USRDS shows the high cost, low awareness of kidney disease

The overall burden of kidney disease remains high in the United States, with the rates of kidney failure ranking among the highest in the world, according to the 2017 annual data report from the United State Renal Data System. This year's report provides data through 2015 and is released by the USRDS coordinating center based at the University of Michigan Kidney Epidemiology and Cost Center, in partnership with Arbor Research Collaborative for Health.

In 2015, 124,111 new cases of end-stage renal disease were reported with a total of nearly 500,000 patients receiving dialysis treatment and more than 200,000 living with a kidney transplant. The prevalence of earlier stages of chronic kidney disease has remained relatively stable at 14.8%. In sharp contrast to the high burden and cost, is the low awareness about the condition among patients with kidney disease, especially those in stages 1 to 3.

The cost to care for patients with CKD is also significant. In 2015, the total Medicare spending for beneficiaries with kidney disease was nearly $100 billion. This included more than $64 billion in spending for all Medicare beneficiaries who have CKD and another $34 billion for beneficiaries with ESRD.

"Over a third of patients starting dialysis have not had the benefit of being evaluated by a kidney doctor prior to this life changing event," says Rajiv Saran, MD, professor of internal medicine at the University of Michigan and director of the USRDS coordinating center. "Whereas kidney disease is often silent until late stages, there are missed opportunities to detect it early and implement therapies that can slow kidney disease progression. If we can target individuals with risk factors for disease, we can do a lot to prevent kidney failure and other devastating consequences."

Other highlights from the report

The one-year ESRD patient mortality among the 0-4-year age group has declined approximately 41.6% over the past decade.

The kidney allocation system policy changes resulted in a 2.3% decrease in the kidney transplant waiting list.

Incidence rates of ESRD disease have stabilized in the U.S., however there are large variations around the country with many hotspots.

Eighty percent of patients still use catheters as the main vascular access at initiation of hemodialysis.

Seventeen percent of patients used an arteriovenous fistula exclusively at dialysis initiation. This increased to 65% by the end of one year on hemodialysis, and to 72% at the end of two years.

Between 2001 and 2015, adjusted mortality rates decreased by 28% for dialysis patients. The net reductions in mortality from 2001 to 2015 were 27% for hemodialysis patients and 41% for peritoneal dialysis patients. However, since there appears to be a stabilization in mortality rates in recent years, there is no room for complacency.

In 2013, Medicare patients aged 66 years and older who were hospitalized for an acute kidney injury had a 35% cumulative probability of a recurrent AKI hospitalization within one year.