Report identifies positive news on kidney disease in the U.S., yet challenges remain

ANN ARBOR, Mich. – The annual data report from the United States Renal Data System (USRDS) reveals both positive and negative trends in kidney disease in the U.S.

The report 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.

Highlights from the report include:

• Fewer deaths were reported among dialysis and kidney transplant patients in 2013, dropping by 28 percent and 40 percent, respectively, since 1996.
• Prevalence of end-stage kidney disease—the last stage of chronic kidney disease when the kidneys can no longer remove waste and excess water from the body, and dialysis or kidney transplantation is necessary for survival— continued to rise. The size of the dialysis population increased 4 percent in 2013, reaching 466,607, and is now 63.2 percent larger than in 2000.
• Home dialysis—when patients have the ability to clear excess fluid and waste from the kidneys by using a dialysis machine in the privacy of their own home—use is 52 percent higher than a decade ago.
• The active waiting list for kidney transplants was 2.7 times larger than the supply of donor kidneys, with 17,600 kidney transplants performed in 2013.

“Overall trends for end-stage kidney disease are promising for those affected,” says Rajiv Saran, M.D., professor of internal medicine at U-M Health System and director of the USRDS coordinating center. “Patients on dialysis are living longer and equally positive, survival rates have steadily improved among recipients of both living and deceased donor kidney transplants.”

While the report highlights several positive trends, Saran mentions it’s important to also consider areas where improvement is needed.

“Several lifestyle-related chronic health conditions, such as diabetes, high blood pressure and other cardiovascular diseases can contribute to kidney disease,” Saran says. “Monitoring and early treatment of those conditions are key to prevention, and can help patients keep their kidney disease under control.”

With patients affected by the disease living longer, the report also highlights increasing medical costs associated with kidney disease.

Medicare spending for patients with chronic kidney disease aged 65 and older exceeded $50 billion in 2013 and represented 20 percent of all Medicare spending in that age group. In addition, the total cost to Medicare for end-stage kidney disease grew to $30.9 billion and accounted for 7.1 percent of the overall paid Medicare claims costs.

Encouragingly, use of home dialysis has increased in recent years. Home dialysis offers patients more flexibility and convenience, allowing for an improved quality of life. Home dialysis use overall in 2013 was 52 percent higher than a decade ago.

Saran mentions the data report continues to emphasize the low awareness of kidney disease in the general population, as well as the fact that rates of screening for the condition by simple urine testing remain low, even among those with risk factors for the disease.

“Awareness of this silent, but deadly killer may help prevent those with early-stage kidney disease from progressing,” Saran says. “Learning more about risk factors for the disease and early diagnosis are of vital importance as symptoms of kidney disease develop much later.”

Authors: In addition to Saran, the report’s U-M authors include Yi Li, Ph.D., Bruce Robinson, M.D., John Ayanian, M.D., Jennifer Bragg-Gresham, Ph.D., Rajesh Balkrishnan, Ph.D., Debbie Gipson, M.D., Yun Han, M.S., Kevin He, Ph.D., William Herman, M.D., Michael Heung, M.D., Richard A. Hirth, Ph.D., David Hutton, Ph.D., Yee Lu, M.D., Hal Morgenstern, Ph.D., Brahmajee Nallamothu, M.D., Brett Plattner, M.D., Ronald Pisoni, Ph.D., Friedrich K. Port, M.D., Panduranga Rao, M.D., Ankit Sakhuja, M.D., Douglas E. Schaubel, Ph.D., David T. Selewski, M.D., Vahakn Shahinian, M.D., Peter Song, Ph.D., and Kenneth Woodside, M.D.

Funding: Funding for the project came from the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, and the U.S. Department of Health and Human Services, under contract HHSN276201400001C, and the USRDS Coordinating Center Team, which consists of investigators and staff from the University of Michigan Health System, the Kidney Epidemiology and Cost Center, in partnership with Arbor Research Collaborative for Health.

Disclosures: Dr. Hal Morgenstern is a consultant at Arbor Research Collaborative for Health.

Reference: United States Renal Data System. 2015 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health. National Institute of Diabetes and Digestive and Kidney Disease, Bethesda, MD, 2015. http://www.usrds.org/adr.aspx.