Kidney Disease: The Basics

American Cancer Society (ACS). Key Statistics for Breast Cancer in Men. Last Revised January 19, 2024.
https://www.cancer.org/cancer/types/breast-cancer-in-men/about/key-statistics.html
[“About 530 men will die from breast cancer.”]

Centers for Disease Control and Prevention. U.S. Cancer Statistics Female Breast Cancer Stat Bite. U.S. Department of Health and Human Services; 2024. Published June 13, 2024.
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[“…in 2022, 42,211 females died from breast cancer.”]

Centers for Disease Control and Prevention (CDC). U.S. Cancer Statistics Prostate Cancer Stat Bite. U.S. Department of Health and Human Services; 2023. Published June 13, 2024.
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[“…in 2022, 33,363 males died from prostate cancer”]

Leading Causes of Death. Centers for Disease Control and Prevention (CDC); National Center for Health Statistics. Last Reviewed: May 2, 2024.
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[#9 Nephritis, nephrotic syndrome, and nephrosis: 57,937]

Polkinghorne KR. ESKD or cancer: given the choice, which would you rather have? AJKD. 2019 April 22;73(6):753-755.
doi: https://doi.org/10.1053/j.ajkd.2019.01.037
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Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2023. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2023.
https://www.cdc.gov/kidney-disease/php/data-research/index.html https://www.cdc.gov/kidney-disease/media/pdfs/CKD-Factsheet-H.pdf

United States Renal Data System. 2023 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2023.
https://usrds-adr.niddk.nih.gov/2023/chronic-kidney-disease/1-ckd-in-the-general-population
[Chronic Kidney Disease: Chapter 1 CKD in the General Population; Highlights Bullet #1]

Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2023. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2023.
https://www.cdc.gov/kidney-disease/php/data-research/index.html
https://www.cdc.gov/kidney-disease/media/pdfs/CKD-Factsheet-H.pdf

Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2023. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2023.
https://www.cdc.gov/kidney-disease/php/data-research/index.html
https://www.cdc.gov/kidney-disease/media/pdfs/CKD-Factsheet-H.pdf

*(Stage 4-5; eGFR <29).
Stages of Chronic Kidney Disease (CKD). National Kidney Foundation.
https://www.kidney.org/atoz/content/stages-chronic-kidney-disease-ckd

Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2023. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2023.
https://www.cdc.gov/kidney-disease/php/data-research/index.html
https://www.cdc.gov/kidney-disease/media/pdfs/CKD-Factsheet-H.pdf
Chronic Kidney Disease Basics. Centers for Disease Control and Prevention. Published February 1, 2024.
https://www.cdc.gov/kidney-disease/about/index.html

NOTE: Estimate of 1 in 3 (approx. 86 million) adults at risk for CKD is based on U.S. prevalence of diabetes, hypertension, and obesity. Without proper treatment, 1 in 3 will develop CKD.

Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2023. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2023.
https://www.cdc.gov/kidney-disease/php/data-research/index.html
https://www.cdc.gov/kidney-disease/media/pdfs/CKD-Factsheet-H.pdf

Ahmad FB, Cisewski JA, Anderson RN. Mortality in the United States — Provisional Data, 2023. MMWR Morb Mortal Wkly Rep. 2024;73:677–681. DOI:
http://dx.doi.org/10.15585/mmwr.mm7331a1
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Rahhal N. CDC reveals leading causes of death for the past 5 years. Here are 5 key takeaways. Yahoo Life. August 8, 2024. Accessed August 8, 2024.
https://www.yahoo.com/lifestyle/cdc-reveals-leading-causes-of-death-for-the-past-5-years-here-are-5-key-takeaways-171231678.html

Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2023. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2023.
https://www.cdc.gov/kidney-disease/php/data-research/index.html
https://www.cdc.gov/kidney-disease/media/pdfs/CKD-Factsheet-H.pdf

A to Z Health Guide: Chronic Kidney Disease (CKD). Kidney.org. Accessed February 12, 2024.
https://www.kidney.org/atoz/content/about-chronic-kidney-disease#about-chronic-kidney-disease-ckd

A to Z Health Guide: Diabetes - A Major Risk Factor for Kidney Disease. Kidney.org. Accessed August 2, 2024.
https://www.kidney.org/atoz/content/diabetes

