1
Kidney Disease: The Basics
Fast Facts
Kidney disease, also known as chronic kidney disease or CKD, causes more deaths than breast cancer or prostate
cancer (NVS 2021 report of 2018 data).
1
It is the under-recognized public health crisis.
• Kidney disease aects an estimated 37 million people in the U.S. (15% of the adult population; more than 1 in 7
adults).
2,3,4
• Approximately 90% of those with kidney disease don’t know they have it.
2
• And 2 of 5 adults with severe kidney disease don’t know they have it.
2
• 1 in 3 adults in the U.S. (approximately 80 million) is at risk for kidney disease.
2,5
• Kidney disease is more common in women (14%) than men (12%).
2
But for every 2 women who develop end-
stage kidney disease (ESKD), 3 men’s kidneys fail.
2
• Kidney disease is a leading cause of death in the U.S.
1,6,7
• About 1 in 2 people with very low kidney function (not on dialysis) don’t know they have kidney disease.
2,13
• Approximately 1 in 3 adults with diabetes and 1 in 5 adults with high blood pressure may have kidney
disease.
2
• Without increased investment in prevention, the total number of patients with kidney failure will likely
exceed 1 million by 2030.
26
• COVID19 is targeting people with kidney disease, kidney transplant patients, and those at risk for kidney
disease. [See www.kidney.org/covid-19]
What is Kidney Disease?
Chronic kidney disease (CKD) means your kidneys are damaged and losing their ability to keep you healthy by
iltering your blood. In the early stages of the disease, most people do not have symptoms. But as kidney disease
gets worse, wastes can build up in your blood and make you feel sick. You may develop other problems, like high
blood pressure, anemia, weak bones, poor nutritional health, and nerve damage. Because kidneys are vital to so
many of the body’s functions, kidney disease also increases your risk of having heart and blood vessel disease.
While these problems may happen slowly and without symptoms, they can lead to kidney failure, which can
appear without warning. Once kidneys fail, dialysis or a kidney transplant is needed to stay alive. Kidney failure is
also called kidney failure with replacement therapy (KFRT).
Note: Footnotes in body text may not run sequentially due to ongoing updates.
However, they do correspond correctly to the numbers in the reference list.
2
What Causes Kidney Disease?
The two main causes of kidney disease are diabetes and high blood pressure.
9
• These two conditions were the primary diagnosis in 76% of kidney failure cases between 20152017: 47% of
new KFRT patients had a primary diagnosis of diabetes
10
, the leading cause of KFRT, while 29% of new KFRT
patients had a primary diagnosis of hypertension
10
, the second leading cause of KFRT.
• Other conditions that can lead to KFRT are: glomerulonephritis (diseases that damage the kidney’s iltering
units), which are the third most common type of kidney disease; inherited diseases, such as polycystic kidney
disease; malformations at birth that occur as a fetus develops; lupus and other immune diseases; obstructions
such as kidney stones or an enlarged prostate; and repeated urinary tract infections
11
, which can also lead to
kidney infections and can cause long-term damage to the kidneys.
• People with kidney disease are at greater risk for cardiovascular disease and death at all stages of kidney
disease. Kidney disease and heart disease are linked and have common risk factors, such as diabetes and
hypertension. Each condition can lead to or worsen the other.
12
How is Kidney Disease Treated?
• The best treatment of kidney disease is facilitated by early detection, when the disease can be slowed or
stopped. Early treatment includes diet, exercise, medications, lifestyle changes, and treating risk factors like
diabetes and hypertension. However, once kidneys fail, treatment with dialysis or a kidney transplant is needed.
• Dialysis comes in two forms: hemodialysis (HD) or peritoneal dialysis (PD). Both forms remove wastes and
extra luid from your blood. Patients receive hemodialysis usually 34 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 luid that is periodically changed. Peritoneal dialysis can be done at
home, at work, at school, or even during travel. Home dialysis is an increasingly popular mode of treatment
56
,
and is associated with better outcomes.
• A kidney transplant places a healthy kidney into your body from a deceased donor or from a living donor, such
as a close relative, spouse, friend, or generous stranger. A kidney transplant, however, is a treatment, not a
cure. Antirejection and other medications are needed to maintain the transplant. Per the United States Renal
Data System (USRDS), more than 22,000 (22,393) kidney transplants were performed in the United States in
2018.
57
The active waiting list remains substantially larger than the supply of donor kidneys, which presents a
continuing challenge.
57
• Although it is very important for patients who are nearing the need for dialysis or kidney transplantation to
be cared for by a nephrologist, in 2018, 38.8% of incident (newly occurring) KFRT patients (1844 years) had
received little or no pre-KFRT nephrology care.
58
3
How Many People Require Dialysis or Transplant?
• In 2018, 785,883 Americans had kidney failure, and needed dialysis or a kidney transplant to survive (2 in
every 1.000 people).
2,14
Approximately 500,000 of these patients received dialysis at least 3 times per week to
replace kidney function
8,14
and about 200,000 lived with a kidney transplant.
8
• About 130,000 people started KFRT treatment in 2018
2,15
of which approximately 128,000 started dialysis as
the initial mode of therapy.
16
• In 2018, 22,393 people received a kidney transplant.
17
By the end of 2018, a total of 229,887 Americans were
living with a kidney transplant.
18
• While about 100,000 Americans are waiting for a kidney transplant, only 22,817 Americans received one in
2020.
19,20
About one-third of these transplants came from living donors.
20
• Living and deceased kidney donors are crucial: 12 people die every day while waiting for a kidney transplant.
21
• In 2016, more than 3,600 kidneys from deceased donors were surgically discarded; NKF is making eorts to
utilize more of these kidneys for transplantation.
22,23
• People with kidney disease are ive to ten times more likely to die prematurely than they are to progress to
KFRT.
24
More than 100,000 people with KFRT died in 2018.
25
Who is at Risk for Kidney Disease?
• 1 in 3 adults in the U.S. is at risk for kidney disease.
5
Some demographic groups are at higher risk. (See “What’s
Behind Racial Disparities in Kidney Disease?” section.)
• Risk factors for kidney disease include: diabetes; high blood pressure; family history of kidney failure; age
60 or older
27
; obesity; heart disease; past damage to kidneys; and being in minority populations that have
high rates of diabetes or high blood pressure, such as Blacks or African Americans, Hispanics or Latinos,
Asian Americans or Paciic Islanders, and American Indians or Alaska Natives (Note: current CDC/ NHANES
demographic terminology.).
2,28
4
What’s Behind Racial Disparities in Kidney Disease?
29
People from some groups are more likely to develop kidney disease than others. Many factors can contribute to
these groups being at higher risk, ranging from societal to medical reasons.
• A breakdown of kidney disease rates within demographic categories of the general population of the United
States for 20152018 (USRDS, Prevalence of CKD in U.S. adults within age, sex, race/ethnicity, & risk factor
categories) showed: 16.0% Non-Hispanic Black or African American; 15.7% Non-Hispanic White; 11.9% Hispanic
or Latino (2018).
