ASN: End-Stage Renal Disease Prevalence Climbing as Baby Boomers Age

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ASN: End-Stage Renal Disease Prevalence Climbing as Baby Boomers Age
   
By Crystal Phend, Staff Writer, MedPage Today
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco
November 05, 2007
 
   
SAN FRANCISCO, Nov. 5 -- The baby boomers are entering the age of end-stage renal disease, and its prevalence is expected to skyrocket over the next decade despite level or declining incidence rates, researchers here estimated.

Absolute prevalence was anticipated to increase about 60% from 484,995 at the last count in 2005 to more than 785,000 by 2020, according to data from the U.S. Renal Data System presented at the American Society of Nephrology meeting. Absolute incidence was projected to increase 41% by 2020, reported David T. Gilbertson, Ph.D., and Allan J. Collins, M.D., both of the USRDS Coordinating Center in Minneapolis.

Prior estimates based on data from 2000 had suggested even greater increases, they said.

However, incidence rates recently leveled off overall and even declined in some subpopulations while the USRDS also began accounting for patients who recover renal function.

These effects may be countered by even stronger forces driving up the overall incidence and prevalence over the next decade, including the falling death rate, increasing diabetes rates, and improvement in treatment of chronic kidney disease and dialysis patients, the investigators noted.

"The primary driver of the increase is the aging baby boomers," Dr. Gilbertson said. "We're just not going to escape that big bolus of the population coming."

The researchers updated their statistical model with USRDS data available from 1978 through 2005, which included census projections accounting for expected demographics changes and incorporating anticipated changes in diabetes prevalence.

The incidence of end-stage renal disease in 2005 was 106,896. The researchers estimated future incidence counts of:

120,253 for 2010 based on the current projection, similar to the previously estimated 120,061.
134,978 for 2015 based on the current projection, down 1.4% from the previous estimate of 136,882.
150,772 for 2020 based on the current projection.

The prevalence of end-stage renal disease in 2005 was 484,995. Estimates for future prevalence were:

579,105 for 2010 based on the current projection, down 2.5% from the prior estimate of 593,953.
679,918 for 2015 based on the current projection, down 4.7% from the prior estimate of 713,531.
784,613 for 2020 based on the current projection.

The addition of about 300,000 end-stage patients by 2020 has implications for both clinical practice and policymakers, Dr. Gilbertson said. Medicare pays care of the vast majority of end-stage renal disease patients, who are "very expensive patients" with per-patient costs approaching $60,000 per year, he noted.

Although they constitute a small enough proportion of Medicare patients that they won't break the Medicare bank, "I don't think at this point we're prepared for them," he said.

"That's a lot of extra patients," Dr. Gilbertson said. "Are there going to be enough nephrologists to care for all those patients? I'm not so sure [there will be] even enough dialysis facilities."

The research was funded through the National Institutes of Health. Dr. Gilbertson reported consultancies for Amgen and Roche related to anemia. Dr. Collins reported consultancies or honoraria for Amgen, Baxter, Merck/Schering-Plough, NxStage, and Roche.

Primary source: American Society of Nephrology meeting
Source reference:
Gilbertson DT, Collins AJ, "Projecting the ESRD Population to 2020" ASN meeting 2007; Abstract FC046.