Kidney Disease: The Basics

Chronic Kidney Disease
Chronic kidney disease, or CKD, causes more deaths than breast cancer or prostate cancer. It is the under-recognized public health crisis. It affects an estimated 37 million people in the U.S. (15% of the adult population; more than 1 in 7 adults) and approximately 90% of those with CKD don’t even know they have it.  1 in 3 American adults (approximately 80 million people) is at risk for CKD. CKD is more common in women (15%) than men (12%).  CKD is the 9th leading cause of death in the U.S.  In 2016, over 500,000 patients received dialysis treatment, and over 200,000 lived with a kidney transplant.  The National Kidney Foundation (NKF) has led the way in rallying action on this problem. 
 
What is Chronic Kidney Disease?
Chronic kidney disease (CKD) means your kidneys are damaged and losing their ability to keep you healthy. In the early stages of the disease, most people do not have symptoms. But as CKD 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, CKD 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. This stage of CKD is known as kidney failure, end-stage kidney disease (ESKD), or end-stage renal disease (ESRD).
 
What Causes CKD?
The two main causes of CKD are diabetes and high blood pressure. These two conditions were responsible for nearly 75% of kidney failure cases between 2014–2016:  45% of new ESKD patients had a primary diagnosis of diabetes, the leading cause of ESKD, while 29% of new ESKD patients had a primary diagnosis of hypertension, the second leading cause of ESKD. Other conditions that can lead to ESKD are: glomerulonephritis (diseases that damage the kidney's filtering units), which are the third most common type of CKD; inherited diseases, such as polycystic kidney disease; malformations at birth that occur as a baby develops; lupus and other immune diseases; obstructions such as kidney stones or an enlarged prostate; and repeated urinary tract infections.
 
How Big is This Problem? How Many Lives Are Affected?
An estimated 37 million American adults (1 in 7 adults; 15% of adults) are estimated to have CKD, but most don’t know they have it. In fact, about 1 in 2 people with very low kidney function (not on dialysis) don’t know they have CKD.  Approximately 1 in 3 adults with diabetes and 1 in 5 adults with high blood pressure may have CKD. In 2016, 726,331 Americans had kidney failure, and needed dialysis or a kidney transplant to survive. More than 500,000 of these patients received dialysis at least 3 times per week to replace kidney function. Nearly 125,000 people started ESKD treatment in 2016, of which 121,209 started dialysis. In 2016, more than 215,000 Americans lived with a kidney transplant. While about 100,000 Americans are waiting for a kidney transplant, only 21,167 received one in 2018, about one-third of which came from living donors. Living and deceased kidney donors are crucial: 12 people die every day while waiting for a kidney transplant.

Over 3,500 kidneys are surgically discarded each year; NKF is making efforts to utilize more of these kidneys for transplantation.

People with CKD are five to ten times more likely to die prematurely than they are to progress to ESKD. The number of people who die prematurely from all stages of CKD and conditions related to CKD is much higher than those without CKD. Over 100,000 people with ESKD died in 2016. 
 
Populations:
 
Who is at Risk for CKD?
1 in 3 American adults is at risk for CKD.  Some demographic groups are at higher risk.
 
Risk factors for CKD include: diabetes; high blood pressure; family history of kidney failure; age 60 or older; obesity; heart disease; past damage to kidneys; and minority populations that have high rates of diabetes or high blood pressure, such as African Americans, Hispanics, Asians, Pacific Islanders, and Native Americans.  The risk of developing ESKD among African Americans is roughly 3 times higher than Whites. Compared to non-Hispanics, Hispanics are almost 1.3 times more likely to receive a diagnosis of kidney failure.  Asians and Native Americans also have a higher prevalence of CKD than Whites.
 
Many children and adolescents have conditions that, if left untreated, dramatically increase their risk for CKD and ESKD: about 4% of youths (12-19 yrs) in the U.S. have hypertension, while about 10% have elevated blood pressure. In children aged 2-19 years, the prevalence of obesity is 18.5% (about 13 million), and 193,000 people younger than 20 years are living with diagnosed diabetes.  The growing prevalence of these conditions in children means that the incidence and prevalence of CKD will likely increase further in the coming years.

Children and Adolescents with CKD
Over 5,700 children (<18 yrs old) in U.S. lived with ESKD in 2016. They are 30 times more likely to die prematurely than healthy children. For instance, in one study, adolescents (<18 yrs old) with ESKD since childhood had a life expectancy of 38 years if they were treated with dialysis during childhood, and 63 years if they received a kidney transplant during childhood.  The primary causes of pediatric ESKD in the U.S. between 2012-2016 were: primary glomerular disease (22.3%), CAKUT (congenital anomalies of the kidney and urinary tract; 21.9%), cystic/hereditary/congenital disorders (11.7%), and secondary glomerular disease/vasculitis (10.1 %). Urinary tract infections can also lead to kidney infections, which can cause long-term damage to the kidneys.

