1. Healthy People 2010 Focus Area 4
Chronic Kidney Disease Progress Review
November 20, 2002

2. Chronic Kidney Disease Objectives Targets and Levels Achieved
Direction of change desired
2010 Target
Current level
334
217
145
82.6
66%
Targets-to-be-determined
60% 78
50% 52
45%
27.2%
21.3%
19.6%
26.3%
ESRD
ESRD due
to diabetes
CV deaths in
persons with
ESRD
AV fistula use
hemodialysis
(new patients)
% on
transplant
wait list
% transplanted
within 3 yrs
% of diabetics
with exam / tests
to prevent
ESRD
% with counseling
prior to start of
renal replacement
therapy
Incidence
(per 1,000,000 population)
(per 1,000 patient years)
Source: United States Renal Data System (USRDS)

3. Trends in ESRD: Incidence
Diabetes Prevalence, 2000
Trends in ESRD: Incidence
Rate per million population
334
(current)
217
(target)
Incident rate
Adjusted for age, gender, and race.
Source: United States Renal Data System, (USRDS)
2010 Target

4. End Stage Renal Disease
Incident rate: 1990
Incident rate: 2000
Unadjusted, per million population
370+ (371)
300 to <370
213 to <300
156 to <213
below 156 (135)
370+ (452)
300 to <370
213 to <300
156 to <213
below 156 (136)
Source: United States Renal Data System, (USRDS), modified maps from the USRDS 2002 Annual Data Report (ADR).

5. 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.

6. Trends in ESRD Incident rates, by Primary Diagnosis
Adjusted for age, gender, and race.
Source: United States Renal Data System, (USRDS), graphs from the USRDS 2002 Annual Data Report.
Adjusted for age, gender, and race

7. Incident Rates of ESRD with Primary Diagnosis Diabetes
1990
2000
205+ (260)
125 to <205
57 to <125
49 to <57
below 49 (44)
205+ (245)
125 to <205
57 to <125
49 to <57
below 49 (NA)
Unadjusted, per million population
Source: United States Renal Data System, (USRDS), modified maps from USRDS 2002 Annual Data Report.

8. Trends in Incident Rates of ESRD Due to Diabetes
by Race/Ethnicity
Adjusted for age and gender.
Source: United States Renal Data System, (USRDS), graph from the USRDS 2002 Annual Data Report.

9. Prevalence of Diagnosed Diabetes by Age:
United States,
160
140
65-74 Years
120
75+ Years
100 80
45-64 Years 60
Total 40 20
0-44 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.

10. Diabetes Prevalence, 2000 Age-adjusted per 1,000 standard population
2010
Target
American Indian/
Alaska Native
Asian/Pacific
Islander
Hispanic
Black, not
Hispanic
White, not
Hispanic
Source: National Health Interview Survey (NHIS), CDC, NCHS.

11. Obesity*: Adults, Age 20 and Older
by Race/Ethnicity
2010 Target
Black, not
Hispanic
White, not
Hispanic
Mexican American
Total
Source: National Health and Nutrition Examination Survey (NHANES), CDC, NCHS. *Body Mass Index > 30

12. 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.

13. Trends in Arteriovenous Fistula Use
Incident Hemodialysis Patients (Age 20 and Older)
Diabetes Prevalence, 2000
Percent of patients
50%
(2010 target)
27.2%
(current)
New Patients
Using AV fistulas
Adjusted for age, gender, and race.
Source: United States Renal Data System, (USRDS), modified graph from the 2002 USRDS ADR.
2010 Target

14. Diabetes Prevalence, 2000 Proportion of Dialysis Patients Registered
on the Waiting List for Transplantation:
by Race/Ethnicity, 2000
Diabetes Prevalence, 2000
Percent
2010 Target
American Indian/
Alaska Native
Asian/Pacific
Islander
Hispanic
Black, not
Hispanic
White, not
Hispanic
Source: United States Renal Data System, (USRDS) Note: Patients younger than 70.

15. Percent of Dialysis Patients Receiving a Transplant
Within Three Years of Initiation of Therapy*
Diabetes Prevalence, 2000
Percent of patients
Adjusted for age, gender, and race.
Source: United States Renal Data System, (USRDS). Note: Patients younger than 70.
2010 Target
*Target to be determined

16. 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.

17. Diabetic Patients Receiving All Three Preventive Tests (Age 67 and Older)***
*Developmental objective, target to be determined
**Pre-ESRD data: incident ESRD patients with diabetes one year prior to start of ESRD. Graphs from the 2002 USRDS ADR.

18. Counseling for Chronic Kidney Failure Care,
Diabetes Prevalence, 2000
Counseling 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
2010 Target
American Indian/
Alaska Native
Asian/Pacific
Islander
Hispanic
Black, not
Hispanic
White, not
Hispanic
Source: United States Renal Data System, (USRDS).
2010 Target

19. Data Notes
Full 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
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 , , or 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.