Chronic kidney disease

Prevalence
Many countries have surveillance programmes to 
monitor kidney failure treated by dialysis and 
transplantation 
(fi gure 3).
26
Incidence and prevalence 
vary because of diff erences in underlying diseases rates 
and availability of government-sponsored treatment. 
Incidence is now as high as 200 cases per million per 
year in many countries. It is nearing 400 cases per 
million in the USA, Taiwan, and some regions in 
Mexico, and has risen fastest in older individuals. 
Dialysis is the main treatment method in most 
countries. With average survival of 3–5 years in the 
USA, prevalence is nearing 1800 cases per million. In 
Japan and Taiwan, high survival translates to high 
prevalence nearing 2400 cases per million. Diabetes is 
the main cause of kidney failure in most countries, 
accounting for 40% or more of new patients.
26
The USA 
has a high incidence of disease in racial and ethnic 
minorities, which is probably an indicator of genetic 
and environmental factors in susceptibility, and 
disparities in treatment.
25,27,28
Estimation of the burden of early stages of kidney 
disease is diffi
cult. Prevalence estimates might be biased 
by limitation of the markers and methods that are used 
to estimate GFR and to defi ne kidney damage. In the 
USA, the most accurate estimates based on estimated 
GFR and albuminuria of the prevalence of chronic kidney 
Normal
Screening 
for CKD 
risk factors
Increased
risk
CKD risk
reduction;
screening for
CKD
Damage
Diagnosis and
treatment;
treat comorbid
conditions;
slow progression
↓ GFR
Estimate
progression;
treat complications;
prepare for
replacement