30
• Among Medicare FFS (fee-for-service) beneiciaries, kidney disease is highest among Blacks or African
Americans (33%), followed by American Indians or Alaska Natives (30%), Hispanics or Latinos (28%), and
Asian Americans or Paciic Islanders (26%). Whites (23%) beneiciaries had the lowest percentages of kidney
disease (2018).
31
• Non-Hispanic Black or African-American and Hispanic or Latino people experience more rapid decline
of kidney function than non-Hispanic Whites.
12,32
Minority communities in general are at increased risk of
progressing from CKD to KFRT and of progressing more rapidly.
12,33
• Blacks or African Americans are about 3 times more likely than Whites to develop kidney failure. Blacks or
African Americans are 13% of the U.S. population, while representing 35% of those with kidney failure.
2,34,35
• Black or African-American race is also associated with increased risk for acute kidney injury (AKI).
36,37
• Blacks or African Americans also suer higher rates of comorbid conditions, such as diabetes and high
blood pressure, resulting in higher rates of fair/poor health (age 18+, 22% Blacks or African Americans vs. 16%
Whites).
38
• Compared to non-Hispanics, Hispanics or Latinos are almost 33% (1.3 times) more likely to receive a diagnosis
of kidney failure.
2,34
• Native Hawaiians, Paciic Islanders, American Indians and Alaska Natives also have a higher prevalence of
kidney disease than Whites.
2,12,28,30,34,39,40
• There are disparities in the quality of primary care for patients of dierent racial, ethnic, and socioeconomic
groups who have kidney disease and kidney disease risk factors.
12
These disparities are related to patient,
clinician, clinical, and systemic factors. Patients receiving dialysis in areas with populations that are largely
Black or African American, low-income, or of lower educational attainment, are less likely to have received pre-
dialysis care from a nephrologist. One study found that 52% of Hispanic or Latino patients on hemodialysis had
not received pre-dialysis care from a nephrologist, compared to 44% of non-Hispanic patients.
12
• Blacks or African Americans and Hispanics or Latinos are also less likely to be treated with kidney
transplantation than Whites.
41
• On average, Black or African-American transplant candidates wait longer than White transplant candidates
for kidney, heart, and lung transplants.
42
• In 2018, 57% of White patients with KFRT received in-center hemodialysis, versus 72% of Black or African-
American patients.
43
This may relect fewer Black or African-American patients utilizing home dialysis options.
44
5
How are Children and Adolescents Aected by Kidney Disease?
45
• Many children and adolescents have conditions that, if left untreated, dramatically increase their risk for
kidney disease and KFRT: about 4% of youths (1219 yrs) in the U.S. have hypertension, while about 10% have
elevated blood pressure.
46
In children aged 219 years, the prevalence of obesity is 18.5% (about 13 million)
47
,
and 210,000 people younger than 20 years are living with diagnosed diabetes.
48
The growing prevalence of
these conditions in children means that the incidence and prevalence of kidney disease will likely increase
further in the coming years.
• 6,427 children (<18 yrs old) in the U.S. lived with KFRT in 2017.
49
• According to one study, children with KFRT are 30 times more likely to die prematurely than healthy
children.
50
In another study, adolescents (<18 yrs old) with KFRT since childhood had a life expectancy of 38
years if they were treated with dialysis during childhood, and 63 years if they received a kidney transplant
during childhood.
51
• The primary causes of pediatric KFRT in the U.S. between 20152018 were: primary glomerular disease, CAKUT
(congenital anomalies of the kidney and urinary tract), cystic/hereditary/congenital disorders, and primary/
secondary glomerular disease/vasculitis.
52
Urinary tract infections can also lead to kidney infections, which can
cause long-term damage to the kidneys.
11
• In 2020, 710 children (<18 yrs old) received a kidney transplant.
53
• More than 1,000 children (<18 yrs old) are waiting for a donated kidney.
54
• Recent USRDS data indicates substantial racial and ethnic disparities in KFRT treatment for children and
adolescents:
• White children were twice as likely to receive a kidney transplant as Black or African-American children
(20.8% versus 10.0%).
• More Black or African-American (57.3%) children than White (40.5%) children-initiated hemodialysis (HD).
• Hispanic or Latino children received a kidney transplant less often than non-Hispanic children (12.0% versus
20.2%) and initiated HD more often and PD less often.
• The median kidney transplant waitlist time for children, by race: 35.2 months for Black or African-American
children; 34.0 months for children of other race groups (not Black, White, or Asian); 23.3 months for White
children; and 20.3 months for Asian-American children.
55
6
What are the Costs to Treat Kidney Disease?
59
In 2018, Medicare costs for all people with all stages of kidney disease were $130 billion.
60,61,62
In 2018 Medicare
spent $81 billion for people with kidney disease and an additional $49.2 billion for people with KFRT.
60,61,62
For 2018,
per person per year (PPPY) spending on KFRT patients was $80,426.
62,63
Early detection of kidney disease could
save a substantial percentage of these costs.
• Per type of KFRT treatment, Medicare spent: $93,191 PPPY for HD, $78,741 for PD, and $37,304 for kidney
transplant (2018).
61
• In 2018, Medicare spent an estimated $24,674 PPPY to care for someone with non-KFRT CKD, more than
double the spending on the average Medicare beneiciary ($12,899).
64
• Almost 64.3% of new KFRT patients applied for Medicare (2018).
65
• In 2018, there were over 500,000 Medicare beneiciaries on maintenance dialysis (about 1% of Medicare fee-
for-service population), accounting for 7.2% of the overall claims paid by Medicare.
66
• Total Medicare Part D spending (20092018) rose by 188% for those with CKD ($4.6 to $13.1 billion) and by 37%
for those without CKD ($39.5 to $54.2 billion).
67
• For kidney transplant recipients, Medicare Part B spent $2,453 on immunosuppressive drugs, PPPY (2018).
68
• Medicare Part D spending was 1.7 times higher for those with CKD ($5392 PPPY) than for those without CKD
($3118 PPPY) (2018).
69
• Medicare Part D spending was 2.4 times higher for patients with KFRT ($8,173 PPPY) than those without ($3397
PPPY) (2018).
70
• There is good news, however, for patients burdened with immunosuppressive drug costs when they are no
longer covered by the current 36-month limit. The NKF-supported Comprehensive Immunosuppressive
Drug Coverage for Kidney Transplant Patients Act (S. 3353/H.R. 5534) was passed by both the U.S. House
of Representatives and U.S. Senate in December 2020. This bill ensures that transplant patients on Medicare
will receive lifetime unlimited coverage for immunosuppressive medications. This legislation represents a
signiicant, positive change in the lives of many kidney patients.
71,72
• However, there is still a lot of work to be done: Minority communities may have less access to healthcare than
other Americans. For example, studies found that about one-third of Hispanics or Latinos, 20% Blacks or African
Americans, and nearly 1 out of 3 American Indians and Alaska Natives were uninsured.
73
7
How Do You Prevent Kidney Disease?
Early Detection
Early detection is the most eective way to combat kidney disease. There are two simple, quick, and inexpensive
tests for kidney disease:
• A kidney damage urine albumin-creatinine ratio (uACR) test, measures the amount of protein called albumin
in your urine. Damaged kidneys leak protein into your urine; it should be in your bloodstream.
