Little progress has been made in closing racial and socioeconomic gaps among patients with chronic kidney disease (CKD) in the United States over the last 3 decades, new research suggests.
The Centers for Disease Control and Prevention CKD surveillance team examined data on 54,554 participants (mean age, 46.2 years; 51.7% female) from the National Health and Nutrition Examination Surveys 1988 through 2016. The age-, sex-, and race/ethnicity-adjusted prevalence of CKD stages 3 to 4 (based on estimated glomerular filtration rate) increased from 3.9% in 1988-1994 to 5.2% in 2003-2004 then stabilized at 5.1% in 2015-2016, Priya Vart, PhD, of Radboud University Medical Center in Nijmegen, the Netherlands, and colleagues reported in JAMA Network Open.
The team analyzed results by 4 major race/ethnicity categories: non-Hispanic White, non-Hispanic Black, Mexican American, and Other. For 3 groups, CKD prevalence increased during 1988-1994 to 2003-2004 then remained stable until 2016, according to crude analyses: White (5.1% vs 7.7% vs 7.9%), Black (3.7% vs 5.3% vs 5.5%), and Other (2.9% vs 3.9% vs 3.8%), respectively. For Mexican Americans, CKD prevalence was initially lower than in other groups (1.1% in 1988) but then significantly increased to 3.5% in 2016.
The investigators lacked data on other racial/ethnic groups in the United States, including American Indians, Asians, and Pacific Islanders, as well as other subpopulations of Hispanics, which was a study limitation.
Furthermore, CKD rates tended to be higher in groups with low education and income during the 28 years. In 2016 adjusted analyses, 7.2% low vs 6.2% high education and 6.4% low vs 4.5% high income individuals had CKD. Trends appeared similar when the team included albuminuria to define CKD.
“To achieve health equity, renewed efforts are needed to effectively mitigate persistent disparities in CKD prevalence,” Dr Vart and her collaborators concluded. They highlighted the need for greater CKD awareness and mentioned the success of strategies such as the Indian Health Service program for lowering rates of end-stage kidney disease among persons with diabetes and interventions targeting education and early childhood.
Vart P, Powe NR, McCulloch CE, et al; the Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team. National trends in the prevalence of chronic kidney disease among racial/ethnic and socioeconomic status groups, 1988-2016 [published online July 16, 2020].JAMA Netw Open. 3(7):e207932. doi: 10.1001/jamanetworkopen.2020.7932