Kidney Disease: Fact Sheet

Fast Facts (2024 Update)
What is Kidney Disease?
What Causes Kidney Disease?
Kidney failure or end-stage kidney disease (ESKD)
How is Kidney Disease Treated?
Dialysis
At-Home Hemodialysis
Peritoneal Dialysis (PD)
Transplantation

Fast Facts (2024 Update)

(Updated as of 8/6/2024)

Kidney disease, also known as “chronic kidney disease (CKD),” causes more deaths each year than breast cancer or prostate cancer. It is the under-recognized public health crisis.

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.
https://www.cdc.gov/united-states-cancer-statistics/publications/breast-cancer-stat-bite.html
[“…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.
https://www.cdc.gov/united-states-cancer-statistics/publications/prostate-cancer-stat-bite.html
[“…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.
https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
[#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
https://www.ajkd.org/article/S0272-6386(19)30169-6/fulltext

About 35.5 million U.S. adults are estimated to have kidney disease—that’s more than 1 in 7 (14%).

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

About 9 in 10 adults with kidney disease (≈90%) do not know they have it.

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

People with kidney disease may not feel ill or notice symptoms until the disease is advanced.

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

**About 1 in 3 (40%) of adults with severe kidney disease* don’t know they have it.**

*(Stage 4-5; eGFR <29).

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

Kidney Topics: Stages of Chronic Kidney Disease (CKD). National Kidney Foundation. Accessed November 26, 2024.
https://www.kidney.org/kidney-topics/stages-chronic-kidney-disease-ckd

1 in 3 adults in the U.S. (33%) is at risk for kidney disease.

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

Kidney disease is the 8th leading cause of death in the U.S.

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
https://www.cdc.gov/mmwr/volumes/73/wr/mm7331a1.htm

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

About 1 in 3 adults with diabetes and 1 in 5 adults with high blood pressure may have kidney disease.

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

Diabetes is the most common cause of kidney disease. Diabetes and hypertension cause or contribute to 2 of 3 new cases of kidney failure.

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]

Kidney Topics: Chronic Kidney Disease. Kidney.org. Last Updated: September 11, 2023. Accessed November 25, 2024.
https://www.kidney.org/kidney-topics/chronic-kidney-disease-ckd

Kidney Topics: Diabetes. Kidney.org. Accessed November 25, 2024.
https://www.kidney.org/kidney-health/diabetes

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

Two simple tests (blood/urine) can detect kidney disease early. Earliest detection is crucial so that further damage can be slowed or stopped.

Kidney Topics: Chronic Kidney Disease. Kidney.org. Last Updated: September 11, 2023. Accessed November 25, 2024.
https://www.kidney.org/kidney-topics/chronic-kidney-disease-ckd
[See: "Diagnosis"]

12 people die every day while on a waiting list for a kidney transplant.

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]

Adults with kidney disease are at higher risk of early death.

Prevalence of kidney disease: non-Hispanic Black adults 20%; Hispanic/Latino adults 14%; non-Hispanic Asian adults 14%; non-Hispanic White adults 12%.

Black/African American people have 4 times the incidence of kidney failure (ESKD) as White persons.

Hispanic/Latino and American Indian/Alaska Native people have 2 times the incidence of kidney failure as White persons. Asian people are 1.4 times more likely than Whites to experience kidney failure.

[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.]

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.”]

30% of all patients with kidney failure are Black/African American, even though this group is 13% of the U.S. population.

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]

Almost one-third of people on the kidney transplant waitlist are Black/African American. Black/African American transplant recipients are also less likely to receive a kidney from a living donor.

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 ]

Approximately 1 in 4 Medicare dollars is spent on kidney patients—$156.7 billion and growing.

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.”]

Without increased investment in prevention, the total number of patients with kidney failure (ESKD) will likely exceed 1 million by 2030.

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/

COVID-19 continues to endanger the health and lives of kidney patients. The CDC recently (2/2024) updated their guidelines to recommend that people 65 and older should get vaccine boosters. The CDC recommends that everyone (age 6+ months) get an updated 2024–2025 COVID-19 vaccine.

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

Centers for Disease Control and Prevention. Staying Up to Date with COVID-19 Vaccines. October 3, 2024. Accessed November 25, 2024.
https://www.cdc.gov/covid/vaccines/stay-up-to-date.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.]

What is Kidney Disease?

(Updated as of 11/15/2024)

“Kidney disease” means your kidneys aren't working properly and are beginning to lose their function. “Chronic kidney disease (CKD),” worsens over time (for at least 3 months).
Kidney disease and chronic kidney disease (CKD) mean your kidneys are damaged and losing their ability to keep you healthy by filtering your blood and are having a hard time doing all their important jobs. In the early stages of the disease, most people do not have symptoms. But as chronic 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).

[Reference for above 2 bullet points/facts.]

Chronic Kidney Disease. Cleveland Clinic. Last reviewed May 7, 2023. Accessed August 5, 2024.
https://my.clevelandclinic.org/health/diseases/15096-chronic-kidney-disease

Kidney Topics: Chronic Kidney Disease (CKD). National Kidney Foundation. Accessed August 5, 2024.
https://www.kidney.org/kidney-topics/chronic-kidney-disease-ckd#about-chronic-kidney-disease-ckd

Kidney disease becomes “chronic” (CKD) when kidney function decreases over time (3+ months) and can lead to kidney failure (ESKD). Not all people with CKD will have kidney failure, but it can worsen without treatment. There is no cure, but kidney damage and be slowed or even stopped with treatment. Dialysis and transplantation are the treatments for kidney failure.

Chronic Kidney Disease. Cleveland Clinic. Last reviewed May 7, 2023. Accessed August 5, 2024.
https://my.clevelandclinic.org/health/diseases/15096-chronic-kidney-disease

Kidney Topics: Chronic Kidney Disease (CKD). National Kidney Foundation. Accessed August 5, 2024.
https://www.kidney.org/kidney-topics/chronic-kidney-disease-ckd#about-chronic-kidney-disease-ckd

Diabetes is the most common cause of kidney disease, and about 1 in 3 adults with diabetes has kidney disease. Diabetes and hypertension cause or contribute to 2 of 3 new cases of kidney failure.

Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2023: CKD Risk Factors. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2023.
https://www.cdc.gov/kidneydisease/publications-resources/annual-report/ckd-risk-prevention.html

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

Kidney Topics: Chronic Kidney Disease (CKD). National Kidney Foundation. Accessed February 12, 2024.
https://www.kidney.org/kidney-topics/chronic-kidney-disease-ckd#about-chronic-kidney-disease-ckd

People with kidney disease may not feel ill or notice any symptoms until it is advanced.
Two simple tests (blood/urine) can detect kidney disease early. Earliest detection is crucial so that further damage can be slowed or stopped.

[Reference for above 2 bullet points/facts.]

Kidney Topics: Chronic Kidney Disease (CKD). National Kidney Foundation. Accessed February 12, 2024.
https://www.kidney.org/kidney-topics/chronic-kidney-disease-ckd#about-chronic-kidney-disease-ckd

Anyone can develop CKD—at any age. However, some people are at a higher risk than others. In addition to diabetes and high blood pressure (hypertension), common risk factors include: heart disease and/or heart failure, obesity, age 60+, a family history of CKD or kidney failure, inherited kidney disorders, past damage to the kidneys/AKI (acute kidney injury), smoking and/or use of tobacco products, history of overusing NSAID (nonsteroidal anti-inflammatory drugs) pain relievers or other over-the-counter (OTC) products, and other factors. Exposure to certain environmental chemicals has also been recently highlighted as a risk factor.