• A kidney function blood test, creatinine, is used to measure your glomerular iltration 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.
Keep Kidneys Healthy
2,74,75
• People with kidney disease should: •Lower high blood pressure; •Manage blood sugar levels; •Reduce salt
intake; •Avoid NSAIDs, a type of painkiller; •Moderate protein consumption; •Get an annual lu shot
• Everyone should: •Exercise regularly; •Control weight; •Follow a balanced diet; •Quit smoking; •Drink alcohol
only in moderation; •Stay hydrated; •Monitor cholesterol levels; •Get an annual physical; •Know your family
medical history
2,74,75
Preventative Medicine Pays O
• A recent report from the Centers for Disease Control and Prevention (CDC) states that between 1996 and 2013,
there was a 54% decrease in the incidence of diabetes-related KFRT in Native American and Alaska Natives
since the Special Diabetes Program for Indians (SDPI) began in 1997. The CDC estimates that the decrease in
KFRT related to diabetes resulted in 2,200 to 2,600 fewer cases of diabetes-related KFRT, and estimates $436
to $520 million in savings to Medicare over 10 years.
76
The National Kidney Foundation (NKF) is the largest, most comprehensive, and longstanding patient-centric organization dedicated to the
awareness, prevention, and treatment of kidney disease in the U.S. For more information about NKF, visit www.kidney.org
8
Note 1: Please direct any queries, updates, suggestions for improvements, or corrections for this sheet to:
jamesm@kidney.org
Note 2: The USRDS Annual Data Report (ADR) cites data in several dierent ways and locations. Follow the
instructions at the end of these references to arrive at the correct numbers.
Note 3: KFRT = kidney failure with replacement therapy. Also known as ESRD = end-stage renal disease; ESKD = end-
stage kidney disease.
Note 4: Dierent years are cited, e.g., 2017, 2018, 2019, 2020, because the most up-to-date data available from
dierent sources are being used. Note also that there are varying lags between when data are collected and
when they are synthesized, interpreted, and presented. Some studies are done periodically or one-time-only, and
not annually.
Note 5: Percentages in some facts may not equal 100 due to rounding.
Note 6: From the USRDS ADR: “Although traditional sources of data used in preparation of the ADR involve an
18-month lag, largely due to processing of Medicare claims, we have used quarterly data extracts from the Centers
for Medicare & Medicaid Services’ Renal Management Information System—anchored by the ESRD Medical
Evidence Report and the ESRD Death Notiication—to examine changes in mortality, hospitalization, and onset
of ESRD during the early period of the pandemic.” “…this year’s ADR does not contain data from private insurers.
However, we anticipate that future ADRs will include these data and will also incorporate additional data sources to
more fully characterize non-Medicare populations with kidney disease.”
Notes
9
References
1 Centers for Disease Control and Prevention (CDC). National Vital
Statistics Reports (NVSR). CDC website.
https://www.cdc.gov/nchs/products/nvsr.htm
Also:
https://www.cdc.gov/nchs/data/nvsr/nvsr69/nvsr6913508.pdf
[Volume 69, Number 13; 2021 January 12; Murphy SL, Xu J, Kochanek
KD, Arias E, Tejada-Vera B, Division of Vital Statistics; Deaths: inal
data for 2018]
[Pg.1, Col. 2, & Pg. 9, Col. 1: # 9. Nephritis, nephrotic syndrome and
nephrosis (kidney disease); Table 6. Number of deaths from selected
causes, by age: United States, 2018. p.36, Row: Malignant neoplasm
of breast: 42,950; p.36, Row: Malignant neoplasm of prostate:
31,489; p. 37, Row: Nephritis, nephrotic syndrome and nephrosis:
51,386]
2 Centers for Disease Control and Prevention (CDC). Chronic kidney
disease in the United States, 2021. Atlanta, GA: US Department
of Health and Human Services, Centers for Disease Control and
Prevention; 2021.
https://www.cdc.gov/kidneydisease/publications-resources/ckd-
national-facts.html
PDF: https://www.cdc.gov/kidneydisease/pdf/Chronic-Kidney-
Disease-in-the-US2021-h.pdf
3 37 million. Centers for Disease Control and Prevention (CDC);
Chronic Kidney Disease (CKD) Surveillance System. Prevalence and
incidence. CDC website. https://nccd.cdc.gov/ckd/Default.aspx
[•Prevalence of CKD is likely overestimated by single measurements
of albuminuria and kidney function (eGFR). In clinical practice, CKD is
deined by persistent albuminuria or reduced kidney function for ≥3
months.*
•In 20152016, 14%-15% of adult NHANES participants, representing
~3134 million noninstitutionalized U.S. civilian residents aged 20 years
or older, had evidence of CKD stages 14; of these, ~1518 million had
evidence of CKD stage 3 or 4.**
[Prevalence and Incidence > View Prevalence and Incidence
Summary > Prevalence of CKD in the General Population > CKD
stages among U.S. Adults, 19881994 vs. 19992006 vs. 20072014 vs.
20152016;
*“Methods” tab & **“Key Points” tab.]
Available at: https://nccd.cdc.gov/CKD/detail.
aspx?Qnum=Q8#refreshPosition ]
4 USRDS releases 2020 interactive Annual Data Report [news
release]. 2020, November 11. https://usrds.org/news/
[“Important indings in this year’s Annual Data Report include: A
14.9% prevalence of CKD among US adults.”]
5 NOTE: Estimate of 1 in 3 (approx. 80 million) adults at risk for CKD
is based on U.S. prevalence of hypertension, diabetes, and obesity.
Without proper treatment, 1 in 3 will develop CKD.
6 Kochanek KD, Xu JQ, Arias E. (2020 December). Mortality in the
United States, 2019; NCHS Data Brief, No. 395, December 2020.
Hyattsville, MD: National Center for Health Statistics.
https://www.cdc.gov/nchs/products/databriefs/db395.htm
PDF : https://www.cdc.gov/nchs/data/databriefs/db395H.pdf
[“The 10 leading causes of death in 2019 remained the same as
in 2018, although kidney disease, the eighth leading cause and
inluenza and pneumonia, the ninth in 2019, switched ranks.”]
7 Ahmad FB, Cisewski JA, Miniño A, Anderson RN. Provisional
mortality data—United States, 2020. MMWR Morb Mortal Wkly
Rep. ePub: 31 March 2021. doi: http://dx.doi.org/10.15585/mmwr.
mm7014e1external icon
https://www.cdc.gov/mmwr/volumes/70/wr/mm7014e1.htm
[FIGURE 2. Provisional number of leading underlying causes of
death—National Vital Statistics System, United States, 2020]
8 United States Renal Data System (USRDS). 2020 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, 2020.
https://adr.usrds.org/2020/reference-tables
[2020 Annual Data Report; Reference Tables, Vol. 2ESRD; Ref.
