Individualized Risk for CKD Progression among US Adults

Background: Chronic kidney disease (CKD) is currently defined using glomerular filtration rate (GFR) or albuminuria. This is based on the relative risk of mortality and kidney outcomes compared to a healthy population and does not consider an individual’s absolute risk of CKD progression. Methods: Using National Health and Nutrition Examination Survey data from 1999-2020, we characterized the individual-level absolute 3-year risk of ≥40% decline in estimated GFR (eGFR, mL/min/1.73 m2) or kidney failure (3-year risk) among US adults. We categorized the 3-year risk and considered ≥5% high risk. Results: Among 199.81 million US adults, 8.42 million (4%) had a 3-year risk ≥5%, including 1.04 million adults without CKD (eGFR ≥60 and albuminuria <30 mg/g). These high-risk adults without CKD as currently defined had risk factors including hypertension (98%), heart failure (72%), and diabetes (44%). 15.51 million adults had CKD with preserved eGFR (eGFR ≥60 and albuminuria ≥30 mg/g)—3.73 million had a 3-year risk ≥5%, 41% of whom did not have diabetes and thus would not be screened for albuminuria using current screening recommendations. The 3-year risk of CKD progression was low (risk <5%) in 94% of the 5.66 million US adults with CKD stage G3a-A1 (eGFR 45 to <60 and albuminuria <30 mg/g). Conclusions: Assessment of the individual’s absolute risk of CKD progression allows further risk stratification of patients with CKD and identifies individuals without CKD, as currently defined, that are at high risk of CKD progression.