Causes of Chronic Kidney Disease. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Last Reviewed October 2016. Accessed May 20, 2024.
https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/causes

Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2023: Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2023.
https://www.cdc.gov/kidney-disease/php/data-research/index.html
https://www.cdc.gov/kidney-disease/media/pdfs/CKD-Factsheet-H.pdf

Chronic Kidney Disease Basics. Centers for Disease Control and Prevention. Published February 1, 2024.
https://www.cdc.gov/kidney-disease/about/index.html

High Blood Pressure and Kidney Disease. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Last Reviewed March 2020. Accessed May 20, 2024.
https://www.niddk.nih.gov/health-information/kidney-disease/high-blood-pressure

Kidney Disease Statistics for the United States: Fast Facts on Kidney Disease. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Last reviewed May 2023. Accessed May 20, 2024.
https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease
[data source CDC 2021]

Risk Factors for Chronic Kidney Disease. Centers for Disease Control and Prevention. Accessed August 2, 2024.
https://www.cdc.gov/kidney-disease/risk-factors/index.html

A to Z Health Guide: Chronic Kidney Disease (CKD). Kidney.org. Accessed May 20, 2024.
https://www.kidney.org/atoz/content/about-chronic-kidney-disease#about-chronic-kidney-disease-ckd
[See: "Diagnosis"]

Lentine KL, Smith JM, Lyden GR, Miller JM, Dolan TG, Bradbrook K, Larkin L, Temple K, Handarova DK, Weiss S, Israni AK, Snyder JJ. OPTN/SRTR 2022 Annual Data Report: Kidney. Am J Transplant. 2024 Feb;24(2S1):S19-S118.
doi: 10.1016/j.ajt.2024.01.012. PMID: 38431360.
https://www.amjtransplant.org/article/S1600-6135(24)00077-7/fulltext
[See “Graphical abstract”:
https://www.amjtransplant.org/cms/attachment/2acafeda-7d4c-4ee8-9ab4-5a1f05640cff/ga1_lrg.jpg ]

Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR). OPTN/SRTR 2022 Annual Data Report. U.S. Department of Health and Human Services, Health Resources and Services Administration; 2024. Accessed May 20, 2024.
http://srtr.transplant.hrsa.gov/annual_reports/Default.aspx
https://srtr.transplant.hrsa.gov/annual_reports/2022_ADR_Preview.aspx
[OPTN/SRTR 2022 Annual Data Report: Kidney; Section 2 Adult Kidney Transplant; 2.1 Waiting List: “There were 4,454 waitlist removals due to death in 2022…” https://srtr.transplant.hrsa.gov/annual_reports/2022/Kidney.aspx
4454/365 = 12.20]

Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2023. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2023.
https://www.cdc.gov/kidney-disease/php/data-research/index.html
https://www.cdc.gov/kidney-disease/media/pdfs/CKD-Factsheet-H.pdf
[“Adults with kidney disease are at a higher risk of dying earlier than adults of similar age without CKD.”]

[References for three facts above.]
Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2023. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2023.
https://www.cdc.gov/kidney-disease/media/pdfs/CKD-Factsheet-H.pdf
[“• Non-Hispanic Black persons have 4 times the incidence rate of ESKD than non-Hispanic White persons. • Hispanic persons have twice the incidence rate of ESKD than non-Hispanic White persons.”]
https://www.cdc.gov/kidney-disease/php/data-research/index.html

Diabetes and American Indians/Alaska Natives. U.S. Department of Health and Human Services; Office of Minority Health. Accessed: May 22, 2024.
https://minorityhealth.hhs.gov/diabetes-and-american-indiansalaska-natives
[data source CDC 2021]

Kidney Disease Statistics for the United States: Fast Facts on Kidney Disease. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Last reviewed May 2023. Accessed May 20, 2024.
https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease
[data source CDC 2021]

United States Renal Data System. 2023 USRDS Annual Data Report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2023.
https://usrds-adr.niddk.nih.gov/2023/end-stage-renal-disease/1-incidence-prevalence-patient-characteristics-and-treatment-modalities
[End Stage Renal Disease: Chapter 1 Incidence, Prevalence, Patient Characteristics, and Treatment Modalities: Highlights: Bullet #4: “In 2021, the incidence of ESRD among Black individuals was 3.8 times that of White individuals; the incidence among Native American individuals was 2.3 times as high, and it was twice as high among Hispanic individuals (Figure 1.4). Although these disparities had been improving until 2018, they worsened from 2018 to 2021.”]