Tables D Treatment Modalities; Table D.7 Counts of point prevalent
ESRD patients, by mode of therapy: hemodialysis. Col. U (2018), Row
59 (All) = 495,402 (HD); Table D.8 Counts of point prevalent ESRD
patients, by mode of therapy: peritoneal dialysis. Col. U (2018), Row
59 (All) = 58,558 (PD); Table D.9 Counts of point prevalent ESRD
patients, by mode of therapy: functioning graft. Col. U, Row 59 =
229,887 (TX).]
Also:
United States Renal Data System (USRDS). 2020 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, 2020.
https://adr.usrds.org/2020/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; Highlights;
Bullet #6: “At the end of 2018, there were 554,038 (70.7%) patients
undergoing dialysis and 229,887 (29.3%) patients with a functioning
kidney transplant.” (Figure 1.6)]
9 U.S. Department of Health and Human Services (HHS); National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Causes of chronic kidney disease. NIDDK website. 2016, October.
https://www.niddk.nih.gov/health-information/kidney-disease/
chronic-kidney-disease-ckd/causes
Also: (diabetes)
Broom D. The silent epidemic that is three times as deadly as COVID.
World Economic Forum website. (2020, December 14). https://www.
weforum.org/agenda/2020/12/diabetes-silent-epidemic-world-health/
10
10 United States Renal Data System (USRDS). 2020 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, 2020.
https://adr.usrds.org/2020/reference-tables
[USRDS 2020 ADR Reference Tables, Vol. 2ESRD; Ref. Tables A
Incidence; Table A.4 Incident counts of reported ESRD patients, by
age and primary diagnosis, 20162018 combined. Col. X, Row 38 (All
patients) 382,398; Col. X, Row 33 (Diabetes) 179,706; Col. X, Row 34
(Hypertension) 110,807.] [Computed from: (Col. X shows all gender
and race.) All patients (Col. X, Row 38) = 382,398 / DM (Col. X, Row
33) 179,706; (179,706/382,398) = 47% (0.4699); HTN (Col. X, Row 34)
110,807 (110,807/382,398) = 29% (0.2897)]
11 Ramakrishnan K, Scheid DC. Diagnosis and management of acute
pyelonephritis in adults. Am Fam Physician. 2005;71:933942.
https://www.ncbi.nlm.nih.gov/pubmed/15768623
Also:
Mayo Clinic. Kidney infection. Mayo Clinic website.
https://www.mayoclinic.org/diseases-conditions/kidney-infection/
symptoms-causes/syc-20353387
12 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), Oice of Minority Health (OMH); February 2020.
[Pages 6 & 10]
PDF:
https://www.cms.gov/iles/document/chronic-kidney-disease-
disparities-educational-guide-primary-care.pdf
[NOTE: The booklet above is also footnoted and contains sources for
more detailed data.]
13 United States Renal Data System (USRDS). 2020 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, 2020.
https://adr.usrds.org/2020/chronic-kidney-disease/1-ckd-in-the-
general-population
[2020 ADR Chapters; Volume 1 CKD; Chapter 1: CKD in the General
Population; Figure 1.11; see Stages 13 in igure] [Figure 1.11 caption:
“Figure 1.11 shows that although awareness among individuals with
CKD has increased over time, the vast majority of individuals with
kidney disease remain unaware.” “Those with more advanced stages
of kidney disease were also more likely to be aware than those with
earlier stages, although recognition was still low even in stage 3
(16.9%, compared with 61.9% for stage 4 and 86.3% for stage 5 in
2018).”]
14 United States Renal Data System (USRDS). 2020 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, 2020.
https://adr.usrds.org/2020/reference-tables
[2020 Annual Data Report; Reference Tables, Vol. 2ESRD; Ref.
Tables D. Treatment Modalities. Table D.11 Point prevalent ESRD
patients, 2018, by treatment modality. Col. J, Row 59 (All treatment
modalities/all populations): 785,883; Col. B, Row 59 (Center
hemodialysis/All populations): 484,466; Col. C, Row 59 (Center
self-hemodialysis/All populations): 586; Col. D, Row 60 (Home
hemodialysis/All populations): 10,350. (Total hemodialysis: 495,461)]
Also:
United States Renal Data System (USRDS). 2020 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, 2020.
https://adr.usrds.org/2020/end-stage-renal-disease/1-incidence-
prevalence-patient-characteristics-and-treatment-modalities
[2020 ADR Chapters; Volume 2 End Stage Renal Disease; Chapter
1: Incidence, Prevalence, Patient Characteristics, and Treatment
Modalities; Highlights: Bullet #6: “At the end of 2018, there were
554,038 (70.7%) patients undergoing dialysis and 229,887 (29.3%)
patients with a functioning kidney transplant (Figure 1.6).”]
15 United States Renal Data System (USRDS). 2020 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, 2020.
https://adr.usrds.org/2020/reference-tables
[2020 Annual Data Report; Reference Tables; Volume 2ESRD: A.
Incidence; Table A1 Incident counts of reported ESRD by age, sex,
race, ethnicity & primary cause of ESRD. Col. U, Row 60 (2018/U.S.):
129,604] [“Incident counts,” i.e., starting ESRD.]
Also:
Centers for Disease Control and Prevention (CDC). Chronic kidney
disease in the United States, 2021. Atlanta, GA: US Department
of Health and Human Services, Centers for Disease Control and
Prevention; 2021.
https://www.cdc.gov/kidneydisease/publications-resources/ckd-
national-facts.html
PDF: https://www.cdc.gov/kidneydisease/pdf/Chronic-Kidney-
Disease-in-the-US2021-h.pdf
[Pg. 3, Col. 1, Facts About ESRD, bullet #1: “In 2018, about 131,600
people in the United States started treatment for ESRD.”]
16 United States Renal Data System (USRDS). 2020 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, 2020.
https://adr.usrds.org/2020/reference-tables
[2020 Annual Data Report; Reference Tables; Volume 2ESRD: D.
Treatment Modalities; Table D.2 Counts of incident ESRD patients
by initial mode of therapy: all dialysis. Col. U, Row 60 (2018/All
populations): 127,925]
11
17 United States Renal Data System (USRDS). 2020 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, 2020.
https://adr.usrds.org/2020/reference-tables
[2020 Annual Data Report; Reference Tables; Volume 2 – ESRD: E.
Transplantation: Process; Table E.8 Counts of renal transplants, by
donor type, all donor types. Col. X, Row 101 (2018/All): 22,393]
18 United States Renal Data System (USRDS). 2020 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, 2020.
https://adr.usrds.org/2020/reference-tables
[2020 Annual Data Report; Reference Tables; Vol. 2ESRD; Ref.
Tables D. Treatment Modalities. Table D.9 Counts of point prevalent
ESRD patients, by mode of therapy: functioning graft. Col. U, Row 59
(2018/All populations: 229,887]
19 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; Count: Candidates; Step 2: Choose a report: Overall by Organ;
Change report: Candidates; Column: Kidney = 91,154 (3/2021)]
20 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.] [2020: All donor types: 22,817;
Deceased donor: 17,583; Living donor: 5,234 (3/2021)]
21 NOTE: According to a communication with United Network for
Organ Sharing (UNOS) (2019, June 4), on average, 12 patients died
every day waiting for a kidney transplant in 2017. These candidates
diedin 2017 while on the wait list, or within 30 days of leaving the
list for personal or medical reasons, without receiving an organ
transplant.
