ASN: End-Stage Renal Disease Prevalence Climbing as Baby Boomers Age

SAN FRANCISCO, Nov. 5 -- The baby boomers are entering the age of end-stage renal disease, and its prevalence is expected to skyrocket over the next decade despite level or declining incidence rates, researchers here estimated.Absolute prevalence was anticipated to increase about 60% from 484,995 at the last count in 2005 to more than 785,000 by 2020, according to data from the U.S. Renal Data System presented at the American Society of Nephrology meeting.
Action Points
Explain to interested patients that the rate of end-stage renal disease appears to have slowed or stopped, but the prevalence may swell because of the aging population.
Inform patients that factors such as a growing elderly population and improved care of dialysis and chronic kidney disease patients may be contributing to a continued increase in the absolute number of end-stage renal disease patients.
Absolute incidence was projected to increase 41% by 2020, reported David T. Gilbertson, Ph.D., and Allan J. Collins, M.D., both of the USRDS Coordinating Center in Minneapolis.
Prior estimates based on data from 2000 had suggested even greater increases, they said.
However, incidence rates recently leveled off overall and even declined in some subpopulations while the USRDS also began accounting for patients who recover renal function.
These effects may be countered by even stronger forces driving up the overall incidence and prevalence over the next decade, including the falling death rate, increasing diabetes rates, and improvement in treatment of chronic kidney disease and dialysis patients, the investigators noted.
"The primary driver of the increase is the aging baby boomers," Dr. Gilbertson said. "We're just not going to escape that big bolus of the population coming."
The researchers updated their statistical model with USRDS data available from 1978 through 2005, which included census projections accounting for expected demographics changes and incorporating anticipated changes in diabetes prevalence.
The incidence of end-stage renal disease in 2005 was 106,896. The researchers estimated future incidence counts of:
120,253 for 2010 based on the current projection, similar to the previously estimated 120,061.
134,978 for 2015 based on the current projection, down 1.4% from the previous estimate of 136,882.
150,772 for 2020 based on the current projection.
The prevalence of end-stage renal disease in 2005 was 484,995. Estimates for future prevalence were:
579,105 for 2010 based on the current projection, down 2.5% from the prior estimate of 593,953.
679,918 for 2015 based on the current projection, down 4.7% from the prior estimate of 713,531.
784,613 for 2020 based on the current projection.
The addition of about 300,000 end-stage patients by 2020 has implications for both clinical practice and policymakers, Dr. Gilbertson said. Medicare pays care of the vast majority of end-stage renal disease patients, who are "very expensive patients" with per-patient costs approaching $60,000 per year, he noted.
Although they constitute a small enough proportion of Medicare patients that they won't break the Medicare bank, "I don't think at this point we're prepared for them," he said.
"That's a lot of extra patients," Dr. Gilbertson said. "Are there going to be enough nephrologists to care for all those patients? I'm not so sure [there will be] even enough dialysis facilities."
The research was funded through the National Institutes of Health. Dr. Gilbertson reported consultancies for Amgen and Roche related to anemia. Dr. Collins reported consultancies or honoraria for Amgen, Baxter, Merck/Schering-Plough, NxStage, and Roche.Primary source: American Society of Nephrology meetingSource reference: Gilbertson DT, Collins AJ, "Projecting the ESRD Population to 2020" ASN meeting 2007; Abstract FC046.

Hepatitis C Positivity May Increase Risk for End-Stage Renal Disease

June 27, 2007 — Patients aged 18 to 70 years who have positive findings for hepatitis C virus are at an increased risk of developing end-stage renal disease, according to the results of a retrospective cohort study published in the June 25 issue of the Archives of Internal Medicine.
"Infection with chronic hepatitis C virus (HCV) has been linked to glomerulonephritis," write Judith I. Tsui, MD, from the University of California, San Francisco, and colleagues. "We undertook this study to determine whether having a positive HCV test result was associated with an increased risk for developing treated end-stage renal disease (ESRD)."
Using data from Medicare, the Department of Veterans Affairs (VA), and the US Renal Data System, the investigators performed a retrospective cohort study of 474,369 adult veterans with serum creatinine levels measurements between October 1, 2000, and September 30, 2001, and HCV antibody testing within 1 year of creatinine testing. Follow-up for the outcome of treated ESRD, defined as the onset of long-term dialysis or renal transplantation, continued through October 1, 2004. The relative risk for ESRD associated with HCV, after adjustment for other covariates (age, sex, race/ethnicity, and comorbidities), was determined with Cox proportional hazards models.
Findings from HCV antibody testing were positive in 52,874 (11.1%) of 474,369 patients. Patients with positive HCV test findings were more likely to develop ESRD, with a rate of 4.26 per 1000 person-years (95% confidence interval [CI], 3.97 - 4.57) for HCV-seropositive patients vs 3.05 (95% CI, 2.96 - 3.14) for HCV-seronegative patients.
For patients aged 18 to 70 years in whom estimated glomerular filtration rate was 30 mL/minute/1.73 m2 or greater, HCV seropositivity was associated with more than twice the risk of developing ESRD (adjusted hazard rate, 2.80; 95% CI, 2.43 - 3.23).
Study limitations include lack of generalizability to nonveteran populations; analysis being based on results of HCV antibody testing rather than HCV RNA testing; possibly reduced accuracy of the Modification of Diet in Renal Disease equation used to estimate glomerular filtration rate in patients with HCV; lack of data on proteinuria or albuminuria; use of International Classification of Diseases, Ninth Revision, codes for comorbidity diagnoses, when they are often insensitive and do not provide information on severity or control of the disease condition; possible unknown confounders; and short duration of follow-up.
"In this large national cohort of adult veterans, patients younger than 70 years with HCV seropositivity were at increased risk for developing ESRD treated with dialysis or transplantation," the authors write. "Our findings raise the question of whether current guidelines recommending that patients with ESRD and severe CKD [chronic kidney disease] be screened for HCV be expanded to include patients with moderate CKD and whether patients with HCV should routinely be screened for CKD. Future studies should investigate whether treatment eradicating HCV alters the risk for renal disease and whether existing treatments to delay the progression of CKD are effective in persons with chronic HCV."
The National Center for Research Resources of the National Institutes of Health and the National Institute on Aging supported this study. The authors have disclosed no relevant financial relationships.
Arch Intern Med. 2007;167:1271-1276.