Kidney Disease Statistics for the United States: Fast Facts on Kidney Disease. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Last reviewed May 2023. Accessed May 20, 2024.
https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease
[Data source: CDC 2021]

El-Khoury B, Yang TC. Reviewing racial disparities in living donor kidney transplantation: a socioecological approach. J Racial Ethn Health Disparities.2024 Apr;11(2):928-937. doi: 10.1007/s40615-023-01573-x. Epub 2023 Mar 29. PMID: 36991297; PMCID: PMC10057682.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10057682/
https://link.springer.com/article/10.1007/s40615-023-01573-x

Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR). OPTN/SRTR 2022 Annual Data Report. U.S. Department of Health and Human Services, Health Resources and Services Administration; 2024. Accessed May 20, 2024.
http://srtr.transplant.hrsa.gov/annual_reports/Default.aspx
https://srtr.transplant.hrsa.gov/annual_reports/2022_ADR_Preview.aspx
[“Disparities in access to LDKT [living donor kidney transplantation] persist. While 31.7% of adult waitlisted candidates on December 31, 2022, were Black (Table KI 1), Black patients made up only 12.8% of LDKT recipients versus 34.1% of DDKT recipients that year (Table KI 6). White patients made up 35.5% of the waiting list (Table KI 1), while 61.4% of LDKT recipients and 35.3% of DDKT recipients were White (Table KI 6).”]

U.S. Department of Health & Human Services (HHS); Health Resources and Services Administration (HRSA); Organ Procurement and Transplantation Network (OPTN). Data & Calculators. Organ Procurement and Transplantation Network (OPTN). Accessed June 21, 2024.
https://optn.transplant.hrsa.gov/
[ OPTN Homepage > Tab: Data & calculators > View Data Reports > National Data > Step 1: Choose category: Waiting list; Count: Candidates; Step 2: Choose Organ: Kidney > Step 2: Choose report: Organ by Ethnicity; Change Report: Candidates; Column: Kidney; Rows: Black, Non-Hispanic/All Ethnicities. Results as of 6/21/2024: 26,556/89,414 ]

National Kidney Foundation Advocacy. “1 in 4 Medicare dollars are spent on…” March 7, 2024. Accessed May 21, 2024.
https://x.com/NKF_Advocacy/status/1765882641394675738

United States Renal Data System. 2023 USRDS Annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2023.
https://usrds-adr.niddk.nih.gov/2023/chronic-kidney-disease/6-healthcare-expenditures-for-persons-with-ckd
[Chronic Kidney Disease: Chapter 6 Healthcare Expenditures for Persons with CKD; Highlights Bullet # 2: “Total Medicare FFS spending for all beneficiaries (both older and younger than age 66, in contrast to above) with CKD was $86.1B in 2021, representing 22.6% of total Medicare FFS expenditures (Tables 6.1 and 6.2).”]
https://usrds-adr.niddk.nih.gov/2023/end-stage-renal-disease/9-healthcare-expenditures-for-persons-with-esrd
[End Stage Renal Disease: Chapter 9 Healthcare Expenditures for Persons with ESRD; Highlights Bullet #1: “Total inflation-adjusted Medicare expenditures for patients with ESRD increased steadily from $48.1B in 2011 to $53.8B in 2019, fell for the first time in 2020 to $51.6B, and then increased again in 2021 to $52.3B (Figure 9.1). However, with the transition of many Medicare FFS beneficiaries to Medicare Advantage (MA) in 2021, spending for Medicare Advantage, increased from $12.5B to $18.3B, or by 46.4% in a single year.”]