22 National Kidney Foundation (NKF). Report of National Kidney
Foundation Consensus Conference to Decrease Kidney Discards.
NKF website. October 22, 2018. https://www.kidney.org/news/report-
national-kidney-foundation-consensus-conference-to-decrease-
kidney-discards
23 Cooper M, Formica R, Friedewald J, Hirose R, O’Connor K,
Mohan S, Schold J, Axelrod D, Pastan S. Report of National Kidney
Foundation Consensus Conference to Decrease Kidney Discards.
Clin Transplant. 2019 January;33(1):e13419. doi: 10.1111/ctr.13419. Epub
2018 October 21.
https://onlinelibrary.wiley.com/doi/full/10.1111/ctr.13419
24 Webster AC, Nagler EV, Morton RL, Masson P. Chronic kidney
disease. Lancet. 2017, March 25;389(10075):12381252. doi: 10.1016/
S01406736(16)320645. Epub 2016 Nov 23.
https://www.ncbi.nlm.nih.gov/pubmed/27887750#
https://www.sciencedirect.com/science/article/abs/pii/
S0140673616320645
25 United States Renal Data System (USRDS). 2020 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, 2020.
https://adr.usrds.org/2020/reference-tables
[2020 Annual Data Report; Reference Tables, Vol. 2--ESRD; Ref. Tables
H. Mortality and Causes of Death; Table H.1 Total patient deaths:
ESRD patients. Col. U, Row 64 (2018/All patients): 107,798]
26 McCullough KP, Morgenstern H, Saran R, Herman WH,
Robinson BM. Projecting ESRD incidence and prevalence in the
United States through 2030. JASN. 2019, January;30(1):127135.
doi: 10.1681/ASN.2018050531 https://jasn.asnjournals.org/
content/30/1/127#:~:text=The%20increasing%20size%20of%20
the,of%20687%2C093%20patients%20with%20ESRD
[“The increasing size of the United States population will also aect
the ESRD population size. The number of patients with prevalent
ESRD is projected to continue to increase to between 971,000 and
1,259,000 patients by 2030, an increase of 41%–83% over the 2015
prevalence count of 687,093 patients with ESRD.”]
27 Centers for Disease Control and Prevention (CDC); Chronic
Kidney Disease (CKD) Surveillance System. Chronic Kidney Disease
Prevalence Is Higher in Older Adults. CDC; Chronic Kidney Disease
(CKD) Surveillance System website. 2020, September.
https://nccd.cdc.gov/CKD/AreYouAware.aspx
28 Inker LA, Astor BC, Fox CH, et al. KDOQI US Commentary on
the 2012 KDIGO Clinical Practice Guideline for the Evaluation and
Management of CKD. Am J Kidney Dis. 2014;63(5):713735. https://
www.kidney.org/sites/default/iles/docs/inker_et_al_ajkd_ckd_
commentary_epub.pdf
[See page 5, Box 2]
29 National Kidney Foundation (NKF) and the National Association
for the Advancement of Colored People (NAACP). Kidneys and
COVID19: navigating health disparities in minority communities.
Congressional brieing; 2020, May 27.
https://www.kidney.org/sites/default/iles/20200527_brieing_
kidneys-and-covid_inal.pdf
30 United States Renal Data System (USRDS). 2020 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, 2020.
https://adr.usrds.org/2020/chronic-kidney-disease/1-ckd-in-the-
general-population
[2020 ADR Chapters; Volume 1 CKD; Chapter 1 CKD in the General
Population; Figure 1.5 Prevalence of CKD in U.S. adults within age,
sex, race/ethnicity, & risk factor categories, 20032018; tab: Race/
ethnicity; 20152018]
12
31 Centers for Medicare and Medicaid Services (CMS), Oice of
Minority Health (OMH). Chronic kidney disease disparities in Medicare
fee-for-service beneiciaries. CMS OMH Data Snapshot. Centers for
Medicare and Medicaid Services website. 2020, August.
https://www.cms.gov/About-CMS/Agency-Information/OMH/
Downloads/Data-Snapshot-Chronic-Kidney-Disease.pdf
[NOTE: The sheet above is also footnoted and contains sources for
more detailed data.]
32 Young BA, Katz R, Boulware LE, et al. Risk factors for rapid kidney
function decline among African Americans: The Jackson Heart
Study (JHS). Am J Kidney Dis. 2016;68(2):229239. doi:10.1053/j.
ajkd.2016.02.046
33 American Society of Nephrology (ASN). Why do minorities have
higher rates of kidney failure? (media release). ASN website. 2020,
October 23.
https://www.asn-online.org/about/press/releases/ASN_PR_20201023_
YanKWFINAL10.24.2020.pdf
Also: https://www.asn-online.org/about/press/releases/
34 National Institutes of Health (NIH); National Institute of Diabetes
and Digestive and Kidney Diseases (NIDDK). Race, ethnicity, & kidney
disease. NIDDK website. [2016 data].
https://www.niddk.nih.gov/health-information/kidney-disease/race-
ethnicity
35 United States Renal Data System (USRDS). 2020 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, 2020.
https://adr.usrds.org/2020/end-stage-renal-disease/1-incidence-
prevalence-patient-characteristics-and-treatment-modalities
[2020 ADR Chapters; Volume 2 End Stage Renal Disease; Chapter
1: Incidence, Prevalence, Patient Characteristics, and Treatment
Modalities; Highlights: Bullet #8: The adjusted prevalence of ESRD
was 3.4 times higher in Blacks than Whites in 2018 (Figure 1.8).]
36 Fisher M, Neugarten J, Bellin E et al. AKI in hospitalized
patients with and without COVID19: a comparison study.
Journal of the American Society of Nephrology (JASN). 2020
September;31(9):21452157.
doi: 10.1681/ASN.2020040509
https://jasn.asnjournals.org/content/31/9/2145
37 Hirsch JS, Ng JH, Ross DW, Sharma P, Shah HH, Barnett RL, Hazzan
AD, Fishbane S, Jhaveri KD on behalf of the Northwell COVID19
Research Consortium and the Northwell Nephrology COVID19
Research Consortium. Acute kidney injury in patients hospitalized
with COVID19. Kidney Int. 2020 July;98(1):209218. Published online:
May 13, 2020. doi: 10.1016/j.kint.2020.05.006
38 U.S. Department of Health and Human Services (HHS); Centers
for Disease Control and Prevention (CDC). Cunningham TJ, Croft JB,
Liu Y, Eke PI, Giles WH. Vital Signs: Racial Disparities in Age-Speciic
Mortality Among Blacks or African Americans-United States 1999-
2015. Morb Mortal Wkly Rep. (MMWR). 2017;66:444456.
doi: 10.15585/mmwr.mm6617e1
Available at: BlackDemographics website. https://blackdemographics.
com/are-african-americans-at-risk-for-the-coronavirus/ [See table:
Black Adult Health Risks: Age 18 and Up: Have Fair/Poor Health
Status]
39 Naʻai D, Raphael KL. CKD in Native Hawaiians and Paciic Islanders:
trouble in paradise. CJASN. 2019 November;14(11):16611663. doi: doi.
org/10.2215/CJN.03260319
https://pubmed.ncbi.nlm.nih.gov/31501091/
40 Centers for Disease Control and Prevention (CDC). Chronic
Kidney Disease (CKD) Surveillance System. Focus on Risk Factors and
Themes: Race/Ethnicity. CDC website. https://nccd.cdc.gov/ckd/
FactorsOfInterest.aspx?type=Race/Ethnicity
[“African Americans, Hispanics, and American Indians are at high
risk for developing kidney failure. This risk is because of high rates of
diabetes and high blood pressure in these communities.”]
