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Indicator Details: CKD Prevalence by Hypertension Statusa
Year, Hypertension Status
NHANES
Related Are You Aware (AYA)
Long-term Trends in Prevalence of Chronic Kidney Disease Among People With and Without High Blood Pressure in the United States
CKD Prevalence by Hypertension Status and Yeara
National Health and Nutrition Examination Survey
Hypertension Status
27.1 (CI 25.4-28.8) 26.6 (CI 24.1-29.0) 26.0 (CI 24.4-27.5) 26.5 (CI 24.6-28.5) 28.0 (CI 26.2-29.9)
Undiagnosed
Pre-hypertension
8.9 (CI 7.5-10.3) 10.4 (CI 8.9-11.9) 8.3 (CI 6.7-9.9) 9.7 (CI 7.9-11.6) 8.1 (CI 6.6-9.7)
No Hypertension
5.9 (CI 4.8-6.9) 6.5 (CI 5.6-7.4) 6.2 (CI 5.1-7.3) 6.8 (CI 5.8-7.8) 7.3 (CI 5.9-8.7)
a Diagnosed hypertension defined as adult with self-reported diagnosis, measured blood pressure ≥140/≥90 mmHg and taking hypertension medication; undiagnosed defined as measured blood pressure ≥140/≥90 mmHg without self-reported diagnosis and not taking medication for hypertension; pre-hypertension defined as 120≤SBP≤140/80≤DBP≤90 mmHg. For participants who did not self-report hypertension or were not on medications, exam values for systolic and diastolic blood pressure were used to determine the category of hypertension; No hypertension: SBP <120 and DBP <80 mmHg, Pre-Hypertension: 120≤SBP≤140 mmHg and DBP ≤90 or SBP <120 mmHg and 80≤DBP≤90 mmHg, Hypertension: SBP>140 or DBP>90mmHg.
In people diagnosed with hypertension, the prevalence of CKD slightly increased from 2001 to 2004 (27.1%) to 2017 to March 2020 (28.0%). During this period, prevalence decreased among those who are undiagnosed from approximately 24.7% in 2001-2004 to 17.2% in 2017 to March 2020.
Chart Explanation:
During the period 2001-2004 to 2017-March 2020, prevalence of CKD varied based on hypertension status. Among adults diagnosed with hypertension, prevalence slightly increased from 27.1% in 2001-2004 to 28.0% in 2017-March 2020. In the same time periods, prevalence among those undiagnosed hypertensive adults decreased from 24.7% to 17.2%. Among those found to have pre-hypertension, the prevalence remained relatively the same from 8.9% in 2001-2004 to 8.1% in 2017-March 2020.
The survey consists of a standardized in-home interview and a physical examination with blood and urine collected at a mobile examination center (MEC). Here, we examined data from 2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010, 2011-2012, 2013-2014, 2015-2016, 2017-March 2020 NHANES. The estimated glomerular filtration rate (eGFR) was calculated according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for calibrated creatinine (Levey et al., 2009). Serum creatinine was calibrated for 1999-2000 and 2005-2006 participants; no correction was required for calibrated serum creatinine in participants in the 2001-2002, 2003-2004, 2007-2008, 2009-2010, 2011-2012, 2013-2014, and 2015-2016 surveys (Selvin et al., 2007). Albuminuria was defined by urinary albumin-to-creatinine ratio ≥30 mg/g; moderate albuminuria ranges between 30 and 299 mg/g and severe albuminuria is ≥300 mg/g; pregnant women were excluded. For comparisons across the 18-year period 1999-2016, albuminuria was corrected in 1999-2006 to account for differences in the instrumentation and method for urine creatinine starting in 2007. The prevalence of CKD is likely overestimated by single measurements of albuminuria and kidney function (eGFR). In clinical practice, CKD is defined by persistent albuminuria or reduced kidney function for ≥3 months.
Hypertension is the second leading cause of CKD. Hypertensive disease accounts for 28% of incident ESRD in the United States (United States Renal Data System, 2011). Hypertension is associated with higher risk of cardiovascular outcomes in those with CKD. Additionally, treatment of hypertension in CKD, particularly by ACE inhibitors, has been shown to decrease proteinuria and disease progression (Sarafidis et al., 2008). Thus, assessing the prevalence of this risk factor and its control is essential to CKD surveillance. Self-reported hypertension was defined by answer of "yes" to the question "have you ever been told by a doctor or other health professional that you have hypertension, or high blood pressure?" Blood pressure measurements were taken by standardized protocol during the MEC and the average value (up to four measurements) was used. Hypertension medications were recorded from prescription bottles during the interview.
Prevalence of CKD in the diagnosed, undiagnosed, and pre-hypertension adult population
NCHS/CDC
Noninstitutionalized U.S. residents aged 18+ years
Non-pregnant participants with CKD
Non-pregnant participants with response to self-reported hypertension questionnaire, complete blood pressure measurements, and hypertension drug use.
Definition of CKD
Presence of single albuminuria or eGFR <60 ml/min/1,73 m2
Glomerular filtration rate
Estimated using CKD-EPI equation for calibrated creatinine: eGFR=141 x [min(calibrated serum creatinine in mg/dL) /κ, 1)]α x [max(calibrated serum creatinine in mg/dL/κ, 1)]-1.209 x 0.993age x (1.018 if female) x (1.159 if NH Black)
κ = 0.7 if female, and 0.9 if male
α = -0.329 if female, and -0.411 if male
Urinary albumin-to-creatinine ratios of 30-299 mg/g (microalbuminuria) and >300 mg/g (macroalbuminuria); pregnant/menstruating women excluded
bpq020: "Have you ever been told by a doctor or health professional that you have high blood pressure?" yes/no
Questionnaire (interviewer-administered); ages 16+
bpxsy1-bpxsy4: Up to four blood pressure measurements
Secondary (1) Indicator Method of Measurement
Examination/Laboratory
nhcod/rxddrgid; generic drug codes
Questionnaire (interviewer-administered), with recording of medications from Rx bottles
Frequency of Measurement (Primary)
Once (cross-sectional)
U.S. Region Covered by Primary Variable
Pending Data
Additional Data Items of Interest
Stage of CKD, stratification variables of interest (age, gender, race/ethnicity, BMI, diabetes by self-report)
Albuminuria and kindey function can only be assessed from a one-time cross-sectional measurement, leading to overestimation of prevalence; second measures of albuminuria are available for only 2009-2010 and were first-morning rather than spot urine samples; no second measures of creatinine
Analytic Considerations
Appropriate NHANES survey weights must be used for all analyses; creatinine measurements must be calibrated for 1999-2000 and 2005-2006; many variable names differ across surveys; if SE 30% or more of estimate, must report as "low precision"