American Society of Nephrology (ASN). Certain Environmental Chemicals Linked with Poor Kidney Health. Newswise. Published May 15, 2020. Accessed August 8, 2024.
https://www.newswise.com/articles/certain-environmental-chemicals-linked-with-poor-kidney-health

Chronic Kidney Disease. Cleveland Clinic. Last reviewed May 7, 2023. Accessed February 12, 2024.
https://my.clevelandclinic.org/health/diseases/15096-chronic-kidney-disease

Kidney Topics: Chronic Kidney Disease (CKD). National Kidney Foundation. Accessed August 8, 2024.
https://www.kidney.org/kidney-topics/chronic-kidney-disease-ckd#about-chronic-kidney-disease-ckd

Lao XQ, Bo Y, Chen D, Zhang K, Szeto CC. Environmental pollution to kidney disease: an updated review of current knowledge and future directions. Kidney Int. 2024 Aug;106(2):214-225. doi: 10.1016/j.kint.2024.04.021. Epub 2024 May 24. PMID: 38797324.
https://pubmed.ncbi.nlm.nih.gov/38797324/
https://www.kidney-international.org/article/S0085-2538(24)00344-2/fulltext
https://www.kidney-international.org/article/S0085-2538(24)00344-2/pdf

Mayo Clinic Staff. Chronic kidney disease. Mayo Clinic. Published September 6, 2023. Accessed August 8, 2024.
https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/symptoms-causes/syc-20354521

Risk Factors for Chronic Kidney Disease. Centers for Disease Control and Prevention. Published May 15, 2024. Accessed August 8, 2024.
https://www.cdc.gov/kidney-disease/risk-factors/index.html

The Greatest Environmental Risk Factors for Kidney Health: What the Latest Studies Reveal About Fetal, Infant, and Childhood Exposures: A Conversation with Mount Sinai’s Alison P. Sanders, PhD, a widely recognized authority on environmental risk hazards to humans. Mount Sinai. Accessed August 8, 2024.
https://reports.mountsinai.org/article/peds2021-03-environmental-risk-factors-kidney-health

Tsai HJ, Wu PY, Huang JC, Chen SC. Environmental Pollution and Chronic Kidney Disease. Int J Med Sci. 2021 Jan 1;18(5):1121-1129. doi: 10.7150/ijms.51594. PMID: 33526971; PMCID: PMC7847614.
https://pubmed.ncbi.nlm.nih.gov/33526971/

Webb MJ. Certain environmental chemicals linked to increased kidney disease risk. Healio. Published May 26, 2020. Accessed August 8, 2024.
https://www.healio.com/news/nephrology/20200526/certain-environmental-chemicals-linked-to-increased-kidney-disease-risk

Weidemann DK, Weaver VM, Fadrowski JJ. Toxic environmental exposures and kidney health in children. Pediatr Nephrol. 2016 Nov;31(11):2043-54. doi: 10.1007/s00467-015-3222-3. Epub 2015 Oct 12. PMID: 26458883; PMCID: PMC4829489.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4829489/

A “cause” is something that directly brings about a disease. A “risk factor” is an occurrence or characteristic that is associated with an increased rate of a disease. A “risk factor” may or may not be a “cause”; the term “risk factor” is more widely applicable. Sometimes the terms can be used interchangeably, sometimes not; check sources.

Norwood D. Word for Word: Risk Factor vs. Cause. University of Texas; MD Anderson Cancer Center; Research Medical Library.
https://openworks.mdanderson.org/cgi/viewcontent.cgi?article=1005&context=word2023#:~:text=In%20contrast%20with%20the%20definition,than%20that%20of%20a%20cause

Increasing rates of diabetes, obesity, and hypertension compromise efforts to reduce CKD in the population.

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
[Volume 1: Chronic Kidney Disease: Chapter 1: CKD in the General Population: Summary: “Increasing rates of obesity, hypertension, and diabetes in the population threatens public health efforts at reducing the prevalence of CKD in the population as a whole and highlights the importance of addressing these major CKD risk factors in efforts to reduce the overall burden of CKD. The need for prevention of risk factors for CKD can be appreciated by considering lifestyle factors.”]

Kidney disease increases the risk of heart disease and stroke.

Kidney Topics: Chronic Kidney Disease (CKD). National Kidney Foundation. Accessed February 12, 2024.
https://www.kidney.org/kidney-topics/chronic-kidney-disease-ckd#about-chronic-kidney-disease-ckd

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Heart Disease & Kidney Disease. Last reviewed June 2016. Accessed 2/12/2024.
https://www.niddk.nih.gov/health-information/kidney-disease/heart-disease

The Heart and Kidney Connection. National Kidney Foundation. Accessed August 5, 2024.
https://www.kidney.org/atoz/content/heart-and-kidney-connection

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.

Aguilar D. Heart failure, diabetes mellitus, and chronic kidney disease: a clinical conundrum. [Editorial] Circulation: Heart Failure. 13 July 2016. 9(7).
https://doi.org/10.1161/CIRCHEARTFAILURE.116.003316
https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.116.003316

Centers for Disease Control and Prevention. Chronic Kidney Disease and High Blood Pressure. Published May 15, 2024. Accessed 8/6/2024.
https://www.cdc.gov/kidney-disease/risk-factors/chronic-kidney-disease-ckd-and-adults-with-high-blood-pressure.html

Centers for Disease Control and Prevention. Chronic Kidney Disease, Diabetes, and Heart Disease. Published May 15, 2024. Accessed 8/6/2024.
https://www.cdc.gov/kidney-disease/risk-factors/link-between-diabetes-and-heart-disease.html

Muhammad Shariq Usman, Muhammad Shahzeb Khan, Javed Butler; The Interplay Between Diabetes, Cardiovascular Disease, and Kidney Disease. ADA Clinical Compendia. 1 June 2021; 2021 (1): 13–18.
https://doi.org/10.2337/db20211-13 https://diabetesjournals.org/compendia/article/2021/1/13/144946/The-Interplay-Between-Diabetes-Cardiovascular

Scholle SH, Onstad K, Hart A, Hwee T; National Committee for Quality Assurance (NCQA). Chronic kidney disease disparities: educational guide for primary care. Washington, DC: Department of Health and Human Services (DHHS), Centers for Medicare & Medicaid Services (CMS), Office of Minority Health (OMH); February 2020. PDF:
https://www.cms.gov/files/document/chronic-kidney-disease-disparities-educational-guide-primary-care.pdf
[Pages 6 & 10] [NOTE: The booklet above is also footnoted and contains sources for more detailed data.]

Sheikh K. Diabetes Often Leads to Heart and Kidney Disease, Too. New York Times. Published May 15, 2024; Updated May 20, 2024.
https://www.nytimes.com/2024/05/15/well/live/ckm-syndrome-heart-disease-risk.html

Kidney disease is medically classified into five stages, based on the presence of kidney damage and level of kidney function (glomerular filtration rate [GFR]), ranging from early-stage (stage 1) to kidney failure (stage 5, dialysis/transplant needed). It is best to diagnose kidney disease at its earliest stages before more irreversible damage occurs.

Chronic Kidney Disease. Cleveland Clinic. Last reviewed May 7, 2023. Accessed August 8, 2024.
https://my.clevelandclinic.org/health/diseases/15096-chronic-kidney-disease

Kidney Topics: Stages of Chronic Kidney Disease. National Kidney Foundation. Accessed November 26, 2024.
https://www.kidney.org/kidney-topics/stages-chronic-kidney-disease-ckd

National Kidney Foundation. (2002). KDOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. New York: National Kidney Foundation, Inc.
https://www.kidney.org/sites/default/files/docs/ckd_evaluation_classification_stratification.pdf
https://kidneyfoundation.cachefly.net/professionals/KDOQI/guidelines_ckd/p4_class_g1.htm

What Causes Kidney Disease?

(Updated as of 11/15/2024)

The main cause of kidney disease is diabetes, followed by high blood pressure.

Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2023: CKD Risk Factors. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2023.
https://www.cdc.gov/kidneydisease/publications-resources/annual-report/ckd-risk-prevention.html

Kidney Topics: Chronic Kidney Disease (CKD). National Kidney Foundation. Accessed February 12, 2024.
https://www.kidney.org/kidney-topics/chronic-kidney-disease-ckd#about-chronic-kidney-disease-ckd

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Kidney Disease Statistics for the United States. Last reviewed May 2023. Accessed February 12, 2024.
https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease

35.6% of people with CKD had diabetes. (2017-March 2020)

75.3% of people with CKD had hypertension. (2017-March 2020)

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
[Volume 1: Chronic Kidney Disease: Chapter 1: CKD in the General Population;
Highlights: Bullet #4: The prevalence of diabetes mellitus (DM) has increased among individuals with and without CKD since 2005, reaching 9.5% in those without CKD and 35.6% in those with CKD in 2017-March 2020 (Figure 1.6).