41 Purnell TS, Luo X, Cooper LA, et al. Association of race and
ethnicity with live donor kidney transplantation in the United
States from 1995 to 2014. JAMA. 2018;319(1):4961. doi:10.1001/
jama.2017.19152
https://jamanetwork.com/journals/jama/fullarticle/2667722
Also:
JAMA Network. Racial, ethnic disparities persist for patients in
receiving kidney transplants from live donors [news release]. Journal
of the American Medical Association (JAMA) Network website. (2018,
January 2). https://media.jamanetwork.com/news-item/racial-ethnic-
disparities-persist-patients-receiving-kidney-transplants-live-donors/
http://jamanetwork.com/journals/jama/fullarticle/10.1001/
jama.2017.19152
42 The Oice of Minority Health (OMH) at the U.S. Department of
Health and Human Services (HHS). Organ Donation and African
Americans. OMH website. (2020, February 20). https://minorityhealth.
hhs.gov/omh/browse.aspx?lvl=4&lvlid=27
[Bullet #4: “Although the total number of white Americans on organ
transplant waiting lists is about 1.4 times greater than that of Black/
African Americans, the number of candidates waiting for a kidney
transplant is almost the same between Black/African Americans and
white Americans.”] [Source: HRSA. U.S. Organ Procurement and
Transplantation Network (OPTN). Based on OPTN data as of February
20, 2020. https://optn.transplant.hrsa.gov/data/view-data-reports/
national-data/ ]
Also:
Longino K. NKF All Sta; National Minority Donor Awareness Month
(NMDAM). (Kevin Longino, NKF All Sta; personal communication,
August 10, 2020.) [“On average, Black or African American transplant
candidates wait longer than White transplant candidates for kidney,
heart, and lung transplants. Addressing these health disparities are
critically important to our mission and are necessary to help heal and
save lives in our communities.”]
43 United States Renal Data System. 2020 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, 2020.
https://adr.usrds.org/2020/end-stage-renal-disease/1-incidence-
prevalence-patient-characteristics-and-treatment-modalities
[2020 ADR Chapters; Volume 2; End Stage Renal Disease: Chapter
1 Incidence, Prevalence, Patient Characteristics, and Treatment
Modalities; Highlights; Bullet #12: “Whereas 57% of White patients
with prevalent ESRD received in-center hemodialysis at the end of
2018, 72% of Black patients received in-center hemodialysis (Figure
1.14).”]
13
44 African Americans face barriers to alternative modes of renal
replacement therapy. Nephrology News and Issues (NNI). (2020,
January 13). Healio website. https://www.healio.com/news/
nephrology/20200113/african-americans-face-barriers-to-alternative-
modes-of-renal-replacement-therapy
Also:
King A, Lopez FY, Lissanu L, et al. Renal replacement knowledge
and preferences for African Americans with chronic kidney disease.
2020;46(3):151160.
doi: 10.1111/jorc.12312
https://onlinelibrary.wiley.com/doi/abs/10.1111/jorc.12312
45 Summaries of children and adolescent (pediatric) data based on:
Centers for Disease Control and Prevention (CDC), Chronic Kidney
Disease (CKD) Surveillance System. Are you aware? Quick facts about
kidney disease: Almost 10,000 children and adolescents in United
States are living with end-stage renal disease. [Email updates.]. 2017,
July 30.
[Other resources:
https://www.usrds.org/2018/view/v2_07.aspx?zoom_highlight=pediatric
https://nccd.cdc.gov/CKD/Data.aspx ]
46 U.S. Department of Health and Human Services (HHS); Centers for
Disease Control and Prevention (CDC) website. Page last reviewed:
2020, February 24.
https://www.cdc.gov/bloodpressure/youth.htm
[Note: Data used the 2017 American Academy of Pediatrics (AAP)
Clinical Practice Guideline.]
47 Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity
among adults and youth: United States, 20152016. NCHS Data Brief.
2017 October;288. Hyattsville, MD: U.S. Department of Health and
Human Services (HHS); Centers for Disease Control and Prevention
(CDC); National Center for Health Statistics (NCHS).
https://www.cdc.gov/nchs/data/databriefs/db288.pdf
[Page 3, Figure 3]
48 American Diabetes Association (ADA). Statistics about diabetes:
diabetes in youth. ADA website.
http://www.diabetes.org/diabetes-basics/statistics/
49 United States Renal Data System (USRDS). 2020 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, 2020.
https://adr.usrds.org/2020/reference-tables
[2020 ADR Reference Tables; Volume 2; B. Prevalence; Tab B.1
Prevalent counts of reported ESRD: on December 31 of each year, by
age, sex, race, ethnicity and primary cause of ESRD, All patients, U.S.
and territories. Column U, Rows 69] [Column U, Row 6 (04) 862 +
Row 7, (59) 1,331 + Row 8 (1013) 1702 + Row 9 (1417) 2532 = 6,427]
50 McDonald SP, Craig JC for the Australian and New Zealand
Paediatric Nephrology Association. Long-term survival of children
with end-stage renal disease. N Engl J Med, 2004;350:26542662.
doi: 10.1056/NEJMoa031643
https://www.nejm.org/doi/full/10.1056/NEJMoa031643
[“A total of 1634 children and adolescents were followed for a median
of 9.7 years. The long-term survival rate among children requiring
renal-replacement therapy was 79 percent at 10 years and 66 percent
at 20 years. Mortality rates were 30 times as high as for children
without end-stage renal disease.”]
51 Kramer A, Stel VS, Tizard J, Verrina E, Rönnholm K, Pálsson R,
Maxwell H, Jager KJ. Characteristics and survival of young adults
who started renal replacement therapy during childhood. Nephrol
Dial Transplant. 2009 March;24(3):926933. Epub 2008 Oct 7. doi:
10.1093/ndt/gfn542.
https://www.ncbi.nlm.nih.gov/pubmed/?term=18840894
https://pubmed.ncbi.nlm.nih.gov/18840894/
[“The average life expectancy was 63 years for young adults with a
functioning graft and 38 years for those remaining on dialysis.”]
