Report Targets Chronic Kidney Disease In US
A 30 percent increase in chronic kidney disease over the past decade has prompted the U.S. Renal Data System (USRDS) to issue for the first time a separate report documenting the magnitude of the disease, which affects an estimated 27 million Americans and accounts for more than 24 percent of Medicare costs. The USRDS is funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health (NIH). The USRDS 2008 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease, is online at www.usrds.org .
"NIDDK's annual analysis and publication of data on kidney disease in the United States is essential in quantifying public health trends, guiding funding priorities, and designing targeted kidney research programs," said NIH Director Elias A. Zerhouni, M.D. "The major focus on chronic kidney disease in this year's report acknowledges that this disorder is a growing public health issue deserving of wider public awareness and intensified scientific investigation."
Using data from multiple sources, the USRDS has created a new handbook of information that can be used by researchers, government officials, health program planners, and others to develop research goals, assess public health needs, set program priorities, and inform policymakers and the public. USRDS research depends on collaborations with other agencies of the U.S. Department of Health and Human Services, especially the Centers for Medicare and Medicaid Services, the Health Resources and Services Administration, and the Centers for Disease Control and Prevention. Patient registries for other countries also contribute data for analyses.
Volume One of the report defines the disease burden of chronic kidney disease and examines cardiovascular and other related health problems, rates of adverse health events, preventive care, prescription medication therapies, delivery of care in the transition to end-stage renal disease, and the cost to Medicare and employer group health plans.
One of the major findings central to public health is that those with chronic kidney disease are more likely to die from cardiovascular disease than to reach end-stage kidney disease. However, cardiovascular risk factors can be detected and treated. This suggests that those transitioning from chronic to end-stage kidney disease merit more attention. Expenditures during the transition from chronic to end-stage kidney disease are considerable, ranging from $14,500 for Medicare patients to $29,000 for those covered by employer group health plans in the month of dialysis initiation.
"These latest data on kidney disease underscore the importance of the research we fund," said NIDDK Director Griffin P. Rodgers, M.D. "With rising rates of chronic and end-stage kidney disease, we need to stimulate research that will help us discover new, effective therapies for these devastating disorders."
Volume Two reports that the number of people with end-stage kidney disease is increasing in size and cost. The incidence of chronic kidney disease in 2006 was more than 100,000, or 360 per one million people, an increase of 3.4 percent over the 2005 incidence rate. There were more than half a million patients with end-stage kidney disease in 2006. Of these, 70 percent were on dialysis. An important step before a patient begins dialysis is the preparation of a vascular access, which is the site on the patient's body where blood is removed and returned during dialysis.
The three types of vascular access for dialysis are arteriovenous (AV) fistula, an AV graft, and a venous catheter. Both the fistula and the graft involve connecting an artery to a vein, usually beneath the skin in a patient's arm. The fistula is considered the best long-term vascular access for dialysis. The catheter is a tube inserted into a vein in the patient's neck, chest, or leg near the groin. It is usually only used as a temporary access until a permanent fistula or graft can be developed. This volume reports that more than 80 percent of new dialysis patients started with a catheter, more than 50 percent of current dialysis patients had a fistula, and 30 percent had a graft.
Volume Two also reports that Medicare paid about $70,000 per dialysis patient. Patients with end-stage kidney disease accounted for a little more than 1 percent of the Medicare population and more than 7 percent of Medicare costs. Total cost for end-stage kidney disease was $33.6 billion. This number includes Medicare spending and all expenditures by other payers, such as employer group health plans.
In addition, more than 18,000 kidney transplants were performed in 2006, an increase of 3.5 percent over 2005. Use of deceased donor kidneys increased between 2003 and 2006 at a rate of about 6 percent to 7 percent. Use of living donors fell 3 percent during that period, but the use of living unrelated donors continues to increase relative to the total number of living donations, and now accounts for 45 percent of all living donor transplantations.