Figure 1.2 Demographics of CKD and non-CKD patients; tabs “Diabetes” and “Hypertension”:
•35.6% diabetes (2017-March 2020)
•75.3% hypertension (2017-March 2020)
Caption: “In the case of hypertension, there was relatively little change. In 2017-March 2020, hypertension was present in fully 75.3% of those with CKD but only 45.5% of those without.
Although the prevalence of diabetes among individuals with CKD increased over time, from 27.3% in 2005-2008 to 35.6% in 2017-March 2020, this was also the case for individuals without CKD, in whom diabetes increased from 6.5% in 2005-2008 to 9.5% in 2017-March 2020.”]

These two conditions account for about 75% of new (incident) CKD cases.

United States Renal Data System (USRDS). 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/reference-tables
[USRDS 2023 ADR Reference Tables, Vol. 2—ESRD; Ref. Tables A Incidence; Table A.4 Incident counts of reported ESRD patients, by age and primary cause of ESRD. Col. B, Row 6 All patients: 135,972; Col. B, Row 47 Diabetes: 60,112; Col. B, Row 48 Hypertension: 39,666.]
[Computed from: All patients 135,972 / Diabetes 60,112 = 44% (0.442); All patients 135,972 / Hypertension 39,666 = 29% (0.29172); (D 60,112 + H 39,666 = 99,778 /All pts 135,972 = 0.73381) = 73%]

[Also: USRDS 2023 ADR Reference Tables, Vol. 2—ESRD; Ref. Tables A Incidence; Table A.7 Incidence of reported ESRD of all patients for 2017-2021 combined, by detailed primary diagnosis.
Col. C: Total patients, Row 6: All ESRD (reference): 661,015; Col. C, Total patients, Row 7: Diabetes: 306,064, Col. D: % Incident 46.7; Col. C, Total patients, Row 45: Hypertensive/Large Vessel Disease: 191,052, Col. D: % Incident 29.2; Total % Incident 75.9]

Diabetes is the leading risk factor for CKD. Persons with diabetes make up the fastest-growing group of kidney dialysis and transplant recipients in the United States.

Risk Factors for Kidney Disease. CDC Kidney Disease Surveillance System. Accessed August 6, 2024.
https://nccd.cdc.gov/CKD/default.aspx
[See: "Risk factors."]

The prevalence of CKD among adults with diabetes has decreased from 42.3% in the 2001–2004 National Health and Nutrition Examination Survey (NHANES) to 38.5% in the 2017–March 2020 survey.

But the prevalence of diabetes mellitus (DM) has increased among all people (with and without CKD) since 2005, rising to 9.5% in those without CKD and 35.6% in those with CKD. (2017–March 2020)

Hypertension (HTN) is the second leading risk factor for CKD. CKD can also lead to hypertension. The prevalence of CKD among adults with hypertension was 24.6% in the 2017–March 2020 National Health and Nutrition Examination Survey (NHANES) survey.

Risk Factors for Kidney Disease. CDC Kidney Disease Surveillance System. Accessed August 6, 2024.
https://nccd.cdc.gov/CKD/default.aspx
[See: Risk factors]

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
[Volume 1: Chronic Kidney Disease: Chapter 1: CKD in the General Population; Highlights]

Worldwide rates of obesity, a major risk factor and cause of kidney disease and other conditions, have doubled in the past three decades (1990-2022). More than 2 in 5 adults in the U.S. have obesity.

Adult Obesity Facts. Centers for Disease Control and Prevention (CDC). Published May 14, 2024. Accessed August 9, 2024.
https://www.cdc.gov/obesity/php/data-research/adult-obesity-facts.html

Mitchell A. America’s 100 most obese cities revealed — and the top 10 have something in common. NY Post. Published March 14, 2024. Accessed August 8, 2024.
https://nypost.com/2024/03/14/lifestyle/americas-100-most-obese-cities-revealed-the-top-10-have-something-in-common/

NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet. 2024 Mar 16;403(10431):1027-1050. doi: 10.1016/S0140-6736(23)02750-2. Epub 2024 Feb 29. PMID: 38432237; PMCID: PMC7615769.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02750-2/fulltext
https://pubmed.ncbi.nlm.nih.gov/38432237/

Reed T. Worldwide obesity tops 1 billion. Axios. February 29, 2024. Accessed August 8, 2024.
https://www.axios.com/2024/02/29/worldwide-obesity-doubles

Other causes of CKD include: glomerular diseases (diseases that damage the kidney’s filtering units): glomerulonephritis, IgA nephropathy (IgAN), and HIV nephropathy; inherited conditions: polycystic kidney disease; autoimmune conditions: lupus (lupus nephritis); membraneous nephropathy (MN); severe infections: sepsis and hemolytic uremic syndrome (HUS); kidney cancer; kidney stones; frequent untreated and/or long-lasting urinary tract infections (UTIs) and obstructions; hydronephrosis; kidney and urinary tract abnormalities before birth; nephrotic syndrome; exposure to certain chemicals, toxins, contrast dyes, and drugs (including overuse of NSAIDs (nonsteroidal anti-inflammatory drug pain relievers)); etc.

Chronic Kidney Disease. Cleveland Clinic. Last reviewed May 7, 2023. Accessed February 12, 2024.
https://my.clevelandclinic.org/health/diseases/15096-chronic-kidney-disease

Chronic kidney disease. Mayo Clinic. Published September 6, 2023. Accessed August 9, 2024.
https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/symptoms-causes/syc-20354521

Kidney Topics: Chronic Kidney Disease (CKD). National Kidney Foundation website. Accessed February 12, 2024.
https://www.kidney.org/kidney-topics/chronic-kidney-disease-ckd#about-chronic-kidney-disease-ckd

Risk Factors for Chronic Kidney Disease. Centers for Disease Control and Prevention. Published May 15, 2024. Accessed August 8, 2024.
https://www.cdc.gov/kidney-disease/risk-factors/index.html

Lupus nephritis (LN), a major cause of kidney disease, is an inflammation of the kidneys caused by lupus, an autoimmune disease (systemic lupus erythematosus (SLE)). About half of people diagnosed with lupus nephritis didn't know they had it. The prevalence of LN is 30.9 per 100,000, and it is most common at ages 20 to 40. LN patients are mostly Black/African American, White, and Hispanic/Latino people, but it affects all races and ethnicities. 9 out of 10 people with lupus are women, but men are more likely to develop lupus nephritis.

Lupus Nephritis. Cleveland Clinic. Last reviewed on 09/09/2021. Accessed August 9, 2024.
https://my.clevelandclinic.org/health/diseases/21809-lupus-nephritis

Lupus Nephritis & Your Kidneys. National Kidney Foundation. Accessed August 9, 2024.
https://www.kidney.org/content/lupus-nephritis-your-kidneys-patients

Lupus and the Kidneys. Lupus Foundation of America. Last updated: January 13, 2021; Medically reviewed: December 23, 2020. Accessed August 9, 2024.
https://www.lupus.org/resources/how-lupus-affects-the-renal-kidney-system

Pryor KP, Barbhaiya M, Costenbader KH, Feldman CH. Disparities in Lupus and Lupus Nephritis Care and Outcomes Among US Medicaid Beneficiaries. Rheum Dis Clin North Am. 2021 Feb;47(1):41-53. doi: 10.1016/j.rdc.2020.09.004. Epub 2020 Oct 29. PMID: 34042053; PMCID: PMC8171807.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8171807/

AKI

Acute kidney injury (AKI), also known as acute renal failure (ARF), is a sudden episode of kidney failure or kidney damage. For most people, AKI develops within 48 hours, but sometimes it can take as long as 7 days. (This replaces an older term, “acute renal failure” (or ARF), which you may still see or hear occasionally.)

Kidney Topics: Acute Kidney Injury. National Kidney Foundation. Last Updated: February 26, 2024. Accessed November 26, 2024.
https://www.kidney.org/kidney-topics/acute-kidney-injury-aki

Acute kidney injury (AKI) is a major global public health problem affecting millions of patients worldwide.

