Kidney Disease Research Updates

End-Stage Renal Disease Rate Stabilizing, USRDS Finds

Promising Trend Likely Due to Better Care of Patients with Kidney Disease

The rate of end-stage renal disease (ESRD) has stabilized for the first time in the 2 decades such records have been kept, a new Government analysis showed, suggesting that improved treatment may have stopped the steady rise in the number of patients with kidney failure.

The findings, which were released in the National Institute of Diabetes and Digestive and Kidney Diseases’ (NIDDK) U.S. Renal Data System (USRDS) 2005 Annual Data Report, showed that 338 out of every million Americans had kidney failure in 2003, down slightly from the 340 per million figure in 2002. Still, rates have quadrupled since 1980.

“These findings are clearly exceedingly important,” said Paul Eggers, Ph.D., one of the USRDS project officers for the NIDDK. In addition to the benefit of alleviation of suffering related to kidney failure, each patient that does not go on to ESRD saves $300,000 in health care costs over 5 years. “Cutting ESRD rates has real budgetary implications.”

Economic Impacts
Though only a fraction of patients with chronic kidney disease (CKD) go on to develop renal failure, the condition is expensive to treat, requiring frequent dialysis or transplantation. Because of the impact on the health care system, the number of patients developing the condition is carefully tracked.

The positive news about ESRD comes even as the number of patients at risk for CKD continues to grow. Those with diabetes constitute 44 percent of new cases of kidney failure, and the population of people with diabetes is growing.

Improved Treatment
Research published during the 1990s recommended that doctors use new medications to help control diabetes and its consequences, and Eggers said the new data suggests that more and more patients are receiving those drugs.

“The number of people with diabetes is going up but ESRD has stabilized, which suggests that despite the increasing epidemic of diabetes, efficacious treatment is out there,” Eggers said. Use of heart drugs, such as angiotension-converting enzyme (ACE) inhibitors and angiotension receptor blockers (ARBs), has been shown to protect the kidneys of patients with diabetes, and increasing the use of those medications as treatments is a major goal of the NIDDK’s National Kidney Disease Education Program.

To better understand the reasons for the falling rates of renal failure among people with diabetes, Eggers said the NIDDK is trying to track people with diabetes through the course of their disease to assess whether keeping close track of blood glucose levels is associated with a drop in the risk of kidney failure.

Healthy People 2010 Goals
The stabilizing rate of kidney failure moves clinicians one step closer to meeting the Government’s Healthy People 2010 goal of reducing ESRD. The Healthy People goal, set in 2000, stated that without intervention, the rate of kidney failure would continue to grow at 5 percent a year.

The promising results, however, were not distributed evenly across the patients surveyed. The most marked ESRD decrease was in Caucasian people with diabetes who are younger than 40; their rate of kidney failure dropped 47 percent. But other patient groups, particularly African Americans, have not seen similar gains.

Eggers said the USRDS data, though clearly showing disparity, does not pinpoint the underlying reasons. “The fact of the matter is that minority populations, mostly African Americans, but also Native Americans and even Asian Americans, have much higher rates of ESRD.”

David Badman, Ph.D., shown with his former mentor, Ruth Kirschstein, M.D., senior advisor to the NIH director. Photo credit: Ernie Branson (NIH).

Badman Retires After More than 3 Decades at NIDDK

Colleagues, friends, and family gathered at the NIH on May 3 to honor David Badman, Ph.D., a relentless advocate for iron research. Officially retired January 1, 2005, after 30-plus years, Badman’s out-of-office message often reads “Gone Fishing.” But with one hand on a fishing rod and one on an NIH Roadmap drug development project, you might not have noticed.

“I had a terrific career at the NIDDK, a wonderful institute to work for—encouraging freedom to find things needing to be done and to do them,” Badman told the NIH Record. ”There’s always a way to do something. You just have to figure out how.”

Kidney Disease Research Updates

Kidney Disease Research Updates is published four times a year by the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). The newsletter features news about kidney disease, special events, patient and professional meetings, and new publications available from the NKUDIC and other organizations.

Subscriptions are free but available only to health professionals. Send subscription inquiries to: National Kidney and Urologic Diseases Information Clearinghouse, 3 Information Way, Bethesda, MD 20892–3580. This publication is available online at: www.kidney.niddk.nih.gov/about/newsletter.htm.

NIH Publication No. 06–4531
July 2006