52 United States Renal Data System (USRDS). 2020 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, 2020.
https://adr.usrds.org/2020/end-stage-renal-disease/7-%20esrd-
among-children-and-adolescents
[2020 ADR Chapters; Volume 2; End Stage Renal Disease: Chapter
7; ESRD among Children and Adolescents; Figure 7.4 Distribution of
primary cause of ESRD in children with incident ESRD, by age, 2015-
2018]
53 U.S. Department of Health and Human Services (HHS); Organ
Procurement and Transplantation Network (OPTN). HHSOPTN
website.
https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/
[Home>> Data>> View Data Reports>> National Data>> From
dropdown menus, select: Step 1: Choose Category: Transplant; Step
2: Choose a report: Transplants by Recipient Age; Change Report:
Organ; Kidney; 2020: (age) (<1) 0 + (15) 184 + (610) 129 + (1117) 397
= 710]
54 U.S. Department of Health and Human Services (HHS); Organ
Procurement and Transplantation Network (OPTN). HHSOPTN
website.
https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/
[Home>> Data>> View Data Reports>> National Data>> From
dropdown menus, select: Step 1: Choose Category: Waiting List;
Count: Candidates; Column: Kidney: (<1) 0 + (15) 222 + (610) 245 +
(1117) 649 = 1,116 (3/2021)]
14
55 United States Renal Data System (USRDS). 2020 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, 2020.
https://adr.usrds.org/2020/end-stage-renal-disease/7-%20esrd-
among-children-and-adolescents
[2020 ADR Chapters; Volume 2; End Stage Renal Disease: Chapter
7; ESRD among Children and Adolescents; Highlights; Bullet # 3: “At
onset of ESRD, there was substantial racial and ethnic disparity in
ESRD treatment modality (Figure 7.3). White children were twice as
likely to receive a kidney transplant as Black children (20.8% versus
10.0%). A substantially higher percentage of Black (57.3%), compared
with White (40.5%) children initiated hemodialysis (HD). Hispanic-
Latino children received a kidney transplant at ESRD onset less often
than did non-Hispanic children (12.0% versus 20.2%) and initiated HD
more often and PD less often than non-Hispanic children.”; Bullet #14:
“The median time to receive a kidney transplant from initial waitlisting
varied substantially by race: 35.2 months for Black children, 34.0
months for children of other races, 23.3 months for White children,
and 20.3 months for Asian children (Figure 7.19).”]
56 United States Renal Data System (USRDS). 2020 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, 2020.
https://adr.usrds.org/2020/end-stage-renal-disease/1-incidence-
prevalence-patient-characteristics-and-treatment-modalities
[2020 ADR Volume 2; End Stage Renal Disease: Chapter 1; Incidence,
Prevalence, Patient Characteristics, and Treatment Modalities;
Highlights; Bullet #2: “The number of patients with incident ESRD
who initiated in-center hemodialysis ranged from 111,000 to 113,000
for the fourth consecutive year in 2018. Meanwhile, the number
of patients who initiated peritoneal dialysis and who received a
preemptive transplant reached an all-time high of 18,631 (Figure 1.2).”
(See also Figure 1.6.)]
57 United States Renal Data System (USRDS). 2020 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, 2020.
https://adr.usrds.org/2020/end-stage-renal-disease/6-transplantation
[2020 ADR Volume 2; End Stage Renal Disease; Chapter 6;
Transplantation; Highlights; Bullet #1: “In 2018, the cumulative
number of kidney transplants reached an all-time high of 22,393,
an increase of 6.5% since 2017 (Figure 6.9). However, the kidney
transplant rate among ESRD patients increased only slightly between
2017 and 2018, from 3.5 to 3.6 transplants per 100 patient-years.”;
Bullet #3: “The total number of individuals with ESRD on the kidney
transplant waiting list hit an all-time high in 2014 (Figure 6.2). Since
that time, it has decreased, but the decrease has been predominantly
among those with inactive status, with only a small decline in those
on the waiting list with active status.”]
58 United States Renal Data System (USRDS). 2020 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, 2020.
https://adr.usrds.org/2020/end-stage-renal-disease/1-incidence-
prevalence-patient-characteristics-and-treatment-modalities
[2020 ADR Volume 2; End Stage Renal Disease: Chapter 1 Incidence,
Prevalence, Patient Characteristics, and Treatment Modalities;
Highlights; Bullet # 13: “Pediatric patients were most likely to receive
pre-ESRD nephrology care (75.5%), and patients aged 1844 years
were least likely (61.2%) (Figure 1.16).” (i.e., 38.8% of 1844 years did
not)]
59 Baseline/general reference: Centers for Medicare & Medicaid
Services (CMS). CMS Oice of the Actuary releases 2018 National
Health Expenditures (press release). CMS website; Newsroom.
December 05, 2019. https://www.cms.gov/newsroom/press-releases/
cms-oice-actuary-releases-2018-national-health-expenditures
[“Medicare spending: (21 percent of total health care spending) grew
6.4 percent to $750.2 billion in 2018, which was faster than the 4.2
percent growth in 2017.”]
60 United States Renal Data System (USRDS). 2020 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, 2020.
https://adr.usrds.org/2020/chronic-kidney-disease/6-healthcare-
expenditures-for-persons-with-ckd
[2020 ADR Volume 1 Chronic Kidney Disease; Chapter 6 Healthcare
Expenditures for Persons with CKD; Highlights; Bullet #1: “Medicare
fee-for-service (FFS) spending for beneiciaries with CKD who did not
have ESRD exceeded $81 billion in 2018 and represented 22.3% of
Medicare FFS spending (Tables 6.1 and 6.2).”]
61 United States Renal Data System (USRDS). 2020 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, 2020.
https://adr.usrds.org/2020/end-stage-renal-disease/9-healthcare-
expenditures-for-persons-with-esrd
[2020 ADR Volume 2; End Stage Renal Disease: End Stage Renal
Disease: Chapter 9 Healthcare Expenditures for Persons with
ESRD; Highlights; Bullet #1: “Total Medicare-related expenditures
for beneiciaries with ESRD rose to $49.2B in 2018.”; Bullet #7: “In
unadjusted terms, PPPY spending in Medicare FFS beneiciaries with
ESRD increased from $86,939 to $93,191 for HD, from $67,196 to
$78,741 for PD, and from $33,613 to $37,304 (also Ref. Table K.9) for
kidney transplant (Figure 9.9).”]
15
62 Centers for Disease Control and Prevention. Chronic Kidney
Disease Initiative. Chronic kidney disease basics. CDC website.
https://www.cdc.gov/kidneydisease/basics.html
[“Costs: •Overall Medicare costs for people with CKD were over $81.8
billion in 2018, or $23,700 per person. •Total Medicare spending
(excluding prescription drugs) for patients with ESRD or kidney
failure reached $36.6 billion in 2018, or $80,000 per person,
accounting for about 7% of the Medicare paid claims costs.”]
63 United States Renal Data System (USRDS). 2020 USRDS annual
data report: epidemiology of kidney disease in the United States.
National Institutes of Health, National Institute of Diabetes and
Digestive and Kidney Diseases, Bethesda, MD, 2020.
https://adr.usrds.org/2020/reference-tables
[2020 ADR Reference Tables, Volume 2ESRD; K. Expenditures for
ESRD Patients; Section K: Medicare Costs for ESRD patients; K.5.