Abebe, A., Kumela, K., Belay, M. et al. Mortality and predictors of acute kidney injury in adults: a hospital-based prospective observational study. Sci Rep 11, 15672 (2021).
https://doi.org/10.1038/s41598-021-94946-3
https://www.nature.com/articles/s41598-021-94946-3

Gameiro J, Agapito Fonseca J, Jorge S, Lopes JA. Acute Kidney Injury Definition and Diagnosis: A Narrative Review. J Clin Med. 2018 Sep 28;7(10):307. doi: 10.3390/jcm7100307. PMID: 30274164; PMCID: PMC6211018.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6211018/

Singbartl K, Kellum JA. AKI in the ICU: definition, epidemiology, risk stratification, and outcomes. Kidney Int. 2012 May;81(9):819-25. doi: 10.1038/ki.2011.339. Epub 2011 Oct 5. PMID: 21975865.
https://pubmed.ncbi.nlm.nih.gov/21975865/
https://www.kidney-international.org/article/S0085-2538(15)55401-X/fulltext

The in-hospital mortality rate for AKI patients is 40%-50%, and for AKI patients in ICU, more than 50%. Long term, at least 12% to 15% of AKI patients with may need permanent dialysis.

Goyal A, Daneshpajouhnejad P, Hashmi MF, et al. Acute Kidney Injury. [Updated 2023 Nov 25]. StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 Jan. Last Update: November 25, 2023.
https://www.ncbi.nlm.nih.gov/books/NBK441896/

Acute kidney injury (AKI) can be a complication of pregnancy. AKI in pregnancy is a public health problem and is a cause of maternal and fetal morbidity and mortality. AKI during pregnancy (PR-AKI) has rates of maternal mortality and fetal loss that range from 30 to 60%, making it life-threatening.

Liu Y, Ma X, Zheng J, Liu X, Yan T. Pregnancy outcomes in patients with acute kidney injury during pregnancy: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2017 Jul 18;17(1):235. doi: 10.1186/s12884-017-1402-9. PMID: 28720086; PMCID: PMC5516395.
https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-017-1402-9
https://pubmed.ncbi.nlm.nih.gov/28720086/

Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A; World Kidney Day Steering Committee. What we do and do not know about women and kidney diseases; questions unanswered and answers unquestioned: reflection on World Kidney Day and International Woman's Day. BMC Nephrol. 2018 Mar 15;19(1):66. doi: 10.1186/s12882-018-0864-y. PMID: 29544451; PMCID: PMC5856379.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5856379/

Szczepanski J, Griffin A, Novotny S, Wallace K. Acute Kidney Injury in Pregnancies Complicated With Preeclampsia or HELLP Syndrome. Front Med (Lausanne). 2020 Feb 7;7:22. doi: 10.3389/fmed.2020.00022. PMID: 32118007; PMCID: PMC7020199.
https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2020.00022/full
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7020199/

Taber-Hight E, Shah S. Acute Kidney Injury in Pregnancy. Adv Chronic Kidney Dis. 2020 Nov;27(6):455-460.
doi: 10.1053/j.ackd.2020.06.002. PMID: 33328061; PMCID: PMC7751749.
https://pubmed.ncbi.nlm.nih.gov/33328061/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7751749/

The rate of AKI was about 81% higher among African American/Black Medicare fee-for-service (FFS) beneficiaries than among White beneficiaries (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/chronic-kidney-disease/4-acute-kidney-injury
[Volume 1 Chronic Kidney Disease; Chapter 4. Acute Kidney Injury; Highlights; Bullet #2; “In 2021, the rate of AKI was about 81% higher among Black Medicare fee-for-service (FFS) beneficiaries, at 108.8 per 1000 person-years, than among White beneficiaries (60.1 per 1000 person-years; Figure 4.1).”]

Medicare (FFS) beneficiaries starting outpatient hemodialysis for AKI increased to almost 12,000 people (2017-2020), amounting to almost 10% of new in-center HD patients in 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/introduction
[Introduction: Section: Racial differences in outpatient dialysis for AKI: “The number of Medicare FFS beneficiaries who initiated outpatient hemodialysis for AKI has grown since 2017 to reach almost 12,000 individuals each year over the last three years, constituting almost 10% of the total new in-center HD starts in 2021.”]

Kidney failure or end-stage kidney disease (ESKD)

(Updated 11/15/2024)

Also called kidney failure with replacement therapy (KFRT) or end-stage renal disease (ESRD).

Nomenclature for Kidney Function and Disease: A KDIGO Consensus Conference on Nomenclature. June 27-29, 2019. Amsterdam, Netherlands.
Kidney Disease Improving Global Outcomes (KDIGO). Accessed August 12, 2024.
https://kdigo.org/wp-content/uploads/2018/10/KDIGO-Nomenclature-Conf_Scope-for-Public-Review.pdf

“Kidney failure” means that one or both kidneys have shut down completely and are no longer functioning. This is an irreversible, life-threatening condition.

Chronic Kidney Disease. Cleveland Clinic website. Last reviewed 05/07/2023. Accessed 2/12/2024.
https://my.clevelandclinic.org/health/diseases/15096-chronic-kidney-disease

Kidney Topics: Chronic Kidney Disease (CKD). National Kidney Foundation website. Accessed 2/12/2024.
https://www.kidney.org/kidney-topics/chronic-kidney-disease-ckd#about-chronic-kidney-disease-ckd

Almost 808,000 people in the US (2 in every 1,000) lived with ESKD: 69% on dialysis and 31% with a kidney transplant. (2020 data)
130,500 people in the US started treatment for ESKD. (130,522; 2020 data)
Among men, the incidence rate of ESKD was 60% higher than women. (2020 data)
Diabetes (38%) and high blood pressure (27%) were the major causes of end-stage kidney disease (ESKD) in the U.S. (65%; 2020 data)

[Reference for 4 bullets/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/php/data-research/index.html
[See link to pdf sheet: https://www.cdc.gov/kidney-disease/media/pdfs/CKD-Factsheet-H.pdf]

United States Renal Data System (USRDS). 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.
[End Stage Renal Disease: Chapter 1: Incidence, Prevalence, Patient Characteristics, and Treatment Modalities: Figure 1.5 Prevalence of ESRD, 2001-2021: 2021: 808, 536]
https://usrds-adr.niddk.nih.gov/2023/end-stage-renal-disease/1-incidence-prevalence-patient-characteristics-and-treatment-modalities

Between 2019-2021 diabetes (46%; 179,187 count), the leading cause of kidney failure (KFRT), and hypertension (high blood pressure; 29%; 113,887 count), the second leading cause of KFRT, were the primary diagnosis in 76% (293,074 count) of all new (incident) kidney failure cases (391,387 count). (USRDS)

United States Renal Data System (USRDS). 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/reference-tables
[USRDS 2023 ADR Reference Tables, Vol. 2—ESRD; Ref. Tables A Incidence; Table A.4 Incident counts of reported ESRD patients, by age and primary diagnosis, 2019-2021 combined; U.S. patients, unknown sex and other or unknown race/ethnicity dropped. Table A.4 Incident counts of reported ESRD patients, by age and primary diagnosis, 2019-2021 combined. Column B All, Row 7 All: 391,387; Column B All, Row 35 Diabetes: 179,187 (179,187/391,387 = 0.4578; 46%); Column B All, Row 36 Hypertension: 113,887 (113,887/391,387 = 0.290; 29%). Diabetes and Hypertension (46% + 29%) 76%.]

Most people with newly diagnosed (incident) ESKD had diabetes (DM; 59%); 25% had heart failure (HF). The percentage of diabetes was high in Native American (American Indian) patients (80%) and was also high among Native Hawaiian/Pacific Islander (NHPI; 74%) and Hispanic/Latino (67%) ESKD patients compared to Asian American (62%), African American/Black (57%), and White (56%) patients.

Other conditions that can lead to kidney failure (kidney failure with replacement therapy; 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, Fabry disease; malformations at birth that occur as a fetus develops; lupus nephritis, IgA nephropathy (IgAN; Berger's disease), and other immune diseases; obstructions such as kidney stones or an enlarged prostate; pyelonephritis or inflammation of the kidney due to bacterial infection; and repeated urinary tract infections, which can also lead to kidney infections and can cause long-term damage to the kidneys.

