Data Presentation [PPT - 1.2 MB]
Transcript of Data Presentation [PPT - 1.2 MB]
Healthy People 2010Focus Area 4
Chronic Kidney Disease Progress Review
November 20, 2002
Source: United States Renal Data System (USRDS)
ESRD % transplantedwithin 3 yrs
AV fistula use hemodialysis (new patients)
ESRD due to diabetes
CV deaths in persons with
ESRD
Chronic Kidney Disease Objectives Targets and Levels Achieved
% ontransplant
wait list
% of diabetics with exam / tests
to prevent ESRD
2010 Target Current levelDirection of change desired
% with counseling prior to start of
renal replacement therapy (per 1,000,000 population)
- - - - - Incidence - - - - - -(per 1,000 patient years)
334
217
145
7852
82.650%
66%
27.2% 21.3% 19.6% 26.3%
60%
45%
Targets-to-be-determined
0
50
100
150
200
250
300
350
1992 1993 1994 1995 1996 1997 1998 1999 2000
2010 Target
Diabetes Prevalence, 2000Trends in ESRD: Incidence
Source: United States Renal Data System, (USRDS)
334(current)
217(target)
Adjusted for age, gender, and race.
Incident rate
Rate per million population
End Stage Renal Disease
Source: United States Renal Data System, (USRDS), modified maps from the USRDS 2002 Annual Data Report (ADR).
Incident rate: 1990 Incident rate: 2000
370+ (371)300 to <370213 to <300156 to <213below 156 (135)
370+ (452)300 to <370213 to <300156 to <213below 156 (136)
Unadjusted, per million population
Trends in ESRD Incident Rates, by Age and Race/Ethnicity
*Adjusted for gender and race.
* **
**Adjusted for age and gender.
Source: United States Renal Data System, (USRDS), graphs from the USRDS 2002 Annual Data Report.
Trends in ESRD Incident rates, by Primary Diagnosis
Adjusted for age, gender, and raceSource: United States Renal Data System, (USRDS), graphs from the USRDS 2002 Annual Data Report.
Adjusted for age, gender, and race.
Incident Rates of ESRD with Primary Diagnosis Diabetes
Source: United States Renal Data System, (USRDS), modified maps from USRDS 2002 Annual Data Report.
205+ (245)125 to <20557 to <12549 to <57below 49 (NA)
Unadjusted, per million population
1990 2000
205+ (260)125 to <20557 to <12549 to <57below 49 (44)
Trends in Incident Rates of ESRD Due to Diabetesby Race/Ethnicity
Adjusted for age and gender.
Source: United States Renal Data System, (USRDS), graph from the USRDS 2002 Annual Data Report.
0
2
4
6
8
10
12
14
16
1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999
Rat
e p
er 1
,000
po
pu
lati
on
0-44 Years
Total
45-64 Years
65-74 Years75+ Years
Note: Data are three-year averages. Data from 1997 and later years my not be comparable with earlier years due to a redesign of the NHIS in 1997.Source: National Health Interview Survey (NHIS), CDC, NCHS.
Prevalence of Diagnosed Diabetes by Age:
United States, 1980-1999
20
40
60
160
140
120
100
80
Source: National Health Interview Survey (NHIS), CDC, NCHS.
0
25
50
75
100
125
150
American Indian/Alaska Native
White, notHispanic
Black, notHispanic
HispanicAsian/Pacific Islander
2010Target
Diabetes Prevalence, 2000
Age-adjusted per 1,000 standard population
Source: National Health and Nutrition Examination Survey (NHANES), CDC, NCHS. *Body Mass Index > 30
Obesity*: Adults, Age 20 and Olderby Race/Ethnicity
0
5
10
15
20
25
30
35
40
45
White, notHispanic
Black, notHispanic
2010 Target
Total
Mexican American
1988-94 1999-2000
Trends in All-Cause and Cardiovascular Mortality Rates in ESRD Patients by Race/Ethnicity
Source: United States Renal Data System, (USRDS), graphs from the USRDS 2002 Annual Data Report.