McCullough KP, Morgenstern H, Saran R, Herman WH, Robinson BM. Projecting ESRD incidence and prevalence in the United States through 2030. J Am Soc Nephrol. 2018 Dec;30(1):127–135. ASN.2018050531 doi: 10.1681/ASN.2018050531. Epub 2018 Dec 17. PMID: 30559143; PMCID: PMC6317596.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6317596/
https://www.researchgate.net/publication/329721173_Projecting_ESRD_Incidence_and_Prevalence_in_the_United_States_through_2030
[“Conclusions: The burden of ESRD will increase in the United States population through 2030 due to demographic, clinical, and lifestyle shifts in the population and improvements in RRT. Planning for ESRD resource allocation should allow for substantial continued growth in the population of patients with ESRD. Future interventions should be directed to preventing the progression of CKD to kidney failure.”]

Murray R, Zimmerman T, Agarwal A, Palevsky PM, Quaggin S, Rosas SE, Kramer H. Kidney-related research in the United States: a position statement from the National Kidney Foundation and the American Society of Nephrology. Am J Kidney Dis.2021 Aug;78(2):161-167.
doi: 10.1053/j.ajkd.2021.04.006. Epub 2021 May 11. PMID: 33984405; PMCID: PMC10718284.
https://www.ajkd.org/article/S0272-6386(21)00594-1/fulltext
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10718284/
https://pubmed.ncbi.nlm.nih.gov/33984405/

Centers for Disease Control and Prevention. CDC updates and simplifies respiratory virus recommendations (press release). March 1, 2024.
https://www.cdc.gov/media/releases/2024/p0301-respiratory-virus.html
https://www.cdc.gov/coronavirus/2019-nCoV/index.html

Del Vecchio L, Balafa O, Dounousi E, Ekart R, Fernandez BF, Mark PB, Sarafidis P, Valdivielso JM, Ferro CJ, Mallamaci F. COVID-19 and cardiovascular disease in patients with chronic kidney disease. Nephrol Dial Transplant. 2024 Jan 31;39(2):177-189. doi: 10.1093/ndt/gfad170.
PMID: 37771078; PMCID: PMC10828215.
https://academic.oup.com/ndt/article/39/2/177/7285814
https://pubmed.ncbi.nlm.nih.gov/37771078/

Geetha, D., Kronbichler, A., Rutter, M. et al. Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions.
Nat Rev Nephrol. 18, 724–737 (2022). https://doi.org/10.1038/s41581-022-00618-4
https://www.nature.com/articles/s41581-022-00618-4

Hartmann-Boyce J. The disproportionate toll that COVID-19 took on people with diabetes continues today. The Conversation. June 6, 2024.
https://theconversation.com/the-disproportionate-toll-that-covid-19-took-on-people-with-diabetes-continues-today-227314

Whyte LE. U.S. tries to be clearer on who should get covid booster: the CDC says people 65 and older should get shots this spring, stronger language than the agency had used. Wall Street Journal. February. 28, 2024.
https://www.wsj.com/health/healthcare/cdc-advisers-try-to-be-clearer-on-who-should-get-covid-booster-a95d0450 [Quoted: “Should.”—Federal vaccine advisers’ guidance on spring Covid-19 boosters for people 65 and older, a stronger recommendation than the CDC’s current language saying older adults “may” get the shots. The agency has to sign off on the tougher guidance, but it usually follows the committee’s advice. Doing so would ensure most health plans cover the inoculations without an out-of-pocket charge. The virus leads to around 20,000 new hospital admissions and 2,000 deaths every week. People 75 years and older die at the highest rate.” —Wall Street Journal email newsletter. February 29, 2024.]

Chronic kidney disease (CKD) means your kidneys are damaged and losing their ability to keep you healthy by filtering your blood. In the early stages of the disease, most people do not have symptoms. But as kidney disease gets worse, wastes can build up in your blood and make you feel sick. You may develop other problems, like high blood pressure, anemia, weak bones, poor nutritional health, and nerve damage. Because kidneys are vital to so many of the body's functions, kidney disease also increases your risk of having heart and blood vessel disease. While these problems may happen slowly and without symptoms, they can lead to kidney failure, which can appear without warning. Once kidneys fail, dialysis or a kidney transplant is needed to stay alive. Kidney failure is also called kidney failure with replacement therapy (KFRT).

The two main causes of kidney disease are diabetes and high blood pressure.