Kidney Failure. Cleveland Clinic. Last reviewed on October 4, 2022. Accessed August 14, 2024.
https://my.clevelandclinic.org/health/diseases/17689-kidney-failure

Kidney Topics: Kidney Failure. National Kidney Foundation. Accessed August 14, 2024.
https://www.kidney.org/kidney-topics/kidney-failure

Mayo Clinic Staff. Kidney infection. Mayo Clinic. August 6, 2022. Accessed August 14, 2024.
https://www.mayoclinic.org/diseases-conditions/kidney-infection/symptoms-causes/syc-20353387

Ramakrishnan K, Scheid DC. Diagnosis and management of acute pyelonephritis in adults.Am Fam Physician. 2005 Mar 1;71(5):933-42. Erratum in: Am Fam Physician. 2005 Dec 1;72(11):2182. PMID: 15768623.
https://www.ncbi.nlm.nih.gov/pubmed/15768623

Salifu MO, Saggi SJ. Chronic Glomerulonephritis. Medscape. Updated: Nov 01, 2022. Accessed August 14, 2024.
https://emedicine.medscape.com/article/239392-overview

Types of Congenital Kidney & Urinary Tract Problems. Hassenfeld Children’s Hospital at NYU Langone. Accessed August 14, 2024.
https://nyulangone.org/conditions/congenital-kidney-urinary-tract-problems/types

How is Kidney Disease Treated?

Treatment of kidney disease is best facilitated by early detection when the disease can be slowed or stopped. Early treatment includes: diet, exercise, medications, lifestyle changes (e.g., stopping smoking), avoiding non-steroid anti-inflammatory drugs (NSAIDs), and treating risk factors like diabetes and hypertension. However, once kidneys fail, treatment with dialysis or a kidney transplant is needed to survive.
Checking for CKD is easy with two simple tests: a blood test known as the estimated glomerular filtration rate (eGFR); a urine test known as the urine albumin-creatinine ratio (uACR).

[Reference for above 2 bullet points/facts]

Kidney Topics: Chronic Kidney Disease (CKD). National Kidney Foundation website. Accessed 2/12/2024.
https://www.kidney.org/kidney-topics/chronic-kidney-disease-ckd#about-chronic-kidney-disease-ckd

There are two treatment options for kidney failure (ESKD/ESRD): dialysis (hemodialysis or peritoneal dialysis) and kidney transplantation.

Kidney Topics: Choosing A Treatment for Kidney Failure. National Kidney Foundation. Accessed August 14, 2024.
https://www.kidney.org/kidney-topics/choosing-treatment-kidney-failure

CDC: Nearly 808,000 people in the United States, or 2 in every 1,000 people, were living with ESKD: 69% were on dialysis and 31% were living with a kidney transplant. (2020 data)

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/kidneydisease/publications-resources/ckd-national-facts.html
[See link to pdf sheet: https://www.cdc.gov/kidneydisease/pdf/CKD-Factsheet-H.pdf]

United States Renal Data System (USRDS). 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.
[End Stage Renal Disease: Chapter 1: Incidence, Prevalence, Patient Characteristics, and Treatment Modalities: Figure 1.5 Prevalence of ESRD, 2001-2021: 2021: 808, 536]
https://usrds-adr.niddk.nih.gov/2023/end-stage-renal-disease/1-incidence-prevalence-patient-characteristics-and-treatment-modalities

Although it is very important for patients nearing dialysis or kidney transplantation to be cared for by a nephrologist, White (34.9% >12 months of care) and Asian American (32.9%) people had the longest durations of pre-ESKD nephrology care, while Hispanic (22.7% >12 months of care), African American/Black (25.6%), and Native Hawaiian/Pacific Islander (27.5%) people had the shortest duration of pre-ESKD care.

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
[Volume 2 End-Stage Renal Disease: Chapter 1 Incidence, Prevalence, Patient Characteristics, and Treatment Modalities; Figure 1.12 Duration of pre-ESRD nephrology care among incident ESRD patients by patient characteristics, 2021; caption & figure]

Dialysis

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. 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. At-home dialysis offers better quality of life for most patients, and can lead to improved clinical outcomes, with proper education, compliance, and support.

Kidney Topics: Dialysis. National Kidney Foundation. Accessed 2/14/2024.
https://www.kidney.org/kidney-topics/dialysis

Levinson K. Survival rate similar for patients on home hemodialysis vs peritoneal dialysis. Nephrology News and Issues. Published August 23, 2021. Accessed August 14, 2024.
https://www.healio.com/news/nephrology/20210823/survival-rate-similar-for-patients-on-home-hemodialysis-vs-peritoneal-dialysis

Miller BW, Himmele R, Sawin DA, Kim J, Kossmann RJ. Choosing Home Hemodialysis: A Critical Review of Patient Outcomes. Blood Purif. 2018;45(1-3):224-229. doi: 10.1159/000485159. Epub 2018 Jan 26. PMID: 29478056.
https://pubmed.ncbi.nlm.nih.gov/29478056/

Dialysis is usually performed at a dialysis center, but some patients perform hemodialysis at home. “In-center hemodialysis” is performed at a dialysis facility. “Home hemodialysis” (HHD) as a term can cover “at-home hemodialysis,” where the dialysis is done by a machine in your home (standard, short daily, or nightly), or “peritoneal dialysis,” where you (CAPD) or a machine (APD) exchange a special dialysis fluid through your belly to perform the filtering functions of your kidneys.

Ashby D, Borman N, Burton J, et al. Renal Association Clinical Practice Guideline on Haemodialysis. BMC Nephrol. 2019 Oct 17;20(1):379. doi: 10.1186/s12882-019-1527-3. PMID: 31623578; PMCID: PMC6798406.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6798406/

Choosing a Treatment for Kidney Failure. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Last Reviewed January 2018. Accessed August 14, 2024.
https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/choosing-treatment

Hemodialysis. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Last Reviewed January 2018. Accessed August 14, 2024.
https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/hemodialysis

Kidney Topics: Dialysis. National Kidney Foundation. Accessed 2/14/2024.
https://www.kidney.org/kidney-topics/dialysis

Kidney Topics: Home Hemodialysis. National Kidney Foundation. Accessed August 14, 2024.
https://www.kidney.org/kidney-topics/home-hemodialysis

Mehmood Y, Ali I, Zahra K, Ashra U. Hemodialysis. The Professional Medical Journal. 2019 January;26(01). doi:10.29309/TPMJ/2019.26.01.2511
https://www.researchgate.net/publication/330361385_HEMODIALYSIS

About 550,000 people in the United States receive some form of dialysis to replace kidney function.

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
[Volume 2 End-Stage Renal Disease: Chapter 1 Incidence, Prevalence, Patient Characteristics, and Treatment Modalities; Figure 1.6 Prevalent ESRD by modality, 2001-2021; Tab Prevalent Count: Year 2021: In-Center Hemodialysis: 462,539, Peritoneal Dialysis: 66,184, Home Hemodialysis: 12,603, TOTAL: 541,326]

360 people begin dialysis every 24 hours.

Chronic Kidney Disease Basics. Centers for Disease Control and Prevention (CDC). Accessed August 14, 2024.
https://www.cdc.gov/kidney-disease/about/index.html

113,309 patients (2021) started in-center HD, or 83.8% of individuals with incident ESKD; this was a decrease from a peak of 91.4% in 2008.

At-Home Hemodialysis

13.7% of all dialysis patients performed dialysis at home. (NIH 2020)
Home dialysis increased approximately 50% between 2010 and 2020.

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); National Institutes of Health. Kidney Disease Statistics for the United States. Last Reviewed May 2023. Accessed August 14, 2024.
https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease

Incident dialysis patients performing home dialysis increased from 7.5% to 13.4%, from 2011 to 2021.
White and Asian American patients were more likely to dialyze at home than African American/Black and Hispanic/Latino patients. (2011-2021)

[Reference for two facts/bullet points above.]

Peritoneal Dialysis (PD)

In 2021, 17,236 patients started peritoneal dialysis (PD), or 12.7% of people with incident ESKD— double the percentage since 2008.

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
[Volume 2 End-Stage Renal Disease: Chapter 1: Incidence, Prevalence, Patient Characteristics, and Treatment Modalities; Bullet #2]

Compared with African American/Black people, a higher percentage of White patients started peritoneal dialysis (PD) in 2021. The highest percentage using PD was among Asian American patients (20%).

