Trends in US Incidence of ESKD: Differences by Race and Age

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The rate of increase in US incidence of end stage kidney disease (ESKD) has slowed since the 1980s, although risk continues to be higher among Black patients compared with White patients across age groups, reports an article in JASN.

The researchers analyzed age- and race-specific trends in ESKD incidence using US Renal Data System data from 1980 to 2019. Annual percent changes in ESKD were analyzed for Black and White individuals aged 13 to 17 years, 18 to 64 years, and 65 years and older. The study included analyses to identify the time at which a significant change in the annual percent change slope occurred in each group.

In all groups, ESKD incidence increased after 1980. At that time, age-standardized rates were 237.7 per million among Black adults (aged 18 to 64) versus 66.7 per million among White adults. Among Black adults, the rate peaked at 771.8 per million in 1998 and then decreased to 608.5 per million in 2019. In contrast, White adults showed a continued increase in ESKD incidence (up to 236.8 per million in 2019).

Different patterns were seen for Black and White older adults and for adolescents. However, in all groups and at all times, ESKD incidence was higher among Black patients compared with White patients. In the aged 18 to 64 years’ group, the disparity narrowed over time, reflecting a decrease in age-standardized incidence among Black adults and continued increases among White adults.

White adults showed no decrease in ESKD incidence at any time during the 4-decade study period. The rate of increase was faster among White males compared with White females.

The data suggest “an arc of rising and declining incidence” of ESKD among Black and White individuals in the United States from adolescence into older adulthood. Although the study clearly shows a continued higher ESKD burden among Black patients, “some mitigation of disparities can be discerned especially among Black adolescents,” the researchers write. They discuss some possible reasons for the observed trends as well as “population-specific opportunities” to alter the incidence trends and address ongoing racial disparities [Fwu C-W, et al. Age- and race-specific changes in end-stage kidney disease incidence over four decades. J Am Soc Nephrol, published online January 30, 2024. doi: 10.1681/ASN.0000000000000310].