0
10
20
30
40
50
1996 1997 1998 1999-2000
2010 Target
Diabetes Prevalence, 2000
Source: United States Renal Data System, (USRDS), modified graph from the 2002 USRDS ADR.
27.2%(current)
50%(2010 target)
Adjusted for age, gender, and race.
Percent of patients
Trends in Arteriovenous Fistula Use Incident Hemodialysis Patients (Age 20 and
Older)
New PatientsUsing AV fistulas
0
10
20
30
40
50
60
70
American Indian/Alaska Native
White, notHispanic
Black, notHispanic
HispanicAsian/Pacific Islander
2010 Target
Diabetes Prevalence, 2000Proportion of Dialysis Patients Registered on the Waiting List for Transplantation:
by Race/Ethnicity, 2000
Percent
Source: United States Renal Data System, (USRDS) Note: Patients younger than 70.
0
5
10
15
20
25
1992-1994 1995 1996 1997
2010 Target
Diabetes Prevalence, 2000Percent of Dialysis Patients Receiving a TransplantWithin Three Years of Initiation of Therapy*
Source: United States Renal Data System, (USRDS). Note: Patients younger than 70. *Target to be determined
Adjusted for age, gender, and race.
Percent of patients
Dialysis Patients Receiving a Transplant Within 3 years by Age, Gender, Race/Ethnicity and Diagnosis
Source: United States Renal Data System, (USRDS). Note: Patients younger than 70, graphs from the USRDS 2002 ADR.
Diabetic Patients Receiving All Three Preventive Tests (Age 67 and Older)*
**Pre-ESRD data: incident ESRD patients with diabetes one year prior to start of ESRD. Graphs from the 2002 USRDS ADR.
*Developmental objective, target to be determined
**
0
10
20
30
40
50
60
American Indian/Alaska Native
White, notHispanic
Black, notHispanic
HispanicAsian/Pacific Islander
2010 Target
Diabetes Prevalence, 2000Counseling for Chronic Kidney Failure Care,by Race/Ethnicity, 1996
Percent of new ESRD persons who’ve had counseling at least a year before renal replacement therapy
Source: United States Renal Data System, (USRDS).
2010 Target
Data NotesFull citation for USRDS data, graphs, and maps: U.S. Renal Data System, USRDS 2002 Annual Data Report: Atlas of End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 2002.USRDS data are adjusted by the direct adjustment method with 1999 as the standard population.
NCHS data are age adjusted by the direct adjustment method with 2000 as the standard population.
For the NCHS data, the race/ethnicity groups, American Indian/Alaska Native and Asian/Pacific Islander includes persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race.
A detailed race/ethnicity description of the USRDS data can be found in the USRDS 2002 ADR.
The graphs listed below have additional documentation in the 2002 ADR:
Trends in arteriovenous fistula use in hemodialysis patients-Includes only patients for whom an access type is known.
Dialysis patients receiving a transplant within three years…-”Medicare dialysis patients initiating therapy in the given year; patients older than 69 or with prior transplants are excluded. Cumulative percents are estimated using the Kaplan-Meier methodology. Followup is censored at death or the end of the three-year period.”
Diabetic patients receiving all three preventive health tests…-”General Medicare data: individuals diagnosed with diabetes in 1997, 1998, or 1999, age 67 or older on December 31 of the diagnosis year, and continuously enrolled in Medicare during 1996-1997, 1997-1998, or 1998-1999. Patients diagnosed with ESRD during one of these three periods, enrolled in a managed care program, or with Medicare as secondary payor are excluded. Pre-ESRD data: incident ESRD patients with diabetes one year prior to start of ESRD. Patients enrolled in a managed care program or with Medicare as secondary payor are excluded. The three tests are (1) eye exam, (2) lipids, and (3) A1C test.