• These two conditions were the primary diagnosis in 76% of kidney failure cases between 2015-2017: 47% of new KFRT patients had a primary diagnosis of diabetes, the leading cause of KFRT, while 29% of new KFRT patients had a primary diagnosis of hypertension, the second leading cause of KFRT.
• Other conditions that can lead to KFRT are: glomerulonephritis (diseases that damage the kidney's filtering units), which are the third most common type of kidney disease; inherited diseases, such as polycystic kidney disease; malformations at birth that occur as a fetus develops; lupus and other immune diseases; obstructions such as kidney stones or an enlarged prostate; and repeated urinary tract infections, which can also lead to kidney infections and can cause long-term damage to the kidneys.
• People with kidney disease are at greater risk for cardiovascular disease and death at all stages of kidney disease. Kidney disease and heart disease are linked and have common risk factors, such as diabetes and hypertension. Each condition can lead to or worsen the other.

The best treatment of kidney disease is facilitated by early detection, when the disease can be slowed or stopped. Early treatment includes diet, exercise, medications, lifestyle changes, and treating risk factors like diabetes and hypertension. However, once kidneys fail, treatment with dialysis or a kidney transplant is needed.

• Dialysis comes in two forms: hemodialysis (HD) or peritoneal dialysis (PD). Both forms remove wastes and extra fluid from your blood. Patients receive hemodialysis usually 3–4 times a week, either at home or at a dialysis center. During hemodialysis, your blood is pumped through a dialysis machine, where it is cleaned and returned to your body. With peritoneal dialysis, your blood is cleaned inside your body every day through the lining of your abdomen using a special fluid that is periodically changed. Peritoneal dialysis can be done at home, at work, at school, or even during travel. Home dialysis is an increasingly popular mode of treatment, and is associated with better outcomes.
• A kidney transplant places a healthy kidney into your body from a deceased donor or from a living donor, such as a close relative, spouse, friend, or generous stranger. A kidney transplant, however, is a treatment, not a cure. Antirejection and other medications are needed to maintain the transplant. Per the United States Renal Data System (USRDS), more than 22,000 (22,393) kidney transplants were performed in the United States in 2018. The active waiting list remains substantially larger than the supply of donor kidneys, which presents a continuing challenge.
• Although it is very important for patients who are nearing the need for dialysis or kidney transplantation to be cared for by a nephrologist, in 2018, 38.8% of incident (newly occurring) KFRT patients (18–44 years) had received little or no pre-KFRT nephrology care.

• In 2018, 785,883 Americans had kidney failure, and needed dialysis or a kidney transplant to survive (2 in every 1,000 people). 554,038 of these patients received dialysis to replace kidney function and 229,887 lived with a kidney transplant.
• About 130,000 people started KFRT treatment in 2018, of which approximately 128,000 started dialysis as the initial mode of therapy.
• In 2018, 22,393 people received a kidney transplant. By the end of 2018, a total of 229,887 Americans were living with a kidney transplant.
• While about 100,000 Americans are waiting for a kidney transplant, only 22,817 Americans received one in 2020. About one-third of these transplants came from living donors.
• Living and deceased kidney donors are crucial: 12 people die every day while waiting for a kidney transplant.
• In 2016, more than 3,600 kidneys from deceased donors were surgically discarded; NKF is making efforts to utilize more of these kidneys for transplantation.
• People with kidney disease are five to ten times more likely to die prematurely than they are to progress to KFRT. More than 100,000 people with KFRT died in 2018.
• Without increased investment in prevention, the total number of patients with kidney failure will likely exceed 1 million by 2030.

• 1 in 3 adults in the U.S. is at risk for kidney disease. Some demographic groups are at higher risk. (See "What's Behind Racial Disparities in Kidney Disease?" section.)
• Risk factors for kidney disease include: diabetes; high blood pressure; family history of kidney failure; age 60 or older; obesity; heart disease; past damage to kidneys; and being in minority populations that have high rates of diabetes or high blood pressure, such as Black/African Americans, Hispanics or Latinos, Asian Americans or Pacific Islanders, and American Indians or Alaska Natives (Note: current CDC/ NHANES demographic terminology.).

People from some groups are more likely to develop kidney disease than others. Many factors can contribute to these groups being at higher risk, ranging from societal to medical reasons.