Transplantation

Transplantation is a treatment for kidney failure using a healthy kidney from a living or deceased donor that can help patients live a longer, better life than with dialysis treatments. A kidney transplant comes from a deceased donor or from a living donor, such as a close relative, spouse, sibling, friend, or generous stranger. Most people get a kidney transplant after being on dialysis for some time. Studies show that people with kidney transplants live longer than those who stay on dialysis.
Compared to dialysis, benefits of kidney transplant include: better quality of life; lower risk of death; fewer dietary restrictions; ease of travel, lower treatment cost; and increased ability to remain employed.
A kidney transplant is a treatment, not a cure. Antirejection and other medications are needed to maintain the transplant. For some patients, a kidney transplant may be riskier than dialysis because of age, certain illnesses, or other factors.

[References for 3 bullet points/facts above.]

Benefits of Kidney Transplant vs. Dialysis. Beth Israel Deaconess Medical Center (BIDMC). Accessed August 20, 2024.
https://www.bidmc.org/centers-and-departments/transplant-institute/kidney-transplant
[“… patients who receive a kidney transplant typically live longer than those who stay on dialysis. A living donor kidney functions, on average, 12 to 20 years, and a deceased donor kidney from 8 to 12 years. Patients who get a kidney transplant before dialysis live an average of 10 to 15 years longer than if they stayed on dialysis. Younger adults benefit the most from a kidney transplant, but even adults as old as 75 gain an average of four more years after a transplant than if they had stayed on dialysis.”]

Kidney Topics: Kidney Transplant. National Kidney Foundation. Last Updated: March 15, 2024. Accessed April 22, 2024.
https://www.kidney.org/kidney-topics/kidney-transplant

Mayo Clinic Staff. Kidney transplant. Mayo Clinic. March 28, 2024. Accessed August 14, 2024.
https://www.mayoclinic.org/tests-procedures/kidney-transplant/about/pac-20384777

More than 27,000 kidney transplants were performed in the United States in 2023 (Organ Procurement and Transplantation Network (OPTN)). The active waiting list remains substantially larger than the supply of donor kidneys, which presents a continuing challenge.

Kidney Topics: Kidney Transplant. National Kidney Foundation. Last Updated: March 15, 2024. Accessed April 22, 2024.
https://www.kidney.org/kidney-topics/kidney-transplant

U.S. Department of Health & Human Services (HHS); Organ Procurement and Transplantation Network (OPTN). National data. OPTN website.
https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/
[From dropdown menus, select: Step 1: Choose Category: Transplant; Choose Organ: Kidney; Step 2: Choose a report: Transplants by Donor Type; Change Report: Organ: Kidney.] [2023: All donor types: 27,332]

U.S. Department of Health & Human Services (HHS); Organ Procurement and Transplantation Network (OPTN). National data. OPTN website.
https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/
[From dropdown menus, select: Step 1: Choose Category: Waiting List; Step 2: Overall by organ; Change Report: Candidates; Kidney [As of 8/14/2024: 89,805]

About 250,000 people in the US live with a kidney transplant. (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
[Volume 2 End-Stage Renal Disease: Chapter 1 Incidence, Prevalence, Patient Characteristics, and Treatment Modalities; Figure 1.6 Prevalent ESRD by modality, 2001-2021; Tab Prevalent Count: Year 2021: Transplant: 251,988]

About 90K people are on the waitlist for a kidney transplant. (OPTN 8/14/2024: 89,805)
27,000+ people received a kidney transplant in 2023.
6,290 of these transplants were from a living donor. (2023)

[Reference for the three bullets/facts above]

12 people die every day while waiting for a lifesaving kidney transplant.

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]
[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]

86% of people on the organ transplant waitlist are in need of a kidney.

Kidney Donation. Donate Life America. Accessed August 20, 2024.
https://donatelife.net/donation/organs/kidney-donation/

Organ Procurement and Transplantation Network. Data and Calculators. Accessed October 28, 2024.
https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/#
[Data & Calculators > View Data Reports > National Data > Step #1 Choose Category: Waiting List; Choose Organ: All Organs > Count: Candidates > Step #2 Choose a report > Overall by Organ > Candidates; All Organs: 104,529; Kidney: 90,235. 90,235/104,529 = 0.863]

Some people receive a “preemptive” kidney transplant before going on dialysis. An early transplant, with little or no time on dialysis, can lead to better long-term health. Preemptive kidney transplant was highest among White people (4%).

Mayo Clinic Staff. Kidney transplant. Mayo Clinic. March 28, 2024. Accessed August 14, 2024.
https://www.mayoclinic.org/tests-procedures/kidney-transplant/about/pac-20384777

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
[Volume 1 Chronic Kidney Disease: Chapter 1: CKD in the General Population: Highlights: Bullet #9: “Compared with Black individuals, a higher percentage of White individuals initiated kidney replacement therapy with PD (Figure 1.9). The percentage using PD was highest among Asian individuals (20%), and the percentage who received a preemptive kidney transplant was highest among White individuals (4%).”]

The average kidney transplant patient waits 2 to 5 years for an organ. Wait times vary in regions, states, and networks throughout the country, and can be as long as 10 years.

Adult Kidney Transplant. UCLA Health. Accessed August 15, 2024.
https://www.uclahealth.org/medical-services/transplants/kidney-transplant/adult
[“The average wait time for a kidney could be five to ten years, depending on your blood type. Patients with blood type O experience the longest wait of ten years. It is important to discuss living donation with your family and friends in order to decrease your wait time.”]

Davis AE, Mehrotra S, McElroy LM, et al. The extent and predictors of waiting time geographic disparity in kidney transplantation in the United States. Transplantation. 2014 May 27;97(10):1049-57. doi: 10.1097/01.tp.0000438623.89310.dc. PMID: 24374790.
https://pubmed.ncbi.nlm.nih.gov/24374790/

Kidney Topics: The Kidney Transplant Waitlist. National Kidney Foundation. Last Updated: April 3, 2024. Accessed April 22, 2024.
https://www.kidney.org/kidney-topics/kidney-transplant-waitlist
[“… it can take 2-5 years or more.”]

Stewart D, Mupfudze T, Klassen D. Does anybody really know what (the kidney median waiting) time is? Am J Transplant. 2023 Feb;23(2):223-231. doi: 10.1016/j.ajt.2022.12.005. Epub 2023 Jan 12. PMID: 36695688.
https://www.amjtransplant.org/article/S1600-6135(22)29281-8/fulltext
https://pubmed.ncbi.nlm.nih.gov/36695688/
https://www.sciencedirect.com/science/article/pii/S1600613522292818

The kidney transplant waitlist. UNOS Transplant Living. Accessed August 15, 2024.
https://transplantliving.org/kidney/the-kidney-transplant-waitlist/
[“Most people in the United States wait about 4 years to get a kidney from the waitlist. Some people wait longer. The average wait time will vary depending on which transplant center you register with – it could be anywhere from 4 months to more than 6 years. Some people never get a matching kidney from the list. 1 out of 20 (5%) kidney patients die each year while they wait for a kidney.”]

The need for kidney transplants grows dramatically. UCI Health. Apr 6, 2021. Accessed August 15, 2024.
https://www.ucihealth.org/blog/2021/04/need-for-kidney-transplants-grows-dramatically
[“In California, with one of the longest wait times in the nation at up to 10 years…”]

12.4% of kidney transplant candidates were waiting 5 years or longer. (2022 data)

Adult Kidney Transplant. UCLA Health. Accessed August 15, 2024.
https://www.uclahealth.org/medical-services/transplants/kidney-transplant/adult
[“The average wait time for a kidney could be five to ten years, depending on your blood type. Patients with blood type O experience the longest wait of ten years. It is important to discuss living donation with your family and friends in order to decrease your wait time.”]

Lentine KL, Smith JM, Lyden GR, et al. 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://pubmed.ncbi.nlm.nih.gov/38431360/

The waiting time is longer for patients with blood type O or B, and shorter for patients with blood type A or AB.

Accepted for a Kidney Transplant. Beth Israel Deaconess Medical Center (BIDMC). Accessed August 15, 2024.
https://www.bidmc.org/centers-and-departments/transplant-institute/kidney-transplant/accepted-for-a-kidney-transplant

One year after waitlisting, 12.3% of kidney patients had received a living donor transplant, 15.2% a deceased donor transplant, and 1.7% had died; 3.6% had been removed from the waitlist. 67.2% patients were still on the list and receiving dialysis. (2016-2018)
Five years after waitlisting, nearly half (46.3%) of kidney patients had received a transplant, while 18.5% had died. (2016)

[Reference for the two bullet points/facts above.]