In 2018, 755 children age 18 and younger received a kidney transplant and more than 1,000 children are waiting for a donated kidney.    
 
How is CKD Treated?
The best treatment of CKD is early detection, when the disease can be slowed or stopped. Early treatment includes diet, exercise, medications, lifestyle changes, and treating risk factors like diabetes and hypertension. However, once kidneys fail, treatment with dialysis or a kidney transplant is needed.
 
Dialysis comes in two forms: hemodialysis or peritoneal dialysis. Both forms remove wastes and extra fluid from your blood. Patients receive hemodialysis usually 3-4 times a week, either at home or at a dialysis center. During hemodialysis, your blood is pumped through a dialysis machine, where it is cleaned and returned to your body. With peritoneal dialysis, your blood is cleaned inside your body every day through the lining of your abdomen using a special fluid that is periodically changed. Peritoneal dialysis can be done at home, at work, at school, or even during travel.
 
—A kidney transplant places a healthy kidney into your body from a deceased donor or from a living donor, such as a close relative, spouse, friend, or generous stranger. A kidney transplant, however, is a treatment, not a cure. Antirejection and other medications are needed to maintain the transplant.
 
Although it is very important for patients who are nearing the need for dialysis or kidney transplantation to be cared for by a nephrologist, in 2016, only 32% of ESKD patients received such care for a year or more prior to their kidney failure.
 
What are the Costs?
In 2016, Medicare costs for all people with all stages of CKD were $114 billion. Medicare spent $35 billion in 2016 to care for people with ESKD, and $79 billion for people with CKD without kidney failure. The same year, Medicare spent an estimated $23,558 per-person to care for someone with non-ESKD CKD, nearly double the spending on the average Medicare beneficiary. In 2016, Medicare spent over $89,000 per dialysis patient and almost $35,000 per transplant patient. Early detection of CKD could save a substantial percentage of these costs.
 
663,205 (1%) of Medicare beneficiaries have kidney failure, yet account for 7.2% of total Medicare spending. Almost 76% of new ESKD patients apply for Medicare. For kidney transplant recipients, Medicare Part B spends $2,303 on immunosuppressive drugs, per year, per patient. And for ESKD patients, Medicare Part D prescription spending is 4.1 times greater than non-ESKD patients.
 
Prevention
Early detection is the most effective way to combat CKD. There are two simple, quick, and inexpensive tests for CKD: A urine test, albumin-creatinine ratio (ACR), measures the amount of protein (albumin) in your urine. Damaged kidneys leak protein into your urine when it should be in your bloodstream. A blood test, creatinine, is used to measure your glomerular filtration rate (GFR), which tells how well your kidneys are working to remove wastes from your blood. It is the best way to check kidney function.

And preventative medicine pays off: A recent report from the CDC states that between 1996 and 2013, there was a 54% decrease in the incidence of diabetes-related ESKD in Native American and Alaska Natives since the Special Diabetes Program for Indians (SDPI) began in 1997. The CDC estimates that the decrease in ESKD related to diabetes resulted in 2,200 to 2,600 fewer cases of diabetes-related ESKD, and estimates $436 to $520 million in savings to Medicare over ten years.

What Does It Feel Like to Have Chronic Kidney Disease? Ask People Who Know.
"I was diagnosed with CKD in 2000. I had extreme fatigue; my world kept shrinking around me. I remember waking up in the morning, feeling like I hadn’t slept at all.…I had high blood pressure and migraine headaches. Working closely with my doctor, I've been able to put my CKD into remission. As a chef, I enjoy food, so developing recipes that are good for people with kidney disease …has become my passion."
— Duane, Spokane, WA
 
“Dialysis was, and still is, the most painful thing, physically and emotionally, I've had to endure. You are hooked to a machine that feels like a vacuum, occasionally pulling on your insides, pulling you apart. Once hooked up, you cannot move or go anywhere beyond the tubing. I wouldn't wish it upon anyone to experience dialysis….”
— Hannah, Henrico, VA
 
“Since my kidney transplant, I feel like me again. I’m back to working and back to being a full-time student in the nursing program. I feel so much freedom and gratitude. Life is simply incredible. I’ve even done a bit of traveling—it’s all such a blessing!”
Cindy, Queens, NYC
 
The National Kidney Foundation (NKF) is the largest, most comprehensive, and longstanding organization dedicated to the awareness, prevention, and treatment of kidney disease. For more information about NKF, visit www.kidney.org
 
You can view a fully annotated fact sheet here.