• A breakdown of kidney disease rates within demographic categories of the general population of the United States for 2015—2018 (USRDS, Prevalence of CKD in U.S. adults within age, sex, race/ethnicity, & risk factor categories) showed: 16.0% Non-Hispanic Black/African American; 15.7% Non-Hispanic White; 11.9% Hispanic or Latino (2018).
• Among Medicare FFS (fee-for-service) beneficiaries, kidney disease is highest among Blacks/African Americans (33%), followed by American Indians or Alaska Natives (30%), Hispanics or Latinos (28%), and Asian Americans or Pacific Islanders (26%). Whites (23%) beneficiaries had the lowest percentages of kidney disease (2018).
• Non-Hispanic Black/African-American and Hispanic or Latino people experience more rapid decline of kidney function than non-Hispanic Whites. Minority communities in general are at increased risk of progressing from CKD to KFRT and of progressing more rapidly.
• Black/African American people are more than 4 times as likely as White people to develop kidney failure. Black/African American people are 13% of the U.S. population, while representing 35% of those with kidney failure.
• Black/African-American race is also associated with increased risk for acute kidney injury (AKI).
• Black/African Americans also suffer higher rates of comorbid conditions, such as diabetes and high blood pressure, resulting in higher rates of fair/poor health (age 18+, 22% Black/African Americans vs. 16% Whites).
• Compared to non-Hispanics, Hispanics or Latinos are almost 33% (1.3 times) more likely to receive a diagnosis of kidney failure.
• Native Hawaiians, Pacific Islanders, American Indians and Alaska Natives also have a higher prevalence of kidney disease than Whites.
• There are disparities in the quality of primary care for patients of different racial, ethnic, and socioeconomic groups who have kidney disease and kidney disease risk factors. These disparities are related to patient, clinician, clinical, and systemic factors. Patients receiving dialysis in areas with populations that are largely Black/African American, low-income, or of lower educational attainment, are less likely to have received pre-dialysis care from a nephrologist. One study found that 52% of Hispanic or Latino patients on hemodialysis had not received pre-dialysis care from a nephrologist, compared to 44% of non-Hispanic patients.
• Black/African Americans and Hispanics or Latinos are also less likely to be treated with kidney transplantation than Whites.
• On average, Black/African-American transplant candidates wait longer than White transplant candidates for kidney, heart, and lung transplants.
• In 2018, 57% of White patients with KFRT received in-center hemodialysis, versus 72% of Black/African- American patients. This may reflect fewer Black/African-American patients utilizing home dialysis options.

Many children and adolescents have conditions that, if left untreated, dramatically increase their risk for kidney disease and KFRT: about 4% of youths (12–19 yrs) in the U.S. have hypertension, while about 10% have elevated blood pressure. In children aged 2–19 years, the prevalence of obesity is 18.5% (about 13 million), and 210,000 people younger than 20 years are living with diagnosed diabetes. The growing prevalence of these conditions in children means that the incidence and prevalence of kidney disease will likely increase further in the coming years.

• 6,427 children (<18 yrs old) in the U.S. lived with KFRT in 2017.
• According to one study, children with KFRT are 30 times more likely to die prematurely than healthy children. In another study, adolescents (<18 yrs old) with KFRT since childhood had a life expectancy of 38 years if they were treated with dialysis during childhood, and 63 years if they received a kidney transplant during childhood.
• The primary causes of pediatric KFRT in the U.S. between 2015–2018 were: primary glomerular disease, CAKUT (congenital anomalies of the kidney and urinary tract), cystic/hereditary/congenital disorders, and primary/secondary glomerular disease/vasculitis. Urinary tract infections can also lead to kidney infections, which can cause long-term damage to the kidneys.
• In 2020, 710 children (<18 yrs old) received a kidney transplant.
• More than 1,000 children (<18 yrs old) are waiting for a donated kidney.
• Recent USRDS data indicates substantial racial and ethnic disparities in KFRT treatment for children and adolescents
  • White children were twice as likely to receive a kidney transplant as Black/African-American children (20.8% versus 10.0%).
  • More Black/African-American (57.3%) children than White (40.5%) children-initiated hemodialysis (HD).
  • Hispanic or Latino children received a kidney transplant less often than non-Hispanic children (12.0% versus 20.2%) and initiated HD more often and PD less often.
  • The median kidney transplant waitlist time for children, by race: 35.2 months for Black/African-American children; 34.0 months for children of other race groups (not Black, White, or Asian); 23.3 months for White children; and 20.3 months for Asian-American children.