Per person per year spending ($): all ESRD patients, with unknown
modalities dropped (model 1). Row 61, All/Column Q, 2018: $80,426]
64 United States Renal Data System (USRDS). 2020 USRDS annual
data report: epidemiology of kidney disease in the United States.
National Institutes of Health, National Institute of Diabetes and
Digestive and Kidney Diseases, Bethesda, MD, 2020.
https://adr.usrds.org/2020/reference-tables
[USRDS 2020 ADR Reference Tables, Volume 1CKD: K. Expenditures;
K.1 Per person per year estimated costs ($): all fee-for-service non-
ESRD Medicare patients; Row 40, All/Column U, 2018: $12,899; Row
38, CKD/Column U, 2018: $24,674; also, Table K.2 Per person per year
estimated costs ($): fee-for-service non-ESRD Medicare patients with
chronic kidney disease (CKD): Row 41, All/Column U, 2018: $24,674]
65 United States Renal Data System (USRDS). 2020 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, 2020.
https://adr.usrds.org/2020/end-stage-renal-disease/9-healthcare-
expenditures-for-persons-with-esrd
[2020 ADR Volume 2 End Stage Renal Disease: Chapter 9 Healthcare
Expenditures for Persons with ESRD; Figure 9.3a “Sources of medical
coverage for patients with incident ESRD, 20092018, by treatment
modality; 2018; Non-Medicare: 35.7%; Medicare Advantage 23.8%;
MSP: 5.8%; MPP: dual Medicare/Medicaid: 10.3%; MPP Medicare only:
24.4%....Total Medicare-related: 64.3%; non-Medicare 35.7%”]
66 United States Renal Data System (USRDS). 2020 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, 2020.
https://adr.usrds.org/2020/end-stage-renal-disease/9-healthcare-
expenditures-for-persons-with-esrd
[2020 ADR Volume 2 End Stage Renal Disease; Chapter 9 Healthcare
Expenditures for Persons with ESRD; Introduction; Paragraph #2:
“At the end of 2018, there were over 500,000 patients receiving
maintenance dialysis, who represent approximately 1% of the
U.S. Medicare fee-for-service (FFS) population but account for
approximately 7.2% of Medicare FFS spending.”]
67 United States Renal Data System (USRDS). 2020 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, 2020.
https://adr.usrds.org/2020/end-stage-renal-disease/10-prescription-
drug-coverage-in-patients-with-esrd
[2020 ADR; Volume 2 End Stage Renal Disease; Chapter 10
Prescription Drug Coverage in Patients with ESRD; Highlights; Bullet
#1: “Between 2009 and 2018, total Medicare Part D spending rose
by 188% in those with CKD ($4.6 to $13.1 billion) and by 37% in those
without CKD ($39.5 to $54.2 billion).”
68 United States Renal Data System (USRDS). 2020 USRDS annual
data report: epidemiology of kidney disease in the United States.
National Institutes of Health, National Institute of Diabetes and
Digestive and Kidney Diseases, Bethesda, MD, 2020.
https://www.usrds.org/reference.aspx
[2020 ADR Reference Tables; Volume 2; K. Expenditures for ESRD
Patients; Table K.b Medicare payments ($) per person per year:
2018, by claim type (model 1); Column G, Transplant/Row 50,
Immunosuppressive drugs = $2,453]
69 United States Renal Data System (USRDS). 2020 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, 2020.
https://adr.usrds.org/2020/chronic-kidney-disease/7-prescription-
drug-coverage-in-patients-with-ckd
[2020 ADR Volume 1 CKD; Chapter 7 Prescription Drug Coverage in
Patients with CKD; Highlights; Bullet #6: “In 2018, per person per year
Medicare Part D spending was 1.7 times higher for those with CKD
($5392) than for those without CKD ($3118) (Figure 7.7).”]
70 United States Renal Data System (USRDS). 2020 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, 2020.
https://adr.usrds.org/2020/end-stage-renal-disease/10-prescription-
drug-coverage-in-patients-with-esrd
[2020 ADR Volume 2 End Stage Renal Disease: Chapter 10
Prescription Drug Coverage in Patients with ESRD; Highlights; Bullet
# 6: “In 2018, Medicare Part D spending was 2.4 times higher for
patients with ESRD ($8173) than those without ($3397) (Figure 10.7).”
(Bullet #5: “Per person per year Part D spending also increased in
beneiciaries with ESRD until 2017, after which there was a large
decrease (Figure 10.5)…”)]
16
71 National Kidney Foundation. National Kidney Foundation Applauds
House Passage of Landmark Immunosuppressive Drug Coverage Bill
(news release). National Kidney Foundation website; Press Room.
(2020, December 8).
https://www.kidney.org/news/national-kidney-foundation-applauds-
house-passage-landmark-immunosuppressive-drug-coverage-bill
Also:
Congressional Budget Oice. (2020, November 2). Congressional
Budget Oice cost estimate: at a glance: H.R. 5534, Comprehensive
Immunosuppressive Drug Coverage for Kidney Transplant Patients
Act of 2020.
https://www.cbo.gov/system/iles/202011/hr5534.pdf
Congressional Budget Oice. Frequently asked questions about CBO
Cost Estimates. CBO website. https://www.cbo.gov/about/products/
ce-faq
72 National Kidney Foundation. NKF Applauds Immunosuppressive
Drug Coverage Legislation Passed in the U.S. Senate (news release).
National Kidney Foundation website; Press Room. (2020, December
22). https://www.kidney.org/news/national-kidney-foundation-
applauds-landmark-immunosuppressive-drug-coverage-legislation-
passed
Also:
Congressional Budget Oice. (2020, November 2), Congressional
Budget Oice cost estimate: at a glance: H.R. 5534, Comprehensive
Immunosuppressive Drug Coverage for Kidney Transplant Patients
Act of 2020. https://www.cbo.gov/system/iles/202011/hr5534.pdf
Congressional Budget Oice. Frequently asked questions about CBO
Cost Estimates. CBO website. https://www.cbo.gov/about/products/
ce-faq
73 Oice of Disease Prevention and Health Promotion (ODPHP);
Healthypeople.gov. Access to health services. Oice of Disease
Prevention and Health Promotion website.
https://www.healthypeople.gov/2020/topics-objectives/topic/social-
determinants-health/interventions-resources/access-to-health
[NOTE: The webpage above is also footnoted and contains sources
for more detailed data.]
74 Centers for Disease Control and Prevention (CDC). (2021, February
18). Live well with chronic kidney disease. CDC website.
https://www.cdc.gov/kidneydisease/publications-resources/live-well-
with-chronic-kidney-disease.html
75 National Kidney Foundation (NKF). 6-step guide to protecting
kidney health. NKF website. https://www.kidney.org/atoz/content/
sixstepshealthprimer
76 U.S. Department of Health and Human Services (HHS); ASPE Oice
of the Assistant Secretary for Planning and Evaluation. The Special
Diabetes Program for Indians: estimates of Medicare savings. ASPE
website. (2019, May 10).
https://aspe.hhs.gov/pdf-report/special-diabetes-program-indians-
estimates-medicare-savings
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