# Presentation: 676978

## Healthy People 2010Focus Area 4

**Healthy People 2010****Focus Area 4**

**Chronic Kidney Disease Progress Review**
**November 20, 2002**

## Chronic Kidney Disease Objectives 

- Source: United States Renal Data System (USRDS)

**ESRD**

**% transplanted**
**within 3 yrs**

**AV fistula use**
** ****hemodialysis**
** ****(new patients****)**

**ESRD  due**
** ****to diabetes**

**CV deaths in **
**persons with **
**ESRD **

**Chronic Kidney Disease Objectives **
**Targets and Levels Achieved**

**% on**
**transplant **
**wait list**

**% of diabetics **
**with exam / tests**
** ****to prevent **
**ESRD**

**2010 Target**

**Current level**

**Direction of change desired**

**% with counseling **
**prior to start of **
**renal replacement**
** ****therapy  **

**(per 1,000,000 population)**

**- - - - - Incidence - - - - - -**

**(per 1,000 patient years)**

**334**

**217**

**145**

**78**

**52**

**82.6**

**50****%**

**66****%**

**27.2****%**

**21.3****%**

**19.6****%**

**26.3****%**

**60****%**

**45****%**

**Targets-to-be-determined**

## Trends in ESRD: Incidence

**2010 Target**

**Diabetes Prevalence, 2000**

**Trends in ESRD: Incidence**

- Source: United States Renal Data System, (USRDS)

**334**
**(current)**

**217**
**(target)**

- Adjusted for age, gender, and race.

**Incident rate**

**Rate per million population**

## End Stage Renal Disease

**End Stage Renal Disease**

- Source: United States Renal Data System, (USRDS), modified maps from the USRDS 2002 Annual Data Report (ADR).

**Incident rate: 1990**

**Incident rate: 2000**

**370+ (371)**
**300 to <370**
**213 to <300**
**156 to <213**
**below 156 (135)**

**370+ (452)**
**300 to <370**
**213 to <300**
**156 to <213**
**below 156 (136)**

**Unadjusted, per million population**

## Trends in ESRD Incident Rates, by Age and Race/Ethnicity

**Trends in ESRD Incident Rates, by Age and Race/Ethnicity**

- *Adjusted for gender and race.

- *

- **

- **Adjusted for age and gender.

- Source: United States Renal Data System, (USRDS), graphs from the USRDS 2002 Annual Data Report.

## Trends in ESRD Incident rates, by Primary Diagnosis

**Trends in ESRD Incident rates, by Primary Diagnosis**

- Adjusted for age, gender, and  race

- Source: United States Renal Data System, (USRDS), graphs from the USRDS 2002 Annual Data Report.

- Adjusted for age, gender, and race.

## Incident Rates of ESRD with Primary Diagnosis Diabetes  

**Incident**** ****Rates of ESRD with Primary Diagnosis Diabetes  **

- Source: United States Renal Data System, (USRDS), modified maps from USRDS 2002 Annual Data Report.

**205+ (245)**
**125 to <205**
**57 to <125**
**49 to <57**
**below 49 (NA)**

**Unadjusted, per million population**

**1990**

**2000**

**205+ (260)**
**125 to <205**
**57 to <125**
**49 to <57**
**below 49 (44)**

## Trends in Incident Rates of ESRD Due to Diabetes

**Trends in Incident Rates of ESRD Due to Diabetes**
**by Race/Ethnicity    **

- Adjusted for age and gender.

- Source: United States Renal Data System, (USRDS), graph from the USRDS 2002 Annual Data Report.

## Prevalence of Diagnosed Diabetes by Age:

**0-44 Years**

**Total**

**45-64 Years**

**65-74 Years**

**75+ Years**

- Note: Data are three-year averages. Data from 1997 and later years my not be comparable with earlier years due to a redesign of the NHIS in 1997.
- Source: National Health Interview Survey (NHIS), CDC, NCHS.

**Prevalence of Diagnosed Diabetes by Age:**
**United States, 1980-1999**

- 20

- 40

- 60

- 160

- 140

- 120

- 100

- 80

## Diabetes Prevalence, 2000

- Source: National Health Interview Survey (NHIS), CDC, NCHS.

