.

Incident and prevalent cases in both years were higher for White individuals, men, and individuals aged between 45 and 64 years. Men also saw greater percentage changes compared with women, but individuals aged between 65 and 74 years, as well as Asian individuals, saw greater percentage changes than other age and race and ethnicity groups.

Based on race and ethnicity, incident ESKD cases increased significantly among Asian individuals (149.5%), and prevalent cases more than tripled for Asian (249.6%), Native Hawaiian or other Pacific Islander (240.6%), and Hispanic individuals (234.6%).

Meanwhile, Native American and Native Alaskan individuals saw the smallest increases in both cases.

“Population health and team-based approaches to diabetes care, including kidney disease testing and case management, implemented by the Indian Health Service, tribal and urban Indian health facilities, and supported by the Special Diabetes Program for Indians were associated with an estimated Medicare savings as high as $520.4 million in ESKD cases averted,” the report noted. “This program might explain the lower percentage change in ESKD cases during 2000–2019.”

The data also showed variations in the primary cause of ESKD. For incident cases, diabetes was the leading cause in both years, however there was a larger increase in ESKD cases caused by hypertension (60.5%) compared with diabetes (48.4%).

Meanwhile, most (40.5%) prevalent ESKD cases were caused by conditions other than diabetes and hypertension in 2000, but more cases were caused by diabetes in 2019 (39.2%) and the greatest percentage difference was noted for ESKD from hypertension (150.7%).

The report also mentioned that the extension of Medicare coverage of immunosuppressive drugs for patients receiving kidney transplants from 36 months to the lifetime of the recipient prevents the return to dialysis. This extension is expected to save Medicare $400 million over the next decade.

According to the report, better ESKD management can lead to healthier lives for patients and reduced costs to the health care system.

“Effective management of diabetes and hypertension, including kidney disease testing and management as part of diabetes care in at-risk populations, can help prevent ESKD,” the report said. “Monitoring trends and racial or ethnic disparity gaps in ESKD, and tracking other factors such as kidney disease awareness, pre-ESKD care, and risk factor (e.g., diabetes or hypertension) control and prevention, will be very important to evaluate the success of these interventions.”

Reference

Burrows NR, Koyama A, Pavkov ME. Reported cases of end-stage kidney disease—United States, 2000–2019. MMWR Morb Mortal Wkly Rep. 2022;71(11);412-415. doi:10.15585/mmwr.mm7111a3