Individualized Risk of CKD Progression among US Adults.

Key Points: A total of 8.42 million US adults have high CKD progression risk, and 4.77 million of them have eGFR >60 ml/min per 1.73 m. An individual's absolute risk of CKD progression is important in the diagnosis and prognostication of CKD.

Background: CKD is currently defined using GFR or albuminuria. This is on the basis of the relative risk of mortality and kidney outcomes compared with 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 to 2020, we characterized the individual-level absolute 3-year risk of ≥40% decline in eGFR (ml/min per 1.73 m) or kidney failure (3-year risk) among US adults. We categorized the 3-year risk and considered ≥5% as 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%). A total of 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 allowed further risk stratification of patients with CKD and identified individuals without CKD, as currently defined, who were at high risk of CKD progression.

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