**American Indian/**
**Alaska Native**

**White, not**
**Hispanic**

**Black, not**
**Hispanic**

**Hispanic**

**Asian/Pacific**
** ****Islander **

**2010**
**Target**

**Diabetes Prevalence, 2000**

**Age-adjusted per 1,000 standard population**

## Obesity*: Adults, Age 20 and Older

- Source: National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.  *Body Mass Index _>_ 30

**Obesity*: Adults, Age 20 and Older**
**by Race/Ethnicity**

**White, not**
**Hispanic**

**Black, not**
**Hispanic**

**2010 Target**

**Total**
**  **

**Mexican American**

**1988-94**

**1999-2000**

## Slide 12

## Diabetes Prevalence, 2000

**2010 Target**

**Diabetes Prevalence, 2000**

- Source: United States Renal Data System, (USRDS), modified graph from the 2002 USRDS ADR.

**27.2%**
**(current)**

**50%**
**(2010 target)**

- Adjusted for age, gender, and race.

**Percent of  patients**

**Trends in Arteriovenous Fistula Use **
**Incident Hemodialysis Patients (Age 20 and Older)**

**New Patients**
**Using AV fistulas**

## Diabetes Prevalence, 2000

**American Indian/**
**Alaska Native**

**White, not**
**Hispanic**

**Black, not**
**Hispanic**

**Hispanic**

**Asian/Pacific**
** ****Islander **

**2010 Target**

**Diabetes Prevalence, 2000**

**Proportion of Dialysis Patients Registered **
**on the Waiting List for Transplantation: **
**by Race/Ethnicity, 2000**

**Percent**

- Source: United States Renal Data System, (USRDS)  Note: Patients younger than 70.

## Diabetes Prevalence, 2000

**2010 Target**

**Diabetes Prevalence, 2000**

**Percent of Dialysis Patients Receiving a Transplant**
**Within Three Years of Initiation of Therapy***

- Source: United States Renal Data System, (USRDS).  Note: Patients younger than 70.

***Target to be determined**

- Adjusted for age, gender, and race.

**Percent of  patients**

## Dialysis Patients Receiving a Transplant Within 3 years 

- <date/time>

**Dialysis Patients Receiving a Transplant Within 3 years **
**by Age, Gender, Race/Ethnicity and Diagnosis**

- Source: United States Renal Data System, (USRDS).  Note: Patients younger than 70, graphs from the USRDS 2002 ADR.

## Diabetic Patients Receiving All Three Preventive Tests (Age 67 and Older)*

**Diabetic Patients Receiving All Three Preventive Tests (Age 67 and Older)***

- **Pre-ESRD data: incident ESRD patients with diabetes one year prior to start of ESRD.  Graphs from the 2002 USRDS ADR.

- *Developmental objective, target to be determined

******

## Diabetes Prevalence, 2000

**American Indian/**
**Alaska Native**

**White, not**
**Hispanic**

**Black, not**
**Hispanic**

**Hispanic**

**Asian/Pacific**
** ****Islander **

**2010 Target**

**Diabetes Prevalence, 2000**

**Counseling for Chronic Kidney Failure Care,**
**by Race/Ethnicity, 1996**

**Percent of new ESRD persons who’ve had counseling at least a year before renal replacement therapy**

- Source: United States Renal Data System, (USRDS).

**2010 Target**

## Data Notes

- Full citation for USRDS data, graphs, and maps:  U.S. Renal Data System, USRDS 2002 Annual Data Report: Atlas of End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD  2002.

- USRDS data are adjusted by the direct adjustment method with 1999 as the standard population.
- NCHS data are age adjusted by the direct adjustment method with 2000 as the standard population.
- For the NCHS data, the race/ethnicity groups, American Indian/Alaska Native and Asian/Pacific Islander includes persons of Hispanic and non-Hispanic origin.  Persons of Hispanic origin may be of any race.
- A detailed race/ethnicity description of the USRDS data can be found in the USRDS 2002 ADR.
- The graphs listed below have additional documentation in the 2002 ADR:
**Trends in arteriovenous fistula use in hemodialysis patients-**Includes only patients for whom an access type is known.
**Dialysis patients receiving a transplant within three years**...-”Medicare dialysis patients initiating therapy in the given year; patients older than 69 or with prior transplants are excluded.  Cumulative percents are estimated using the Kaplan-Meier methodology.  Followup is censored at death or the end of the three-year period.”
**Diabetic patients receiving all three preventive health tests**...-”General Medicare data: individuals diagnosed with diabetes in 1997, 1998, or 1999, age 67 or older on December 31 of the diagnosis year, and continuously enrolled in Medicare during 1996-1997, 1997-1998, or 1998-1999.  Patients diagnosed with ESRD during one of these three periods, enrolled in a managed care program, or with Medicare as secondary payor are excluded.  Pre-ESRD data: incident ESRD patients with diabetes one year prior to start of ESRD.  Patients enrolled in a managed care program or with Medicare as secondary payor are excluded.  The three tests are (1) eye exam, (2) lipids, and (3) A1C test.