Numbers of Renal Disease Cases is Astounding

Hello. This is Jeffrey Berns, Editor-in-Chief of Medscape Nephrology. If you haven't seen it yet, you ought to take a look at a recent paper in the American Journal of Kidney Disease by Grams and colleagues[1] that used Markov chain modeling to estimate the lifetime incidence of chronic kidney disease (CKD), stages 3 through end-stage renal disease (ESRD), in the United States.

This mathematical modeling technique that they used was based on National Health and Nutrition Examination Surveys and other population data. This allowed them to estimate the lifetime risk of developing CKD in patients who didn't already have CKD, and to estimate the progression through the various stages of CKD.

The numbers are quite astounding. The residual lifetime risk of developing CKD was:

• Stage 3a or higher CKD: 60%-70% (depending upon gender and ethnicity);

• Stage 3b or higher CKD: 30%-40%;

• Stage 4 CKD: 10%-20%; and

• ESRD: 2%-9%.

As you can imagine, there were significant racial differences, with black persons having much higher risk of developing stage 4 CKD or ESRD, and they develop CKD at a much younger age than white persons do.

Of interest, women had a higher risk of developing CKD than men, but men had a higher risk of developing ESRD. When the investigators translate these risks into population prevalences, it is just mind-boggling. They estimated that 13.5 million white people in this country have CKD stage 3 or higher, and 1.8 million black persons -- and then 136 million, or almost 64% of the entire population of the United States, combining white and black persons -- either have or will develop CKD stage 3 or higher. Furthermore, 26 million people either have or will develop CKD stage 4 or higher.

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Much debate has taken place about the CKD stage 3a group in particular, and whether they really have CKD or just a reduced glomerular filtration rate (GFR). We should certainly be aware of that reduced GFR, particularly in the dosing of medications, avoidance of nephrotoxins, and so on -- but whether these patients have a "disease" or just reduced GFR, and whether that is an important distinction, remain areas of debate.

Clearly, these data are important from a public health perspective and a nephrology perspective, and may have huge ramifications for healthcare costs down the road, given the large numbers of patients that we can project are going to reach ESRD -- and thus is quite a public health concern. We should certainly do everything we can to enhance its attention in the eye of the community, the public, and the government to make sure that CKD gets the public health attention it needs. This quite interesting and somewhat alarming and astounding study is worth reading.

Thank you for listening. This is Jeff Berns from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.

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