On average, a kidney transplant from a living donor lasts about 15 to 20 years, and a kidney from a deceased donor lasts 8 to 12 years. Some will last longer; others will last less.

Hassanzadeh J, Hashiani AA, Rajaeefard A, Salahi H, Khedmati E, Kakaei F, Nikeghbalian S, Malek-Hossein A. Long-term survival of living donor renal transplants: A single center study. Indian J Nephrol. 2010 Oct;20(4):179-84. doi: 10.4103/0971-4065.73439. PMID: 21206678; PMCID: PMC3008945.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3008945/

Kidney Transplant. Cleveland Clinic. Last reviewed March 14, 2022. Accessed August 20, 2024.
https://my.clevelandclinic.org/health/treatments/22537-kidney-transplant
[“How long a kidney transplant lasts can vary from person to person. In general, kidneys donated by a living person last longer than kidneys donated by a deceased person. On average, however, transplanted kidneys last approximately 10 years.” “On average, a kidney from a living donor lasts about 12 to 20 years, while a kidney from a deceased donor lasts about eight to 12 years. Some people receive more than one kidney transplant in their lifetime.”]

Kidney Transplant. National Kidney Foundation. Last Updated: March 15, 2024. Accessed August 20, 2024.
https://www.kidney.org/kidney-topics/kidney-transplant
[“On average, a kidney transplant from a living donor lasts about 15 to 20 years, and a kidney from a deceased donor lasts 8 to 12 years. Some will last longer; others will last less.”]

Mayo Clinic Staff. Kidney transplant. Mayo Clinic. March 28, 2024. Accessed August 14, 2024.
https://www.mayoclinic.org/tests-procedures/kidney-transplant/about/pac-20384777

The longer the wait for a kidney, the more a patient’s health and quality of life can deteriorate, meaning the eventual transplant will not likely work as well or last as long.

Ellis EL. Multiple Listing for a Kidney Transplant: What You Need to Know and Why You Should Register at Duke. DukeHealth. Published October 11, 2023. Accessed August 14, 2024.
https://www.dukehealth.org/blog/multiple-listing-kidney-transplant

More than a quarter of all kidneys (living and nonliving donors) procured for transplant are discarded and not used.

34 Lives’ Post: Unused Donor Kidneys Increased Again in 2023. LinkedIn. Posted January 2024. Accessed August 20, 2024.
https://www.linkedin.com/posts/34lives_unused-donor-kidneys-increased-again-in-2023-activity-7152396034600554497-Pq0L/

Bunnapradist S, Rosenthal JT, Huang E et al. Deceased Donor Kidney Nonuse: A Systematic Approach to Improvement. Transplant Direct. 2023 May 26;9(6):e1491. doi: 10.1097/TXD.0000000000001491. PMID: 37250491; PMCID: PMC10219747.
https://journals.lww.com/transplantationdirect/fulltext/2023/06000/deceased_donor_kidney_nonuse__a_systematic.11.aspx
https://pubmed.ncbi.nlm.nih.gov/37250491/

Cooper M, Formica R, Friedewald J et al. Report of National Kidney Foundation Consensus Conference to Decrease Kidney Discards. Clin Transplant. 2019 Jan;33(1):e13419. doi: 10.1111/ctr.13419. Epub 2018 Oct 21. PMID: 30345720.
https://onlinelibrary.wiley.com/doi/10.1111/ctr.13419
https://pubmed.ncbi.nlm.nih.gov/30345720/
https://www.kidney.org/press-room/report-national-kidney-foundation-consensus-conference-to-decrease-kidney-discards
[“Approximately 12 people die each day waiting for a kidney transplant while about 10 kidneys are discarded daily.”]

David P. Schladt, Ajay K. Israni. OPTN/SRTR 2022 Annual Data Report: Introduction. US Department of Health and Human Services, Health Resources and Services Administration, The Scientific Registry of Transplant Recipients (SRTR).
https://srtr.transplant.hrsa.gov/annual_reports/2022/Introduction.aspx

Discarded deceased donor kidneys have increased since 2018. Nephrology News and Issues. March 17, 2023.
https://www.healio.com/news/nephrology/20230317/discarded-deceased-donor-kidneys-have-increased-since-2018

Friedewald JJ, Schantz K, Mehrotra S. Dealing With the Kidney Discard Problem in the United States-One Potential Solution for a Difficult Problem. Am J Kidney Dis. 2022 Mar;79(3):333-334. doi: 10.1053/j.ajkd.2021.09.022. Epub 2022 Jan 13. PMID: 35033385.
https://pubmed.ncbi.nlm.nih.gov/35033385/
https://www.ajkd.org/article/S0272-6386(21)00997-5/fulltext

Lentine KL, Smith JM, Lyden GR, et al. 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://pubmed.ncbi.nlm.nih.gov/38431360/

Mezrich J. Too many donor organs go to waste. Here’s how to get them into the patients who need them. Stat. Published March 2, 2024. Accessed August 20, 2024.
https://www.statnews.com/2024/03/02/donor-organs-kidney-transplant-discard/

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 August 20, 2024.
http://srtr.transplant.hrsa.gov/annual_reports/Default.aspx

Too Many Donor Kidneys Are Discarded in U.S. Before Transplantation. [news release]. Penn Medicine. Published December 16, 2020. Accessed August 20, 2024.
https://www.pennmedicine.org/news/news-releases/2020/december/too-many-donor-kidneys-are-discarded-in-us-before-transplantation

Kidneys from African American/Black donors are more likely to be discarded.

Iltis AS. Kidneys from Black donors are more likely to be thrown away − a bioethicist explains why. The Conversation. Published: June 25, 2024. Accessed August 20, 2024.
https://www.msn.com/en-us/health/other/kidneys-from-black-donors-are-more-likely-to-be-thrown-away-a-bioethicist-explains-why/
https://theconversation.com/kidneys-from-black-donors-are-more-likely-to-be-thrown-away-a-bioethicist-explains-why-225546

Total kidney transplants in the US reached a record in 2022 through continuing growth in deceased donor kidney transplants (DDKTs).

Lentine KL, Smith JM, Lyden GR et al. 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://pubmed.ncbi.nlm.nih.gov/38431360/

Total kidney transplant patients increased to 245,506 at the end of 2021, a 39.1% increase over the decade. Number of ESRD patients with kidney transplant were unchanged at ≈30%.

Lifesaving antirejection medications are key to successful kidney transplants. These drugs are often very expensive, and patients need help covering the costs. After 20 years of advocacy from organizations, including The National Kidney Foundation, Congress passed the Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act (“Immuno Bill”) in November 2020. This law indefinitely extends Medicare coverage of immunosuppressive medications for kidney transplant (KT) patients if they do not have other public or private health insurance that contains this benefit.

Levan ML, Reich DJ, Segev DLL. After 20 Years of Advocacy, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Finally Become Law. Transplantation. 2022 Jan 1;106(1):9-11. doi: 10.1097/TP.0000000000003899. PMID: 34342961; PMCID: PMC8678179.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8678179/

To date (8/2024) three genetically edited kidneys from pigs have been transplanted into living human recipients. Two living patients have also received genetically edited heart transplants from pigs. Previous experimental pig transplants have occurred in brain dead patients. The procedure is still in the experimental stage and is still under review and being debated in the medical community, with further trial procedures planned. Per the NY Times (March 22, 2024), “Doctors hope the procedure will someday make dialysis obsolete.”