In 2018, Medicare costs for all people with all stages of kidney disease were $130 billion. In 2018 Medicare spent $81 billion for people with kidney disease and an additional $49.2 billion for people with KFRT. For 2018, per person per year (PPPY) spending on KFRT patients was $80,426. Early detection of kidney disease could save a substantial percentage of these costs.

• Per type of KFRT treatment, Medicare spent: $93,191 PPPY for HD, $78,741 for PD, and $37,304 for kidney transplant (2018).
• In 2018, Medicare spent an estimated $24,674 PPPY to care for someone with non-KFRT CKD, more than double the spending on the average Medicare beneficiary ($12,899).
• Almost 64.3% of new KFRT patients applied for Medicare (2018).
• In 2018, there were over 500,000 Medicare beneficiaries on maintenance dialysis (about 1% of Medicare fee-for-service population), accounting for 7.2% of the overall claims paid by Medicare.
• Total Medicare Part D spending (2009–2018) rose by 188% for those with CKD ($4.6 to $13.1 billion) and by 37% for those without CKD ($39.5 to $54.2 billion).
• For kidney transplant recipients, Medicare Part B spent $2,453 on immunosuppressive drugs, PPPY (2018).
• Medicare Part D spending was 1.7 times higher for those with CKD ($5392 PPPY) than for those without CKD ($3118 PPPY) (2018).
• Medicare Part D spending was 2.4 times higher for patients with KFRT ($8,173 PPPY) than those without ($3397 PPPY) (2018).
• There is good news, however, for patients burdened with immunosuppressive drug costs when they are no longer covered by the current 36-month limit. The NKF-supported Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act (S. 3353/H.R. 5534) was passed by both the U.S. House of Representatives and U.S. Senate in December 2020. This bill ensures that transplant patients on Medicare will receive lifetime unlimited coverage for immunosuppressive medications. This legislation represents a significant, positive change in the lives of many kidney patients.

However, there is still a lot of work to be done: Minority communities may have less access to healthcare than other Americans. For example, studies found that about one-third of Hispanics or Latinos, 20% Black/African Americans, and nearly 1 out of 3 American Indians and Alaska Natives were uninsured.

Early Detection

Early detection is the most effective way to combat kidney disease. There are two simple, quick, and inexpensive tests for kidney disease:

Keep Kidneys Healthy

• A kidney damage urine albumin-creatinine ratio (uACR) test measures the amount of protein called albumin in your urine. Damaged kidneys leak protein into your urine; it should be in your bloodstream.
• A kidney function blood test, creatinine, is used to measure your glomerular filtration rate (GFR), which tells how well your kidneys are working to remove wastes from your blood. It is the best way to check kidney function.
• People with kidney disease should: •Lower high blood pressure; •Manage blood sugar levels; •Reduce salt intake; •Avoid NSAIDs, a type of painkiller; •Moderate protein consumption; •Get an annual flu shot
• Everyone should: •Exercise regularly; •Control weight; •Follow a balanced diet; •Quit smoking; •Drink alcohol only in moderation; •Stay hydrated; •Monitor cholesterol levels; •Get an annual physical; •Know your family medical history

Preventative Medicine Pays Off

• A recent report from the Centers for Disease Control and Prevention (CDC) states that between 1996 and 2013, there was a 54% decrease in the incidence of diabetes-related KFRT in Native American and Alaska Natives since the Special Diabetes Program for Indians (SDPI) began in 1997. The CDC estimates that the decrease in KFRT related to diabetes resulted in 2,200 to 2,600 fewer cases of diabetes-related KFRT, and estimates $436 to $520 million in savings to Medicare over 10 years.

Download the fully annotated fact sheet to keep this information on hand.

The National Kidney Foundation (NKF) is the largest, most comprehensive, and longstanding patient-centric organization dedicated to the awareness, prevention, and treatment of kidney disease in the U.S.