Epidemiology of Kidney Disease in the United States: Highlights from the Centers for Disease Control and Prevention Kidney Disease Surveillance System

Kidney diseases are an important public health problem, rising in global significance. In place for nearly two decades, the Centers for Disease Control and Prevention’s Kidney Disease Surveillance System (KDSS) is the first comprehensive surveillance system developed in the United States, focused exclusively on tracking kidney disease prior to end-stage kidney disease. The KDSS incorporates key data and trends from multiple, large national-level survey data sources (National Health and Nutrition Examination Survey), electronic medical record data (Military and Veterans Affairs Health Systems), health care claims (Medicare, Optum), and social determinants of health (American Community Survey). The prevalence of chronic kidney disease (CKD) among civilian US adults remains steady between 13%─14%. Prevalence is higher among older, female, non-Hispanic Black adults, and those with diabetes or hypertension. Among US veterans, the incidence of CKD and rates of diagnosis of acute kidney injury (AKI) increased from 2008 to 2022 (Incidence: 62.8 to 71.5/1, 000 person-years, AKI: 84.9 to 241.7 cases/1, 000 person-years. Awareness of the disease nationwide among persons with CKD has historically been low (<10%), but starting in 2013, has increased to approximately 25%. Persons with CKD self-report more problems with sleep, and those aged 65 and older self-report a higher prevalence of functional limitations. Improvements in quality-of-care measures, including medication prescription and increases in both serum creatinine and albuminuria testing were observed. Increased self-reported physical activity was observed among persons with CKD. Food insecurity increased among persons with CKD, with the highest prevalence in young, female, non-Hispanic Black, and Hispanic adults. While population-level prevalence of CKD remains stable, higher AKI and CKD rates are being observed in health systems settings. Robust surveillance is key to raising awareness of kidney disease, its risk factors, care quality, and outcomes. Surveillance findings may inform policy and evidence-based practices that reduce premature morbidity and mortality, improve quality of life, and reduce cost.