Kozlov M. Pig-organ transplants: what three human recipients have taught scientists. Nature. Published May 17, 2024. Accessed August 21, 2024.
https://www.nature.com/articles/d41586-024-01453-2

Neergaard L, Lum S. Pig kidney works a record 2 months in donated body, raising hope for animal-human transplants. Associated Press. Published September 14, 2023. Accessed August 21, 2024.
https://apnews.com/article/pig-kidney-transplant-xenotransplant-83dfb5e6d022ca72039a821cc6bc00ef

Rabin RC. Surgeons Transplant Pig Kidney Into a Patient, a Medical Milestone. New York Times. Published March 21, 2024-March 25, 2024. Accessed August 21, 2024.
https://www.nytimes.com/2024/03/21/health/pig-kidney-organ-transplant.html

Stobbe M. US surgeons transplant a gene-edited pig kidney into a patient for the first time. Associated Press. Published March 21, 2024. Accessed August 21, 2024.
https://apnews.com/article/pig-kidney-transplant-boston-c7fb54b1b1f1ece3b41b85f105fe4b98

Sullivan W. Second Patient Receives Gene-Edited Pig Kidney Transplant in Breakthrough Surgery. Smithsonian. Published April 26, 2024. Accessed August 21, 2024.
https://www.smithsonianmag.com/smart-news/second-patient-receives-gene-edited-pig-kidney-transplant-in-breakthrough-surgery-180984230/

Wise J. Sixty seconds on . . . pig kidney transplants. BMJ. 2024;384:q731.. doi
https://doi.org/10.1136/bmj.q731

Special Populations and Disparities in Wait Times and Transplantation

On July 2, 2020, the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) established a task force to reassess the inclusion of race in diagnosing kidney diseases. The estimated glomerular filtration rate (eGFR) is one of the primary diagnostic methods for detecting and managing kidney disease, planning for dialysis, and evaluating transplantation—including eligibility for the kidney transplant waitlist.

Delgado C, Baweja M, Crews DC, Eneanya ND, Gadegbeku CA, Inker LA, Mendu ML, Miller WG, Moxey-Mims MM, Roberts GV, St Peter WL, Warfield C, Powe NR. A Unifying Approach for GFR Estimation: Recommendations of the NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease. J Am Soc Nephrol. 2021 Dec 1;32(12):2994-3015. doi: 10.1681/ASN.2021070988. Epub 2021 Dec 1. PMID: 34556489; PMCID: PMC8638402.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8638402/
[“On July 2, 2020 the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) announced they would establish a Task Force to reassess the inclusion of race in the estimation of GFR in the United States and its implications for diagnosis and management of patients with, or at risk for, kidney diseases. The rationale for the Task Force includes the following: race is a social and not a biologic construct, the problematic nature of applying race to clinical algorithms, and the need to advance health equity and social justice.”]

Establishing a Task Force to Reassess the Inclusion of Race in Diagnosing Kidney Diseases. [media release]. National Kidney Foundation. Published July 2, 2020. Accessed August 21, 2024.
hhttps://www.kidney.org/press-room/establishing-task-force-to-reassess-inclusion-race-diagnosing-kidney-diseases

On September 23, 2021, the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Diseases released its final report, recommending the adoption of the new eGFR 2021 CKD EPI creatinine equation that estimates kidney function without a race variable. This recommendation was an important step forward in ensuring health and healthcare equity.

NKF and ASN Release New Way to Diagnose Kidney Diseases. [news release]. National Kidney Foundation. Published September 23, 2021. Accessed August 21, 2024.
https://www.kidney.org/press-room/nkf-and-asn-release-new-way-to-diagnose-kidney-diseases

African American/Black and Hispanic/Latino patients wait on average 18–24 months longer for a transplant than White patients.

National Kidney Foundation: New Organ Procurement Transplant Law is a Game Changer. [news release]. National Kidney Foundation. Published September 22, 2023.
https://www.kidney.org/press-room/national-kidney-foundation-new-organ-procurement-transplant-law-game-changer

Overall, White and Asian American patients had the highest rates of kidney transplantation, followed by Hispanic/Latino patients; African American/Black, American Indian/Native American, and Native Hawaiian/Pacific Islander patients had lower rates.

Disparities in access to living donor kidney transplant (LDKT) persist, especially for non-White and publicly insured patients.

Organ Donation and African Americans. U.S. Department of Health and Human Services (HHS), Office of Minority Health (OMH). Accessed August 20, 2024.
https://minorityhealth.hhs.gov/organ-donation-and-african-americans

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
[2.4 Transplants: “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).”]

Patients with kidney failure from marginalized racial and ethnic groups and older patients have reduced access to the transplant waitlist relative to White and younger patients.

Buford J, Retzloff S, Wilk AS, McPherson L, Harding JL, Pastan SO, Patzer RE. Race, Age, and Kidney Transplant Waitlisting Among Patients Receiving Incident Dialysis in the United States. Kidney Med. 2023 Aug 5;5(10):100706. doi: 10.1016/j.xkme.2023.100706. PMID: 37753250; PMCID: PMC10518364.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10518364/
https://www.kidneymedicinejournal.org/article/S2590-0595(23)00124-3/fulltext

For patients: FAQs about eGFR waiting time modifications. Organ Procurement and Transplantation Network (OPTN). Accessed August 20, 2024.
https://optn.transplant.hrsa.gov/policies-bylaws/a-closer-look/waiting-time-modifications-for-candidates-affected-by-race-inclusive-egfr-calculations/for-patients-faqs-about-egfr-waiting-time-modifications/

However, rates of DDKT rose across racial and ethnic groups, especially among Asian, Black, and Multiracial candidates, such that Black candidates had the highest DDKT rate among the groups in 2022.

Deceased donor kidney transplant rates were similar for African American/Black and White patients and slightly lower for Hispanic/Latino patients. According to USRDS, disparities related to social determinants of health were also less prominent for deceased donor than for living donor transplant, but those living in more deprived neighborhoods were still less likely to receive a deceased donor kidney transplant.

Despite the continuing shortfall of kidney donors for recipients in need, there is reason for hope. 2023 saw a record number of organ donations.

Continued increase in organ donation drives new records in 2023; New milestones exceeded. Organ Procurement and Transplantation Network (OPTN). Published January 10, 2024. Accessed August 20, 2024.
https://optn.transplant.hrsa.gov/news/continued-increase-in-organ-donation-drives-new-records-in-2023-new-milestones-exceeded/

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Kidney Disease: Fact Sheet

Table of Contents

Fast Facts (2024 Update)

Kidney disease, also known as “chronic kidney disease (CKD),” causes more deaths each year than breast cancer or prostate cancer. It is the under-recognized public health crisis.

About 35.5 million U.S. adults are estimated to have kidney disease—that’s more than 1 in 7 (14%).

About 9 in 10 adults with kidney disease (≈90%) do not know they have it.

People with kidney disease may not feel ill or notice symptoms until the disease is advanced.

About 1 in 3 (40%) of adults with severe kidney disease* don’t know they have it.

1 in 3 adults in the U.S. (33%) is at risk for kidney disease.

Kidney disease is the 8th leading cause of death in the U.S.

About 1 in 3 adults with diabetes and 1 in 5 adults with high blood pressure may have kidney disease.

Diabetes is the most common cause of kidney disease. Diabetes and hypertension cause or contribute to 2 of 3 new cases of kidney failure.

Two simple tests (blood/urine) can detect kidney disease early. Earliest detection is crucial so that further damage can be slowed or stopped.

12 people die every day while on a waiting list for a kidney transplant.

Adults with kidney disease are at higher risk of early death.

Prevalence of kidney disease: non-Hispanic Black adults 20%; Hispanic/Latino adults 14%; non-Hispanic Asian adults 14%; non-Hispanic White adults 12%.

Black/African American people have 4 times the incidence of kidney failure (ESKD) as White persons.

Hispanic/Latino and American Indian/Alaska Native people have 2 times the incidence of kidney failure as White persons. Asian people are 1.4 times more likely than Whites to experience kidney failure.

30% of all patients with kidney failure are Black/African American, even though this group is 13% of the U.S. population.

Almost one-third of people on the kidney transplant waitlist are Black/African American. Black/African American transplant recipients are also less likely to receive a kidney from a living donor.

Approximately 1 in 4 Medicare dollars is spent on kidney patients—$156.7 billion and growing.

Without increased investment in prevention, the total number of patients with kidney failure (ESKD) will likely exceed 1 million by 2030.

COVID-19 continues to endanger the health and lives of kidney patients. The CDC recently (2/2024) updated their guidelines to recommend that people 65 and older should get vaccine boosters. The CDC recommends that everyone (age 6+ months) get an updated 2024–2025 COVID-19 vaccine.

What is Kidney Disease?

What Causes Kidney Disease?

AKI

Kidney failure or end-stage kidney disease (ESKD)

How is Kidney Disease Treated?

Dialysis

At-Home Hemodialysis

Peritoneal Dialysis (PD)

Transplantation

Special Populations and Disparities in Wait Times and Transplantation

**About 1 in 3 (40%) of adults with severe kidney disease* don’t know they have it.**