Risk of ESRD in the United States

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• 作者：Patrick Albertus ; MPH¹ ; ² ; Hal Morgenstern ; PhD² ; ³ ; ⁴ ; ⁵ ; ^{halm@umich.edu" class="auth_mail" title="E-mail the corresponding author} ; Bruce Robinson ; MD ; MS⁵ ; ⁶ ; ⁷ ; Rajiv Saran ; MD¹ ; ² ; ⁵ ; ⁷
• 关键词：End-stage renal disease (ESRD) ; incidence ; risk ; cumulative incidence ; risk estimate ; lifetime risk ; lifetable ; racial disparity ; US Renal Data System (USRDS) ; epidemiology ; public health ; mortality ; nationwide surveillance ; health inequity
• 刊名：American Journal of Kidney Diseases
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：68
• 期：6
• 页码：862-872
• 全文大小：879 K

文摘

Although incidence rates of end-stage renal disease (ESRD) in the United States are reported routinely by the US Renal Data System (USRDS), risks (probabilities) are not reported. Short- and long-term risk estimates need to be updated and expanded to minority populations, including Native Americans, Asian/Pacific Islanders, and Hispanics.

Study Design

Risk estimation from surveillance data in large populations using life-table methods. A competing-risks framework was applied by constructing a hypothetical cohort followed from birth to death.

Setting & Participants

Total US population. Incidence and mortality rates of ESRD were obtained from the USRDS; all-cause mortality rates were obtained from CDC WONDER.

Predictors

Age, sex, race/ethnicity, and year.

Outcomes

10-year to lifetime risks (cumulative incidence) of ESRD.

Results

Among males, lifetime risks of ESRD from birth using 2013 data were 3.1% (95% CI, 3.0%-3.1%) for non-Hispanic whites, 8.0% (95% CI, 7.9%-8.2%) for non-Hispanic blacks, 3.8% (95% CI, 3.4%-4.9%) for non-Hispanic Native Americans, 5.1% (95% CI, 4.8%-5.4%) for non-Hispanic Asians/Pacific Islanders, and 6.2% (95% CI, 6.1%-6.4%) for Hispanics. Among females, lifetime risks were 2.0% (95% CI, 2.0%-2.1%) for non-Hispanic whites, 6.8% (95% CI, 6.7%-6.9%) for non-Hispanic blacks, 3.6% (95% CI, 3.3%-4.2%) for non-Hispanic Native Americans, 3.8% (95% CI, 3.6%-4.0%) for non-Hispanic Asian/Pacific Islanders, and 4.3% (95% CI, 4.2%-4.5%) for Hispanics. Lifetime risk of ESRD from birth increased from 3.5% in 2000 to 4.0% in 2013 in males and decreased from 3.0% to 2.8% in females.

Limitations

Standard life-time assumption of fixed age-specific rates over time and possible ESRD misclassification. To be useful in clinical practice, this application will require additional predictors (eg, comorbid conditions and chronic kidney disease stage).

Conclusions

ESRD risk in the United States varies more than 2-fold among racial/ethnic groups for both sexes.